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Effective: December 1, 2006 |
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16.05ar1 - When to Refer for Medical Support (Archive) |
Archived: September 1, 2009 |
Determine whether a medical support referral is required for each child under the age of 18 who is eligible for Medical Assistance (MA) or MinnesotaCare.
Note: Medical support may be court-ordered for 18- through 20-year-olds who are disabled or in school. Contact the to determine whether a referral should be sent in these cases.
In some cases, a medical support referral may or may not be required depending on who in the household is eligible for health care coverage. If a minor child lives with a caretaker but only the child is eligible for health care, there are special provisions to consider in addition to the usual medical support referral criteria. See ”Child-Only Cases” below.
A health care case is considered to be "child-only" when a minor child with a non-custodial parent is eligible for federally funded 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 opted not to apply 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.
If paternity has not been legally established, do not refer child-only cases for medical support. If paternity has been legally established, see below for guidelines on when to make a medical support referral.
Always make a medical support referral when a child lives with a caretaker, both of them have MA or MinnesotaCare coverage, 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. There is no court order. 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 paternity has not been established and Maia is not receiving MA or MinnesotaCare herself.
l There is a court order for medical support health insurance, but the parent 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 non-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 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.
When a caretaker notifies you of a change in circumstances that requires a referral, take action within two working days after you learn of the change.
l Send the client referral forms to complete. Request the forms be returned in 30 days.
l Send the forms to IV-D within two working days after you receive them from the client.
Note: If the client does not return the forms, send all available information at the end of the 30-day period.
Medical support referrals are not required in any of the following circumstances:
l Both biological or adoptive parents are in the home and paternity has been legally established.
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 is complying with a medical support order for health insurance for the minor child.
Exception: If the caretaker requests full child support enforcement services, make a referral to the IV-D agency.
Example:
Diana applies for health care program coverage for herself and her two children. She is divorced from the children's father. He is court-ordered to pay $300 per month in child support and carry the children on his health insurance coverage through his employer. He is current in his support payments and insurance is in place. Diana does not request child support enforcement services.
Action:
No referral is required for either MA or MinnesotaCare.
Note: For MinnesotaCare, determine whether the insurance affects the children's eligibility. See MinnesotaCare Other Health Care Coverage Barriers.
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 is owed to the caretaker from a period before MA or MinnesotaCare eligibility.
For more information, see: