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Effective: March 1, 2008 |
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06.05ar2 - Cooperation (Archive) |
Archived: November 1, 2008 |
Clients must comply with various requirements for health care program eligibility. This includes general requirements, such as providing information about and required verifications for eligibility factors such as income and assets. However, there are certain eligibility factors for which the term "cooperation" is used. A few of these specific cooperation requirements are highlighted in this manual section.
For more detailed information on these topics, please see the links to each chapter under Related Topics below.
Medicaid Eligibility Quality Control and Quality Review Cooperation.
Other Health Care Coverage Cooperation.
Medicaid Eligibility Quality Control and Quality Review Cooperation
Clients must cooperate with Medicaid Eligibility Quality Control (MEQC) and MinnesotaCare quality reviews.
l Clients who fail to cooperate will lose eligibility for programs for which they did not cooperate.
l Clients may reapply after cooperating with MEQC before the end of the ineligibility period.
l Clients whose MA or federally funded MCRE is closed for failure to cooperate with an MEQC review are also ineligible for GAMC.
Some caretakers of children who are requesting or receiving MCRE or MA must cooperate with medical support requirements. They must work with the county child support enforcement office, also known as the IV-D Agency , to:
l Obtain medical support.
l Enforce an existing order.
l Establish paternity.
Examples of cooperation include:
l Providing information about non-custodial parents.
l Establishing paternity of eligible dependent children.
l Forwarding any medical support payments received directly from the non-custodial parent to DHS.
Clients assign their (and their legal dependents') rights to medical support by signing the application or renewal.
Caretakers who do not cooperate with obtaining medical support or establishing paternity are not eligible for Minnesota Health Care Program coverage. Non-cooperation is determined by the county child support enforcement office.
Note: Eligibility for the caretaker's children and the caretaker’s spouse are not affected by the caretaker’s actions.
Some Minnesota Health Care Program (MHCP) clients must cooperate with payment requirements to establish and maintain eligibility. The two programs that require a premium payment are:
l MinnesotaCare.
l Medical Assistance for Employed Persons with Disabilities (MA-EPD).
Other Health Care Coverage Cooperation
Most MHCP clients must cooperate by providing information about other health care coverage that they have or that may be available to them. They may also be required to maintain or enroll in coverage that is cost-effective.
l For MinnesotaCare, availability of other health care coverage may be a barrier to program eligibility.
l Most MA and GAMC clients must cooperate with cost-effective insurance requirements. Availability of other health care coverage does not affect eligibility for these programs.
Some other general health insurance cooperation requirements include:
l People who have other health care coverage must assign their rights to coverage to DHS as a condition of eligibility by signing the HCAPP or CAF.
l Adults who refuse to assign their rights or the rights of other household members for whom they are legally able to assign rights are not eligible for MA or GAMC.
Note: Children whose parents refuse to assign their rights to insurance or other third party liability remain eligible.
l Most applicants and enrollees must provide information on other health insurance which is or may be available to them or their dependents, regardless of whether the applicant or enrollee is the policyholder.
l People must cooperate with the MCRE or county agency and the state Benefit Recovery Section (BRS) in identifying potential sources of other health care coverage.
For further information about specific cooperation requirements, see the following chapters: