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Effective: December 1, 2006 |
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07.20.30ar1 - Retroactive MinnesotaCare (Archive) |
Archived: October 1, 2007 |
People who are closed from MA or GAMC may be eligible for retroactive MinnesotaCare (MCRE) to help pay medical expenses during the time between MA/GAMC closure and the enrollment in MCRE.
This policy was designed to eliminate gaps in health care coverage for enrollees moving between programs.
Requirements for Retroactive MCRE.
Applying for Retroactive MCRE.
Retroactive MCRE Notice (DHS-3446).
Non-Timely Retroactive MCRE Requests.
Retroactive MCRE and Verifications.
Retroactive MCRE and Premium Payments.
Retroactive Coverage Services Delivery.
Retroactive Coverage and Adding a Household Member.
Requirements for Retroactive MCRE
The client must comply with the following requirements to be eligible for retroactive MCRE:
l The client must apply for MCRE within 30 days after the MA/GAMC closure.
Remember: Check the MMIS RELG screen to see if there is an MA/GAMC span of eligibility that will be ending or has ended no more than 30 days before receipt of the application.
Example:
Mary’s GAMC was closed effective November 1. She submitted an application to MCRE Operations on November 29. The worker processes the application on December 15.
Action:
Mary is potentially eligible for retroactive MCRE because her application was received within 30 days of GAMC termination.
l The client must return all requested MCRE verifications by the end of the month following the month in which verifications are requested.
Example:
Aimee’s MA closed April 10, effective May 1, due to excess income. Her county of residence is a MCRE enrollment site.
Action:
The county worker must determine MCRE eligibility as well as eligibility for retroactive MCRE.
The same day, the worker determines Aimee is missing health insurance verification.
Action:
Aimee must return the verifications by the end of May to continue to be considered for retroactive MCRE.
l The client must be eligible for ongoing MCRE.
l The client must pay the initial and optional (retroactive) MCRE premiums by the end of the month following the month of premium billing.
Determine MCRE eligibility for the following enrollees:
l People whose MA or GAMC closed due to excess income or assets. If the closing county is:
n A MCRE enrollment site, the worker must determine MCRE eligibility without requiring a new application.
n Not a MCRE enrollment site, the worker must refer the case to MCRE Operations for a mandatory MCRE determination using the most recent renewal form or application. See Shared and Transferred Applications.
l A GHO enrollee is discharged from the hospital.
l People who submit an application no more than one month after MA or GAMC ends for a reason other than previously listed.
Retroactive MCRE Notice (DHS-3446)
Send the Retroactive MinnesotaCare Notice (DHS-3446) to clients who request MCRE within 30 days of MA/GAMC termination and are:
l Eligible for ongoing MCRE and all verifications have been received.
l Pended for more information.
Send the DHS-3446, which explains that the applicant has 30 days from the date of request to submit verifications, along with the Verification Request Form (DHS-3271).
Note: MMIS will not deny retroactive MCRE for lack of verifications until the end of the month following the request.
Non-Timely Retroactive MCRE Requests
If the application was filed between 30 and 60 days of MA/GAMC termination, send a denial of retroactive MCRE if the applicant requested retroactive coverage on the HCAPP or by any other written request.
Note: Consider the applicant to have requested retroactive coverage if the application shows a request for coverage to begin any time before and/or including the month of application.
No denial notice for retroactive MCRE is needed if the application was filed less than 30 or more than 60 days after MA/GAMC termination.
Retroactive MCRE and Verifications
Applicants pended for more information remain potentially eligible for retroactive MCRE if they return verifications by the due date and are determined eligible for ongoing MCRE.
l If applicants return verifications by the due date but the verifications indicate ineligibility, deny ongoing and retroactive MCRE.
l If verifications are not returned by the due date, MMIS will deny retroactive MCRE.
Retroactive MCRE and Premium Payments
Clients must pay the initial and optional (retroactive) MCRE premiums by the end of the month following the month of premium billing. The Retroactive MinnesotaCare Notice (DHS-3446) explains that the applicant has 30 days from the date of billing to pay the premium.
Note: MMIS will base the optional premium on current household size and income. The premium amount includes all household members eligible for retroactive coverage. Apply the All or Nothing Rule if households request coverage for only some members.
