*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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: June 1, 2012 |
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07.05.20 - Applications after Nonpayment of MinnesotaCare Premium |
Archived: June 1, 2016 (Previous Versions) |
All MinnesotaCare enrollees must pay a premium to establish and maintain coverage. Some clients whose MinnesotaCare coverage is closed for failure to pay the premium may apply for Medical Assistance (MA) without completing a new application.
Clients Eligible to Apply for MA without a New Application.
Determining Who Processes MA Eligibility.
MA Determinations Processed by MinnesotaCare Operations.
MA Determinations Processed by County or Tribal Agencies.
Clients Eligible to Apply for MA without a New Application
The following MinnesotaCare clients whose coverage closed on the last day of the previous month solely due to nonpayment of their MinnesotaCare premium, and who did not reinstate their coverage, may apply for MA without completing a new application:
l Children under age 21.
l Parents.
l Stepparents.
l Relative caretakers.
l Foster parents.
l Legal guardians.
The following MinnesotaCare clients must follow general application policy if they want to apply for MA:
l Enrollees closed for reasons other than, or in addition to, nonpayment of premiums.
l Adults without children.
Note: Do not close MinnesotaCare coverage for pregnant women and infants under age two for nonpayment.
See Application Required and Application Not Required for more information.
DHS notifies eligible clients that they may apply for MA without submitting a new application through the following process.
1. DHS sends the MinnesotaCare Program Options letter to the person listed as member 01 in households with a person who is eligible to apply for MA without submitting a new application. This letter invites them to request that the agency review the eligible household members' eligibility for MA. Letters include a postage-paid return envelope pre-addressed for delivery to a central DHS location.
Note: This letter is not available in eDocs. It is sent only to households with at least one person who is eligible to apply for MA without a new application.
2. Individuals and families who want to have their eligibility determined for MA must return the MinnesotaCare Program Options letter in the postage-paid return envelope.
3. DHS will date stamp the returned letters and distribute them to MinnesotaCare Operations and county and tribal agencies based on the MinnesotaCare case service location. A cover sheet helps agencies recognize the MinnesotaCare Program Options letters.
Do not require a new application from clients who:
l receive the MinnesotaCare Programs Option letter, and
l return the MinnesotaCare Programs Option letter on or before the due date.
Note: The due date is the last day of the calendar month following the month of mailing. MMIS prints the due date on the MinnesotaCare Programs Option letter.
Require a new application according to general policy from clients who:
l did not receive the MinnesotaCare Programs Option letter, or
l return their MinnesotaCare Premium Options letter after the due date stated on the letter. Consider the MinnesotaCare Program Options letter a request to apply for MA.
See Date of Application, Application Required and Application Not Required, and Updating an Application for more information.
Determining Who Processes MA Eligibility
Process MA eligibility for clients who return the MinnesotaCare Program Options letter as follows:
MA Determinations Processed by MinnesotaCare Operations
MinnesotaCare Operations determines MA eligibility and provides ongoing case maintenance for families with children who:
n return the MinnesotaCare Program Options letter, and
n whose MinnesotaCare case was administered by MinnesotaCare Operations.
Exception: MinnesotaCare Operations will transfer certain cases, as described below, to the county or tribal agency of residence.
MA Determinations Processed by County or Tribal Agencies
The county or tribal agency will determine MA eligibility for clients who:
n return the MinnesotaCare Program Options letter, and
n whose MinnesotaCare cases were administered by the county or tribal agency.
MinnesotaCare Operations will transfer the MinnesotaCare case file to the county or tribal agency of residence for an MA eligibility determination for clients who return the MinnesotaCare Program Options letter and are households that:
n include members of an active, pending or reinstated MAXIS case (including cash assistance, health care, Supplemental Nutrition Assistance Program (SNAP) or child care).
n include members who are disabled.
n include members who are age 65 or older.
n MinnesotaCare Operations is not able to process for MA due to unforeseen systems issues or other program eligibility outside the scope of MA for families with children.
Example:
MinnesotaCare coverage is closed for a family due to nonpayment of premiums. They do not reinstate their coverage by paying all billed premiums. DHS mails a MinnesotaCare Program Options letter and the family returns the letter by the due date. MinnesotaCare Operations previously administered their MinnesotaCare case; however, the family has an active SNAP case.
Action:
MinnesotaCare Operations notes on the Inter Agency Case Transfer Form (DHS-3195) the reason for transfer as ”Other” and writes ”MA determination needed per HCPM 07.05.20. I am unable to process due to active MAXIS case.” Transfer the family’s MinnesotaCare case with the MinnesotaCare Program Options letter to the county agency in the county where the family resides for an MA determination.
The following processing requirements apply to all cases evaluated for MA after MinnesotaCare has closed for nonpayment of premiums.
l Add MA coverage for clients already counted as a member of an existing MA household to the existing MA case. See Adding a Household Member.
l Follow up with households that include one of more members who continue to be enrolled in MinnesotaCare, such as a pregnant woman, infant under the age of two, or members who were not enrolled when coverage was closed.
n Contact the household by phone or mail to ask if these members want to apply for MA with the other family members. Do not delay processing MA for the other household members while waiting for a response.
n Coordinate the opening of MA and closing of MinnesotaCare. See Eligibility Begin Date for information about coordinating coverage.
l Use the most recent application or renewal to determine MA eligibility.
l The date of application for MA is the DHS date stamp on the MinnesotaCare Programs Option letter.
l Review MinnesotaCare case notes and all MMIS MinnesotaCare screens to ensure the eligibility determination is based on the most current information known to the agency.
l Request verification of MA eligibility criteria, such as income, assets, or disability status, according to policy. See Verification Requirements.
l Approve up to three months of retroactive coverage for clients eligible for MA, beginning with the first day of the month following the effective date of the MinnesotaCare closing. Do not approve MA for any months in which a client was enrolled in MinnesotaCare, unless this coverage is specifically requested. See Program Overlap.
Example:
A family’s MinnesotaCare coverage was cancelled effective December 31 for nonpayment of their monthly premium. They did not reinstate their MinnesotaCare coverage by paying all billed premiums by January 20. DHS mails a MinnesotaCare Program Options letter to the family on January 26. The due date on the letter is February 28. The family returns the MinnesotaCare Program Options letter on February 15. The county agency previously administered their MinnesotaCare case. DHS sends the MinnesotaCare Program Options letter to the county agency.
Action:
The family returned their MinnesotaCare Program Options letter before the due date of February 28 to have MA eligibility determined without having to submit a new application. Determine MA eligibility using the most recent application or renewal. Update the application or renewal if necessary.
Note: The family would have had to complete a new application if they had returned the MinnesotaCare Program Options letter on or after March 1.