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Effective: June 1, 2011 |
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15.05ar9 - MinnesotaCare Other Health Care Coverage Barriers (Archive) |
Archived: October 1, 2011 |
MinnesotaCare has several other health care coverage barriers that exist to prevent individuals and employers from dropping health care coverage in favor of MinnesotaCare. Health care coverage availability may affect people’s eligibility for MinnesotaCare.
The following are other health care coverage barriers for MinnesotaCare eligibility:
l Current health care coverage.
l Enrollment in health care coverage in the past four months.
l Current and past access to Employer-Subsidized Insurance (ESI) .
l Employer termination of ESI as an employee benefit in the past 18 months.
This section provides in-depth policy on each of the MinnesotaCare other health care coverage barriers.
Other Health Care Coverage Barriers Exceptions.
Current Other Health Care Coverage.
Children With Other Health Care Coverage.
Other Health Care Coverage Barriers Exceptions
The following children meet an exception to the other health care coverage barrier policies:
l Children under age 21 with income less than 150% FPG, under certain circumstances.
l Children under age 21 who meet the Children’s Health Plan exception. These are children who were enrolled in the Children's Health Plan (CHP) on or before June 30, 1993, and who have maintained continuous enrollment .
Current Other Health Care Coverage
People who are currently enrolled in certain types of other health care coverage are not eligible for MinnesotaCare. See Types of Other Health Care Coverage for MinnesotaCare for a list of health care coverage that subjects clients to the current health care coverage barrier.
Exception: Children under age 21 who have household income at or below 150% FPG or who meet the Children's Health Plan Exception, and who are underinsured may keep that coverage and enroll in MinnesotaCare, whether or not the health care coverage is ESI.
Children who are not underinsured and are not under 150% FPG are subject to the Four-Month Rule if their other current health care coverage is cancelled.
Example:
Jessica applies for MinnesotaCare for herself and her three children. Jessica has health care coverage through her employer that is not ESI. It meets the requirements for the children to be considered underinsured. Household income is at or below 150% FPG.
Action:
Jessica is ineligible for MinnesotaCare because she has current health care coverage. Jessica’s children are eligible for MinnesotaCare because they are underinsured. Jessica may keep the other health care coverage for the children, or they may cancel it without affecting the children's eligibility.
Note: Parents should not cancel health care coverage that is court-ordered.
People who were enrolled in certain types of other health care coverage in the past four months are not eligible for MinnesotaCare. See Types of Other Health Care Coverage for MinnesotaCare for a list of health care coverage that subjects clients to the four-month rule.
Apply the four-month rule if the enrollee keeps health care coverage after MA determines it is not cost effective or after MA closes.
Exceptions: Do not apply the four-month rule to any health care coverage held by children under age 21 who have household income at or below 150% FPG or who meet the Children's Health Plan Exception.
Do not apply the four-month rule to individuals who were enrolled in the Minnesota COBRA Premium Subsidy and whose COBRA coverage ended within the past four months. Household members who were not enrolled in the Minnesota COBRA Premium Subsidy are not exempt from the four-month rule. See HCPM 03.45.40 for more information.
Do not apply the four-month rule to the following:
l Health care coverage determined cost effective while the person was enrolled in MA, regardless of whether it was paid for by MA,
l Health care coverage paid by the enrollee when the cost of the premiums is applied to the MA enrollee’s spenddown.
See Types of Other Health Care Coverage for MinnesotaCare for more information on what is not other health care coverage.
Example:
Marcia’s MA is closed effective May 1 because she cannot meet a spenddown. She had cost effective health care coverage in effect for which MA paid the premium. She dropped the other coverage effective April 30, because she felt the premium was not affordable. She applies for MinnesotaCare on May 10.
Action:
Exempt Marcia from the four-month rule because the health care coverage was determined cost effective while she was enrolled in MA. She is eligible for ongoing MinnesotaCare effective the month after the initial premium is paid if all other MinnesotaCare factors are met. She also may be eligible for retroactive MinnesotaCare effective May 1.
People who have current access to employer-subsidized insurance (ESI) coverage are ineligible for MinnesotaCare.
Exceptions:
l Children under age 21 who have household income at or below 150% FPG or who meet the Children's Health Plan Exception may still be eligible for MinnesotaCare if they:
q have current access to ESI.
q refuse to enroll in ESI.
q have current ESI coverage and are underinsured.
See Current Other Health Care Coverage.
l Adult clients, ages 21 and over, who may qualify for insurance through a parent’s employer plan. Do not consider these clients to have access to ESI. Do not require adults to provide information about or pursue coverage they may have available through a parent’s employer plan.
When determining whether people have access to ESI, do not consider the distance an individual must travel to see a provider enrolled in the ESI plan.
Current MinnesotaCare adults or children who have income over 150% FPG or who do not meet the Children's Health Plan Exception are ineligible for MinnesotaCare if ESI becomes available to them. They cannot keep MinnesotaCare eligibility by refusing the coverage. They are ineligible regardless of whether they actually accept the ESI.
People who have had access to employer-subsidized insurance (ESI) through a current employer at any time in the preceding 18 months are ineligible for MinnesotaCare.
Exceptions:
l Children under age 21 who have household income at or below 150% FPG or who meet the Children's Health Plan Exception may have had access to ESI through an employer in the preceding 18 months and remain eligible for MinnesotaCare.
l Adult clients, ages 21 and over, who may have had access to ESI through a parent’s employer plan in the past 18 months remain eligible for MinnesotaCare.
Note: Someone who had access to ESI through an employer more than 18 months ago remains ineligible for MinnesotaCare if they have current access to that ESI.
If people are terminated from MinnesotaCare because a current employer offered ESI within the past 18 months, advise them to:
l Ask the employer about special enrollment periods.
Note: Certain employer-sponsored plans must offer a special enrollment period upon MA termination.
l Request enrollment in the employer’s plan within 30 days of MinnesotaCare termination to avoid a break in coverage. The person will not get credit for MinnesotaCare coverage to reduce a pre-existing condition exclusion if there is a break in coverage.
Note: DHS issues a Certificate of Creditable Coverage (COCC) automatically two months after MinnesotaCare ends. See Creditable Coverage for requests for a COCC.
Some employers only offer ESI to employees who work a certain number of hours.
l Full-time employees with access to ESI who lose access to ESI when they reduce their hours or their employer reduces their hours, are ineligible for MinnesotaCare because they had access to ESI through a current employer in the past 18 months.
l People who are initially hired at part-time hours and do not qualify for their employer’s ESI would not be ineligible for MinnesotaCare due to this other health care coverage barrier.
Example:
Lonnie works 40 hours a week at Acme Grocery. Acme Grocery offers ESI to all employees who work 38 hours or more. Lonnie decides to go to school part-time, so he reduces his hours at Acme Grocery to 20 hours a week. He is no longer eligible for ESI.
Action:
Lonnie is ineligible for MinnesotaCare because he had access to ESI through a current employer in the past 18 months.
Example:
Jaime works full-time for an employer who provides ESI to all its full-time employees. Due to a down-turn in the economy, Jaime’s employer reduces Jaime’s hours, making him ineligible for ESI.
Action:
Jaime is ineligible for MinnesotaCare because he had access to ESI through a current employer in the past 18 months.
Example:
Sonya is a full-time college student who accepts a part-time position with an employer that provides ESI to full-time employees, but not to part-time employees. Sonya was never a full-time employee and thus never had access to ESI in the past 18 months.
Action:
The past ESI barrier does not apply to Sonya.
Example:
Arnold applies for MinnesotaCare. He has ESI through his employer.
Action:
Arnold is ineligible for MinnesotaCare because he has current health care coverage.
Arnold applies for MinnesotaCare again after dropping the ESI. He remains employed by the same employer.
Action:
Arnold continues to be ineligible for MinnesotaCare for 18 months because he had access to ESI through a current employer in the past 18 months. He remains ineligible for MinnesotaCare as long as he has access to ESI through his current employer.
People who lost coverage or lost access to employer-subsidized insurance (ESI) because an employer chose to terminate health coverage as an employee benefit in any of the 18 months prior to the month of application are ineligible for MinnesotaCare.
Exceptions: People who lost ESI due to the employer dropping the coverage are exempt from this barrier if they were previously enrolled in MinnesotaCare and reapply within six months of MinnesotaCare termination. Children who have household income at or below 150% FPG or who meet the Children's Health Plan Exception may have had an employer terminate health coverage as an employee benefit in the past 18 months and become or remain eligible for MinnesotaCare.
Example:
Pascal’s employer provides ESI to its employees and their dependents. In October 2008, Pascal’s employer stops offering ESI as an employee benefit. Pascal and his son apply for MinnesotaCare. Household income is below 150% FPG.
Action:
Pascal is ineligible for MinnesotaCare until March 31, 2010, 18 months after the employer dropped ESI as an employee benefit. His son is not subject to this barrier because his income is less than 150% FPG.
Children With Other Health Care Coverage
Complete the following for families with verified income at or below 150% FPG who choose not to request coverage for children and who currently have other health care coverage (including ESI):
l Notify the caretaker by letter or phone that a child may qualify for MinnesotaCare even if the child has other health care coverage that meets certain requirements.
l If the family requests MinnesotaCare for the child, gather information about the child’s coverage by:
n contacting the family by phone,
n sending a Request for Child Insurance Information (DHS-3448), or
n requesting a copy of the child’s insurance card.
l Contact the insurance company to determine if the child is underinsured when the family returns the insurance information.
Note: The insurance company may require a signed release of information.
Reporting Other Health Care Coverage for MCRE.
Types of Other Health Care Coverage for MinnesotaCare.