If the initial premium for ongoing eligibility:
l Is received by the end of the month following the billing month:
n MMIS will send the optional premium notice if the household meets all requirements for retroactive coverage.
n The enrollee must pay the optional premium by the end of the month following the optional billing month to receive retroactive coverage.
l Is not received by the end of the month following the billing month:
n MMIS will deny retroactive MCRE.
n Ongoing MCRE will remain pending for up to three additional months on MMIS.
If the optional premium:
l Is received before the due date:
n MMIS will approve retroactive MCRE from the date that MA or GAMC closed to the date ongoing MCRE began.
n Enrollees must accept retroactive coverage for all months in this period.
Example:
Henry’s MA ended June 30th. He is determined eligible for MCRE in July and pays his initial premium on August 15th. His optional premium of $80 for each month (July and August) for retroactive MCRE coverage is sent the same day.
Action:
If Henry wants retroactive coverage he must pay the entire $160 optional premium. He cannot choose to pay $80 and get retroactive coverage for only one month.
l Is not received by the due date:
n MMIS will deny retroactive MCRE.
n Ongoing MCRE remains active.
Retroactive Coverage Service Delivery
Coverage during the retroactive period will be fee-for-service .
MMIS will generate a letter informing enrollees that coverage during the retroactive period will be fee-for-service.
Note: Enrollees who received services during the retroactive period should contact the provider and ask the provider to bill the state directly.
Retroactive MCRE and Adding a Household Member
Household members who are added to an active case after losing MA or GAMC do not have to pay a premium for retroactive coverage. See Adding a Person to the Household.
Example:
Carol’s TYMA ends effective July 1 and she is not eligible for ongoing MA because of excess income. Her county of residence is a MCRE enrollment site.
Action:
The county worker must determine eligibility for Carol at the time of her MA closure because she is being closed due to excess income.
The county worker has all required information and verifications to determine MCRE eligibility. Carol and her children are eligible.
Action:
The worker approves the case as pending awaiting payment on July 6 and sends Carol the DHS-3446. Carol must pay her initial premium by the end of August (the month following the month of approval) to be considered for retroactive MCRE.
Carol’s initial premium is received on July 23. Ongoing MCRE will begin August 1.
Action:
MMIS computes Carol’s retroactive premium for July and sends the optional premium notice on July 25. Carol must pay the optional premium by the end of August to have coverage for July.
Example:
Colleen submits a HCAPP to MCRE Operations on July 10.
Action:
The worker checks the MMIS RELG screen and finds that Colleen’s MA ended June 30. She meets the requirement of requesting MCRE within 30 days of MA termination.
The MCRE worker learns from the county worker that Colleen’s MA closed because she failed to return her renewal.
Action:
The MCRE worker needs updated income information to determine eligibility. The worker must pend the case for more information and send the DHS 3446 with the request for income information. Colleen must return the verifications by the end of August to be considered for retroactive MCRE.
The worker receives the verifications on August 3 and determines that Colleen is eligible.
Action:
The worker approves the case as pending awaiting payment. Colleen’s initial premium payment must be received by the end of September to qualify for retroactive MCRE.
Colleen’s initial premium is received on September 7. Ongoing MCRE will begin October 1.
Action:
MMIS computes the retroactive premium amounts for July, August and September and sends the optional premium notice on September 8. Colleen must pay the retroactive premiums by the end of October to have coverage for the retroactive months. She may not pay for only one or two months in the retroactive period.
If Colleen does not pay the optional premium for the three retroactive months by the end of October, MMIS will deny retroactive MCRE. Ongoing MCRE will remain active if current premiums are paid.
Example:
Jane’s MA ends on June 30 for herself and her daughter Jill. They are determined eligible for MCRE on July 10. They meet all requirements for retroactive MCRE.
Action:
MMIS computes the retroactive premium for both Jane and Jill.
Jane contacts her worker and says she wants retroactive coverage only for Jill. Jane did not have any bills since MA ended.
Action:
The worker contacts the MMIS User Services Help Desk to request an adjustment. MMIS will not generate a replacement premium notice. The worker informs Jane of the retroactive premium amount for Jill only.