*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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: September 1, 2012 |
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17.10.05 - Three-Generation Households |
Archived: June 1, 2016 (Previous Versions) |
Standard MinnesotaCare household composition policy indicates all people with a parental or marital relationship are in the same household. A three-generation household may be an exception to normal household composition rules for MinnesotaCare when the total household income exceeds 275% FPG, or the youngest generation of the household does not meet certain eligibility criteria.
This policy is a means of creating the following:
l eligibility for the youngest generation of a three-generation household if no eligibility exists, or
l eligibility at a lower premium for the youngest generation of a three-generation household who would otherwise be required to pay the maximum premium.
The three-generation household policy allows the youngest generation to have their eligibility determined based on only their immediate parental relationships and not include the grandparent in the MinnesotaCare household in certain situations.
What is a Three-Generation Household?
Three-Generation Household Determination Steps.
What Is a Three-Generation Household?
A three-generation household consists of:
l Parent of a child under 21 years old who has a child.
l Child under age 21 who is the parent of a minor child . This person is also referred to as the minor parent.
Note: Emancipated children are their own household.
l Child of the minor parent.
l Anyone else who has a parental or marital relationship with the parents, minor parents or minor child.
Example:
Glory, age 17, lives with her parents, Rudolpho and Leann. Glory has a one-year old son, Ernie, who lives with her. Ernie’s father, Randy, also lives in the household, however, he and Glory are not married.
Action:
According to standard household composition rules, Glory, her parents, Ernie, and Randy are a MinnesotaCare household because the parental and marital relationships tie them all together. They are a three-generation household with a household size of five.
Randy's child from another mother moves into the household.
Action:
Increase the household size to six.
Three-Generation Household Determination Steps
Follow these steps to determine when the three-generation household may use the MinnesotaCare household size exception:
1. Determine eligibility for the entire household based on standard household composition rules.
2. If any of the following are true, continue on to Step 3.
n The household income is over 275% FPG.
n The household income is over 200% FPG and the minor parent's child has:
m current other health coverage, but is underinsured. See MinnesotaCare Underinsured Children for policy requirements.
m other health coverage that ended in the last four months.
m current access to employer subsidized insurance (ESI) or past access to ESI in the preceding 18 months.
m employer health coverage that was terminated as an employee benefit in the preceding 18 months.
n The grandparents refuse to cooperate in providing information needed to determine eligibility for the minor parent’s child.
If none of these conditions are true, no exception to household composition rules is needed.
3. Create a new case for the minor parent’s child and the parent of that child who is only included in the first household because of the parental relationship to the child.
n Use a household composition that includes only the minor parent and the minor parent's child.
n Do not include the grandparents or other children of the grandparents.
n Although the minor parent who lives with his or her parents is included in the new household to determine household size, his or her eligibility must be determined in the household that includes the minor parent’s parents. Deny eligibility for the minor parent on the new case.
Example:
Fifteen-year-old Riley lives with her parents and her newborn daughter, Lily. Her parents apply for MinnesotaCare for themselves, Riley and their granddaughter. No one has current health coverage or access to coverage. The household of four has income over 275% FPG.
Action:
Determine eligibility for Lily on her own case. Include Riley in Lily’s household size, making them a household of two. The household income is less than 275% FPG, so Lily is not subject to the maximum premium. Riley is eligible on her parent's case because she is under 21. She is assessed the maximum premium based on the original household size of four with income over 275% FPG.
Example:
Anne lives with her unmarried 16-year-old daughter, Sara, and Sara's one-year-old son, Jacob. Anne is working and is earning $500 a month. Sara does not work. The household receives no other income. No one in the house has health care coverage or access to coverage. The household income is less than 275% FPG.
Action:
Count Anne, Sara and Jacob in the same household because Sara has a parental relationship with both Jacob and Anne (she is Anne's daughter and Jacob's mother).
Approve eligibility for everyone in the household. No exception to household composition policy is needed because Jacob does not have other health care coverage barriers, the income is under 275% FPG, and Anne is cooperating in providing information needed to determine eligibility.
Example:
Bob and Grace live with their 19-year-old daughter, Linda, her one-year-old daughter, Rachel, and Rachel's father, Justin, who is 22 years old.
n Bob has full health insurance benefits through his employer for himself, Grace, and Linda.
n Justin and Rachel have current health care coverage through Justin’s employer. Rachel is underinsured.
n Linda applies for herself, Justin and Rachel.
Action:
Use the following steps to determine eligibility for Linda, Justin and Rachel:
1. Determine the household size. Bob and Grace have a marital relationship. They have a parental relationship to Linda, who in turn has a parental relationship to Rachel. Justin also has a parental relationship to Rachel. Everyone is included in the household. The household size is five.
2. Calculate household income. Household income is over 275% FPG, based on Bob and Grace’s income and Justin’s income. Bob, Grace, and Justin are ineligible because they are over income and have other health coverage. Although Linda and Rachel are not subject to an income limit, they are ineligible because the household income is greater than 200% FPG and they have current other health coverage.
3. Redetermine eligibility for Justin and Rachel on a separate case.
m The household size is three because Linda must be included in the household size due to her parental relationship to Rachel.
m The household income is less than 200% FPG using only Justin’s income, because Linda is not employed.
m Justin is ineligible due to his current health care coverage.
m Rachel is eligible because her household income is less than 200% FPG and she is underinsured.
m Do not determine Linda’s eligibility on this case. Determine Linda's eligibility on her parents' case to include their income, as they have a parental relationship to her. Her eligibility is based on the original case with the household size of five.