*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
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Effective: November 1, 2012 |
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07.05.05 - Applications for Minnesota Health Care Programs (MHCP) |
Archived: June 1, 2016 (Previous Versions) |
There are several applications that can be used to apply for health care depending on the client's situation and the program for which he or she is applying. The applications gather eligibility information about the client.
General Application Requirements.
Health Care Application (HCAPP).
Combined Application Form (CAF).
MinnesotaCare for Volunteer Firefighters and Ambulance Attendants (MVFAA) Application.
Minnesota Family Planning Program (MFPP) Application.
Long-Term Care (LTC) Requests and Applications.
Social Security Administration (SSA) Data as a Request for MHCP.
Request to Reopen MA for Incarcerated Individuals.
General Application Requirements
Accept any of the DHS approved applications as detailed in this section.
l Do not require a specific application when another meets the conditions for use.
Exceptions: Do not use a Minnesota Family Planning Program (MFPP) (DHS-4740) application to determine eligibility for any program other than MFPP.
Do not use the Request for MinnesotaCare (DHS-6179) to determine eligibility for persons other than children who qualify for MinnesotaCare for Certain Children Exiting Foster Care or a Juvenile Residential Correctional Facility.
l Accept unsigned applications to set the date of application. Obtain the application signature as part of the application process.
l Do not require forms or verifications not required as a condition of eligibility regardless of what application is used.
l Provide the following documents with each application:
n Minnesota Health Care Programs (DHS-3182). This brochure briefly describes Minnesota’s health care programs and the eligibility requirements.
n Domestic Violence Information (DHS-3477). This brochure explains what domestic violence is, services available to domestic abuse victims and how victims can get a waiver from some of the Diversionary Work Program (DWP), Minnesota Family Investment Program (MFIP) and Supplemental Nutrition Assistance Program (SNAP) program rules.
Example:
County A has developed a form that includes specific information about the agency’s hours of operation, other resources available in the county, instructions on how and when to reach the worker to report changes, etc. The form also includes some of the client rights and responsibilities that are incorporated on the application.
Action:
County A may send this form to applicants at the time of approval. Do not include the form with the HCAPP or require the applicant to sign and return it.
ApplyMN is a secure, web-based application that allows people to apply for Minnesota Health Care Programs (MHCP), cash assistance, SNAP, Child Care Assistance Program (CCAP) and emergency help. It is online at www.applymn.dhs.mn.gov.
ApplyMN is a "smart application" that only asks questions based on the program(s) requested, the household composition and an applicant’s response to previous questions.
Before using ApplyMN for the first time, the applicant must create a secure Minnesota Human Services Online user account. New users create an account via a link on the ApplyMN page.
Applicants select an application type from the following list:
l Combined application, which allows applicants to apply for MHCP [including Medical Assistance (MA), MinnesotaCare and MA payment of home and community-based waiver services], cash assistance, SNAP, CCAP, emergency help or any combination of these programs.
l MFPP.
l Medical Assistance for Breast and Cervical Cancer (MA-BC).
l Payment of services in a Long-Term Care Facility (LTCF).
Note: Applicants using ApplyMN to apply for MA payment of home and community based waiver services use the "combined application" application type. Applicants using ApplyMN to apply for payment of services in a LTCF use the "payment of services in a LTCF" application type.
ApplyMN allows applicants to:
l submit, save or cancel an application at any time.
l review and edit answers prior to submittal.
l electronically sign the application.
l Electronically attach and submit verifications.
ApplyMN displays all disclosure agreements, such as the Notice of Privacy Practices and the Rights and Responsibilities, required for each program requested in the application. Applicants must check a box indicating they have reviewed each disclosure agreement before they submit the application.
ApplyMN automatically routes applications to the county, tribe, MinnesotaCare Operations, or a combination of these sites, based on the applicant's county of residence, program(s) requested and tribal affiliation.
Health Care Application (HCAPP)
The HCAPP (DHS-3417) allows people to apply for any or all of the Minnesota Health Care Programs (MHCP) on one form. Questions on the HCAPP may apply to all health care programs, only to one or two programs, or to specific populations.
Note: Clients who request MA payment of long-term care (LTC) services, including home and community-based waiver services, using the HCAPP or a Combined Application Form (CAF) must also complete the MHCP Request for Payment of Long-Term Care Services (DHS-3543) before eligibility for payment of those services can be determined.
The HCAPP has several functions:
l Collect eligibility information.
l Provide the client with their rights and responsibilities. Clients should detach these pages and retain them for their records.
Advise clients they can apply online at www.applymn.dhs.mn.gov or print a HCAPP at www.dhs.state.mn.us/healthcare.
Combined Application Form (CAF)
The following clients should use the CAF (DHS-5223) to apply:
l Clients applying for cash, SNAP, or emergency programs, with or without MHCP.
n An interview is required for cash, SNAP, and some emergency programs, but is not required for health care.
n Do not wait for the cash, SNAP or emergency interview or the completion of the MDHS Worker Interview Form (DHS-5223A) to determine health care eligibility. Request the information needed to determine health care eligibility.
l Clients who are uncertain for what programs they are applying.
Note: Clients who request MA payment of long-term care (LTC) services, including home and community-based waiver services, using the HCAPP or a Combined Application Form (CAF) must also complete the MHCP Request for Payment of Long-Term Care Services (DHS-3543) before eligibility for payment of those services can be determined.
Clients who apply for health care coverage only should complete the HCAPP (DHS-3417) or ApplyMN. However, process the application if they use the CAF to request health care only. Request the information needed to determine health care eligibility. See Processing Applications.
Note: Include the Worker Interview Form (DHS-5223A) when transferring an application if the client applied using a CAF and an interview was conducted.
MinnesotaCare for Volunteer Firefighters and Ambulance Attendants Application
Individuals applying for MinnesotaCare for Volunteer Firefighters and Ambulance Attendants must use the MinnesotaCare for Volunteer Firefighters and Ambulance Attendants Application (DHS-5960). Enrollees who wish to apply for other Minnesota Health Care Programs must complete a Health Care Application (DHS-3417) or ApplyMN.
Children residing in foster care or a juvenile correctional facility on their 18th birthday who apply for MinnesotaCare upon their release from care my use the Request for MinnesotaCare (DHS-6179) to apply for coverage. Other individuals who wish to apply for MinnesotaCare must complete a Health Care Programs Application (DHS-3417) or ApplyMN.
Women who are screened and found to need treatment through the Sage Screening Program may apply using the Minnesota Medical Assistance Breast and Cervical Cancer Coverage Group (MA-BC) Application/Renewal (DHS-3525) or ApplyMN.
Clients applying for family planning coverage may use the Minnesota Family Planning Program (MFPP) Application (DHS-4740) or ApplyMN. Do not use the MFPP application to determine other health care program eligibility. See Minnesota Family Planning Program for information.
Eligibility for MA payment of LTC services, including waiver services, cannot be determined until a request for payment of those services has been received using an acceptable request or application form.
Acceptable requests from applicants include:
l ApplyMN. Applicants can request payment of LTC services with ApplyMN.
l The Minnesota Health Care Programs Application for Payment of Long-Term Care Services (DHS-3531). Accept the Health Care Programs Application for Payment of Long-Term Care Services for all applicants even if they are not requesting MA payment of LTC services. Do not require completion of the HCAPP. Request missing or incomplete information and proofs required to determine eligibility.
l The HCAPP (DHS-3417). Clients who request MA payment of long-term care (LTC) services, including home and community-based waiver services, using the HCAPP or a Combined Application Form (CAF) must also complete the MHCP Request for Payment of Long-Term Care Services (DHS-3543) before eligibility for payment of those services can be determined.
MHCP enrollees must complete the MHCP Request for Payment of Long-Term Care Services (DHS-3543) to request payment of these services. Require this form when an enrollee:
l Has moved into a long-term care facility or is requesting services through the home and community-based waiver programs (CADI, CAC, DD, BI and EW).
l Has a break in LTC services and is again requesting MA payment of LTC services, but is not required to complete a new application.
l Allow 10 days for the enrollee to return the DHS-3543.
Do not close MA if the enrollee does not return the form. However, the enrollee is ineligible for payment of LTC services until the form is returned and eligibility for LTC services is determined.
Determine eligibility for MA payment of LTC services even if the DHS-3543 is returned after 10 days if the person has been continuously eligible for MA since becoming a resident in a LTCF. Services through a home and community-based waiver program cannot begin before the DHS-3543 is returned and the enrollee is determined to be eligible for MA payment of LTC services.
The Minnesota Health Care Programs Renewal (DHS-3418), Renewal for People Receiving Long-Term Care Services (DHS-2128), and Combined Six-Month Report (DHS-5576) may be processed as an application if received during the renewal month. If received after the renewal month see Application Required and Application Not Required to determine if a new application is required or if a previous application or renewal can be updated.
SSA Data as a Request for MHCP
People may apply for Extra Help with Medicare Part D costs through SSA. The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requires that SSA, with a Medicare beneficiary’s permission, transmit data from an individual’s Extra Help application to state Medicaid agencies for the purpose of determining Medicare Savings Programs (MSP) eligibility. The data transmitted initiates an MSP application on the client’s behalf. States must use the SSA data to determine eligibility for QMB, SLMB and QI. States may also use the data to initiate applications for Medical Assistance (MA), since Medicare beneficiaries may qualify for MA in addition to QMB and SLMB.
SSA will transmit applicant data frequently, but not necessarily daily. They will transmit data not only for those approved for Extra Help, but also those denied. SSA will not send data for people who opt out, do not live in the United States, or who are already deemed Full-Benefit Dual Eligibles .
Upon receipt of Extra Help application data from SSA, DHS verifies the applicant’s zip code and determines the applicant’s county of residence. Because the data sent by SSA is not sufficient to determine eligibility for MA or MSP, DHS mails a HCAPP and any forms that must be included with the application to the applicant. DHS includes a letter with each HCAPP, which directs the applicant to indicate whether they would like to apply for MSP only, or for MSP and MA.
Review the HCAPP cover letter response to determine which programs the client wishes to apply for:
l Determine only MSP eligibility if the applicant indicates on the HCAPP cover letter that they want to apply for only the MSP. Do not determine eligibility for any other MHCP.
l Determine eligibility for both MA and MSP if the applicant requests both. Determine MA-EPD eligibility if appropriate.
l Determine eligibility for both MA and MSP if the applicant does not return the cover letter with the HCAPP, or returns it blank or incomplete.
l Only make a MinnesotaCare eligibility determination if the applicant is a child under age 21 who does not qualify for MA.
DHS generates an online report in MAXIS that provides the data to pend applications for these applicants. County agencies should designate staff to monitor the online report and check it daily for new applicants. See MAXIS POLI TEMP TE02.07.459 ACCESSING MIPPA LIS APPLICATIONS for more information about accessing the SSA data. Consider the data transmittal a request for coverage .
SSA will send separate records for each person, even if they are transmitting information for a married couple. Compare records to determine if a person is married to another applicant and they should be on the same case. Only require a married couple to return one Health Care Programs Application (HCAPP) (DHS-3417), even though DHS will send a HCAPP to each of them.
An applicant who does not have a verified address will not appear on the MAXIS report. DHS MMIS User Services Help Desk staff will verify the applicant’s address, mail a HCAPP to the applicant, and notify the county agency supervisor by email of the date of application, start date of the processing period, and other information needed to initiate the application for MHCP.
DHS creates a daily list of the Medicare beneficiaries transmitted by SSA for staff at the Senior LinkAge Line®. Senior LinkAge Line® staff attempt to call all individuals referred by SSA and offer assistance with completion of the HCAPP. Senior LinkAge Line® staff will assist all applicants referred by SSA, not just those who are elderly.
Use a health care application along with the Title IV-E Foster Care Supplement to the Health Care Programs Application (DHS-3478) to determine eligibility for Title IV-E for children in placement to eliminate multiple forms.
l If the child is IV-E eligible, MA is automatic without a separate application or eligibility determination.
l If the child is not IV-E eligible, MA is not automatic. An application must be filed on behalf of the child to determine MA or MCRE eligibility.
Incarcerated people may apply for MA with a shortened process using the Request to Reopen Medical Assistance (MA) (DHS-5038) if their MA closed due to incarceration and they were incarcerated for 12 months or less. See MHCP and Incarcerated Individuals for more information.
Applicants and enrollees may need to complete additional forms to complete the application process. Additional forms are based on program requirements, household composition and other conditions.