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Effective: August 1, 2008 |
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03.50.10ar4 - GAMC - Hospital Only (GHO) (Archive) |
Archived: February 1, 2011 |
People who do not have a basis of eligibility for Medical Assistance (MA) and have income of more than 75% FPG and less than or equal to 175% FPG may qualify for GAMC Hospital Only (GHO) for payment of inpatient hospital services. People may apply during an inpatient hospitalization or up to 45 days prior to an anticipated hospitalization.
Note: The requirement that GAMC applicants and enrollees must have a GAMC qualifier does not pertain to GHO.
Eligibility factors and links to standard program guidelines are provided below.
Citizenship/Immigration Status.
Insurance and Benefit Recovery.
Relationship to Other Groups/Bases.
Application Process (standard guidelines)
People with planned hospitalizations, such as elective surgery, may apply for GHO up to 45 days in advance. Do not approve coverage until you confirm that the person has been admitted to the hospital.
Do not require a new application if former GHO enrollees are re-hospitalized within six months of the date of the most recent application.
The earliest possible begin date for GAMC Hospital Only (GHO) is the date of application or the date all eligibility factors (including hospital admission as an inpatient) are met, whichever is later.
Note: People do not have to be eligible for GHO in the month of application. Eligibility may begin at a later date if the applicant meets all eligibility factors by the end of the processing period.
There are no renewals for GHO; eligibility is granted only for the time that the enrollee is hospitalized.
Verifications (standard guidelines)
Follow guidelines in Chapter 9. Also see Verification of Income and Verification of Assets.
Note: No GAMC benefits are available for applicants or enrollees who are otherwise eligible for MA, but fail to verify their assets.
Follow standard guidelines.
Follow guidelines in Chapter 11.
No GAMC applicants and enrollees who are U.S. citizens are required to document their citizenship and identity.
Note: Applicants and enrollees who are otherwise eligible for MA or federally funded MinnesotaCare but fail to document their citizenship and identity are not eligible for GAMC.
Noncitizens who meet the citizenship and immigration status requirements for MA (program MA or program NMED) but do not have an MA basis of eligibility may be eligible for GAMC. Undocumented and non-immigrant people are not eligible.
Follow GAMC residency requirements.
Insurance/Benefit Recovery (standard guidelines)
Follow guidelines in Chapter 15.
Follow guidelines in Chapter 17.
Follow MA Method A to determine which assets to exclude and how to evaluate counted assets. See Chapter 19 for more information on assets.
Follow MA Method B to determine which income to exclude. See Chapter 20 for more information on income.
Asset Guidelines (standard guidelines)
The asset limit is:
l $10,000 for a household of one.
l $20,000 for a household of two or more.
There are no improper transfer provisions for GHO.
The GHO income limit is greater than 75% FPG but less than or equal to 175% FPG.
Note: Clients who have income within the limit for full GAMC benefits (at or below 75% FPG), but who have assets above $1,000 are not eligible for GHO. They may reduce their assets to $1,000 or less to qualify for full GAMC benefits.
No deductions or disregards are allowed for GAMC. Income eligibility is determined using gross countable income.
Spenddowns (standard guidelines)
There are no spenddown provisions for GHO.
Benefits are limited to inpatient hospital services and physician's services received during the inpatient hospitalization. Services after discharge, such as follow-up physician visits, are not covered.
GHO enrollees have a $1,000 co-payment for each inpatient admission.
Note: This $1,000 co-payment may be applied against the spenddown for household members who are applying or eligible for MA.
All GHO enrollees are excluded from managed care enrollment. Coverage will be provided through fee-for-service .
Note: Do not issue MHCP membership cards for GHO.
The requirement that GAMC applicants and enrollees must have a GAMC qualifier does not pertain to GHO.
Eligibility ends effective the date of discharge from inpatient hospitalization. Retroactive closing is allowed; no ten-day notice is required.
Determine eligibility under another basis, including MinnesotaCare, when GHO ends. However, GHO enrollees are not required to accept MinnesotaCare as a condition of future GHO eligibility.
Consider MinnesotaCare for Adults Without Children starting the month after hospital discharge.