*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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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21.15 - MinnesotaCare Excess Income |
Archived: June 1, 2016 (Previous Versions) |
Adults enrolled in MinnesotaCare must continue to meet the income standard for their household size to remain eligible. Whenever a household reports that their income has increased, evaluate if the increase causes their gross annual income to be higher than the MinnesotaCare income standard to determine if coverage may continue.
Do not close coverage for excess income for:
l Pregnant women with incomes over 275% FPG. They remain eligible through the end of the postpartum period .
l Children under 21, including auto newborns.
Close coverage for the following:
l Adults without children whose income exceeds 250% FPG, including adults who lose parental status between renewals. Close for the end of the month following the month in which excess income is determined. Do not change the Major Program Eligibility Type (MPET) or premium of any household member for the additional coverage month.
Example:
Tim is a single adult without children. He is enrolled in MinnesotaCare with income less than 250% FPG. On August 3, Tim calls to report a raise. Tim’s income is now over 250% FPG.
Action:
Close Tim effective September 30 because that is the last day of the month following the month in which his income exceeds 250% FPG.
l Non-pregnant parents and caretakers whose gross annual income exceeds 275% FPG but is less than $57,500. Close for the end of the month following the month in which excess income is determined. Do not change the MPET or premium of any household member for the additional coverage month.
Note: Regardless of the renewal date, do not cancel coverage for individuals exceeding the 275% FPG standard but not the $57,500 limit, until the month following the month that the income determination is made.
Example:
Manny is enrolled in MinnesotaCare. His son Donny is not enrolled because he has other health care coverage through his mother. On February 5, Manny calls to report a new job. The household now has income over 275% FPG, but less than $57,500.
Action:
Close Manny’s coverage effective March 31. Manny will remain eligible as a parent through the end of the month of March because March is the month following the month in which excess income is determined.
l Non-pregnant parents and caretakers whose gross annual income exceeds $57,500, regardless of whether income is over 275% FPG. Close coverage for the first available month for which timely notice can be given.
Note: 10-day notice is not required if income reported at renewal exceeds the $57,500 limit and the household was sent a Notice of Cancellation for Failure to Renew or Incomplete Renewal.
The renewal form advises enrollees that their coverage may stop or change based on information provided on the renewal form; that changes may be made without 10-day notice, and that DHS will send a notice no later than the effective date of the change.
Example:
James, his wife Julie and their three children are enrolled in MinnesotaCare. On September 4, James calls to report an income change. The change results in household income exceeding $57,500, but less than 275% FPG.
Action:
The children remain eligible. Close James and Julie for September 30, because that is the first available month for which timely notice can be given.