*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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. ***
|
Effective: December 1, 2006 |
|
|
16.15 - Good Cause for Non-Cooperation |
Archived: June 1, 2016 |
Caretakers must cooperate in pursuing medical support (including establishing paternity) and Third Party Liability (TPL) for medical services unless they have good cause for not doing so.
Use the Client Statement of Good Cause (DHS-2338) to tell clients about their right to claim good cause and the procedure for determining if good cause exists.
l Give this notice at the time of application, renewal, and requests from caretakers to add children to the case.
l Put a copy of the signed notice in the case file.
Eligibility for Those Who Claim Good Cause.
Good cause is defined as, "The circumstances beyond a person's control which keep the person from following program requirements or specific eligibility conditions, such as premium payment or cooperation with medical support."
There are five potential situations in which a caretaker may claim good cause for not cooperating with medical support enforcement:
1. Cooperation is anticipated to result in physical or emotional harm to the child.
2. Cooperation is anticipated to result in physical or emotional harm to the child's caretaker.
Note: The anticipated harm must be severe enough to reduce the caretaker's capacity to care for the child.
3. The child was conceived as a result of rape or incest.
4. The parent is trying to decide whether to place the child for adoption.
n The parent must be working with a public or licensed private social service agency, and
n The decision process has gone on for three months or fewer.
5. Legal proceedings for the adoption of the child are pending.
For Medical Assistance (MA), the agency's good cause committee makes determinations of good cause.
Note: These committees also determine good cause for residents of the county who apply for or receive Minnesota Family Investment Program (MFIP) or Child Care Assistance .
For MinnesotaCare:
l If the household has chosen the county as the enrollment site, the county agency will make the good cause determination.
l If the household has chosen MinnesotaCare Operations as the enrollment site, the DHS good cause committee will make the determination.
All good cause committees must include at least one representative from the child support enforcement agency.
Caretakers who meet all other program requirements are eligible for health care coverage while the good cause claim is being decided. If the good cause committee notifies the worker that the caretaker is not cooperating or does not meet the criteria for a good cause claim, close the caretaker with ten-day notice.
Note: If the caretaker does not cooperate with or meet good cause, there is no effect on the child's eligibility for health care program coverage.
For further information, see:
Initial Good Cause Determinations.
Approved Good Cause Exemptions.
When to Refer for Medical Support.