*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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: April1, 2013 |
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16.05 - When to Refer for Medical Support |
Archived: June 1, 2016 (Previous Versions) |
This section explains when to make a medical support referral when a child lives with only one parent.
Special rules apply to cases where a child who is not emancipated lives away from both parents. See Minor Child Lives Apart from Both Parents.
For information on how to make the medical support referral, see Referral Process.
A health care case is considered to be "child-only" when a minor child with a non-custodial parent is eligible for Medical Assistance (MA) or MinnesotaCare, and the caretaker is not a Minnesota Health Care Program enrollee. This may be due to one of the following:
l The caretaker is not applying for health care program coverage.
l The caretaker has been found ineligible for health care coverage due to non-cooperation with medical support requirements or not meeting other program eligibility criteria.
Do not refer child-only cases for medical support if paternity has not been legally established.
Exception: Refer the case if the applicant specifically requests child support services.
Follow the guidelines below on when to make a medical support referral if paternity has been legally established.
See Establishing Paternity for more information.
Always make a medical support referral when:
l a child lives with only one parent (and none of the Referral Not Required criteria apply), and both the child and the parent have MA or MinnesotaCare coverage, or
l a case is "child-only" and paternity has been legally established,
and at least one of the following conditions exists:
l There is no court order for medical support health insurance.
Example:
Maia applies for MA for her two daughters, Lou and Seng. She is not requesting MA or MinnesotaCare for herself. She is separated from her husband, who is Lou's father, who moved into his own apartment in St. Paul three months ago. There is no court order regarding medical or child support. She was not married to Seng's father and there is no court order or Recognition of Parentage (ROP) establishing paternity.
Action:
Follow policy according to each child's circumstances:
n For Lou, make a medical support referral because her parents were married when she was born and there is no court order.
n For Seng, do not make a referral. She is considered a ”child-only” case because Maia is not receiving MA or MinnesotaCare herself. Paternity has not been established, so do not refer the case unless Maia specifically requests child support services.
l There is a court order for medical support health insurance, but the person ordered to provide coverage is not in compliance with the order, or was complying but has stopped.
Note: In some cases, it may be the custodial parent who is not complying with an order for medical support. Send a referral for the custodial parent in these cases also. However, make a very clear note explaining that it is the custodial parent who is not complying with an order for medical support. The IV-D worker will set up the case and determine the appropriate action.
l The existing court order does not address medical support or says it’s reserved. ("Reserved" means the court did not set a specific order, but reserves the right to do so in the future.)
l There are court-ordered cash payments for medical support, regardless of whether or not the non-custodial parent or obligor is making the payments.
Example:
Inga applies for MinnesotaCare for her children, Per and Karla.
n Inga was not married to Per's father, but they signed an ROP when Per was born. There is no court order for medical support.
n Inga is divorced from Karla's father and he is complying with an order to make monthly cash medical support payments.
Action:
Make a medical support referral for each child.
l The caretaker requests full child support services.
Do not make a medical support referral in any of the following circumstances:
l Both biological or adoptive parents are in the home and paternity has been legally established.
l The parent who is not living in the home is temporarily absent
l Only the child is applying for or enrolled in MA or MinnesotaCare and paternity has not been legally established (see Child-Only Cases above).
l The non-custodial parent or obligor is complying with a medical support order for health insurance for the minor child.
Exception: Make a referral to the IV-D agency if the caretaker requests full child support enforcement services.
l The applicant is an emancipated minor.
Example:
Tiffany, age 17, is divorced from Josh. They have a one-year-old son, Thomas. Tiffany's parents were divorced five years ago and her father was ordered to provide medical insurance for Tiffany and her brothers.
Action:
Do not make a referral on Tiffany's father even if he does not carry insurance on her because she is emancipated. Make a referral on Josh only if he is not complying with an existing medical support order for Thomas.
l The only unpaid medical support owed is from a period before MA or MinnesotaCare eligibility.
l The child receives state-funded or IV-E adoption assistance.
l The child is in a foster care placement funded through Title IV-E Foster Care .
l A parent is involuntarily out of the household because he or she is being detained by U.S. Immigration and Customs Enforcement (ICE) or is waiting for immigration authorization from U.S. Citizenship and Immigration Services (USCIS) from outside of the United Sates.
Example:
Pete and his two sons, Lucien and Pierre, are approved for MinnesotaCare. Pete reports to the agency that Manon, his wife and his sons’ biological mother, was living with them but returned to France and was not permitted to re-enter the United States. They are waiting for USCIS to resolve an issue with her visa. He states that Manon will return to live with them once the issue is resolved.
Action:
Do not send a medical support referral for Manon. Her absence from the household is involuntary and she intends to reunite with the household once she is able to re-enter the United States.
Example:
Sadira and her five-year old daughter, Ayan, apply for MA. Their permanent resident cards verify that they entered the United States a year ago as refugees. During an office visit, Sadira explains that Abdi, her husband and Ayan’s biological father, has never lived in the United States. He is in Somalia awaiting approval of refugee status from USCIS to join them here. Sadira and Ayan meet all eligibility requirements for MA.
Action:
Approve Sadira and Ayan for MA, but do not complete a medical support referral for Abdi. He is living outside of the United States while waiting for immigration authorization to enter the country.
Example:
Stephanie and her two children, Tomas and Jennifer, are approved for MinnesotaCare. In a written statement submitted with the application, Stephanie indicates that her husband and the father of her two children, Jesse, is currently being detained by ICE at the Ramsey County Adult Detention Center. He will remain there while he is awaiting an immigration hearing.
Action:
Do not send a medical support referral for Jesse. He is involuntarily out of the household because of his detainment by ICE.
For more information, see: