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Effective: October 1, 2009 |
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21.15ar5 - MinnesotaCare Excess Income (Archive) |
Archived: February 1, 2010 |
People 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 .
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 $50,000. 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 $50,000 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 $50,000.
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 $50,000, regardless of whether income is over 275% FPG. Close coverage for the first available month for which timely notice can be given.
Note: Additional 10-day notice is not required if income reported at renewal exceeds the $50,000 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 $50,000, but less than 275% FPG.
Action:
The children remain eligible because household income remains less than 275% FPG. Close James and Julie for September 30, because that is the first available month for which timely notice can be given.
Some children with excess income may remain enrolled in MinnesotaCare if they meet the Minnesota Comprehensive Health Association (MCHA) exemption described below. Take the following steps for all children under age 21 who report income over 275% FPG to determine if the child meets the MCHA exemption:
1. Determine 10% of their gross annual household income.
2. Determine the MCHA premium amount for the household using the Annual MCHA Premiums Table.
Note: Include all household members in the household size whether or not they are enrolled in MinnesotaCare.
3. Determine if 10% of the gross annual household income (Step 1) is less than the premium amount for a policy with a $500 deductible available through MCHA (Step 2).
4. If the gross annual household income from Step 3 is:
n Equal to or greater than the annual MCHA premium, close coverage for the end of the month following the month in which excess income is determined.
n Less than the annual MCHA premium, eligibility continues. This is known as the MCHA exemption.
Example:
A household consists of John, age 35, and his child, age 12. On March 15, their renewal is processed and the household's gross annual income exceeds the MinnesotaCare income standard of 275% FPG for a family of two. Gross income remains under $50,000.
Action:
Close coverage for John effective April 30 (the month following the month he is determined to have excess income).
To determine continued eligibility for the child:
1. Multiply the household's gross annual income by 10%.
2. Calculate the household's annual MCHA premium by adding together the following amounts from Annual MCHA Premiums Table:
m For John, age 35, add the amount for an adult age 35 to 39.
m For the child, add the amount for a household with one dependent child.
3. Compare the Step 1 figure to the Step 2 figure.
m If 10% of the annual income is equal to or greater than the MCHA premium, close coverage for the child effective April 30.
m If 10% of the annual income is less than the MCHA premium, eligibility continues for the child.
Example:
Aman, his wife and their three daughters receive MinnesotaCare. At the time of their annual renewal, processed on March 15, gross income exceeds $50,000. It also exceeds the 275% FPG standard for the household size.
Action:
Aman and his wife are no longer eligible for MinnesotaCare. Close their coverage effective March 31 (the first available month).
The children may remain eligible if 10% of their gross income is less than the premium amount for an MCHA policy with a $500 deductible. Close the children's coverage effective April 30 if 10% of gross income is equal to or greater than the applicable MCHA premium.
For children who have the MCHA exemption:
l If income later increases so that 10% of the gross annual income is equal to or greater than the MCHA premium, the children lose the MCHA exemption.
n Send the Income Change Letter (DHS-3408) advising the household that their MinnesotaCare will end in 12 months.
n Start the 12-month extension period effective the first of the next month.
Example:
Sue (age 12) is enrolled in MinnesotaCare. At her last renewal, her gross annual household income was over 275% FPG, but she met the MCHA exemption. At this year’s renewal, processed on March 15, the gross annual income has increased so that 10% of the annual income now equals or exceeds the household's MCHA premium.
Action:
Send the DHS-3408 notifying the household that Sue’s coverage will end in 12 months. The 12-month extension period begins April 1.
l If income later decreases or a new household member is added before the next renewal, determine if the new income amount remains above the 275% FPG standard for the household size.
n If the new income amount is now at or below 275% FPG, send the Income Change Letter (DHS-3408) to notify the household that they will not be closed.
n If income remains above the income standard, determine if the MCHA exemption is met.
m If it is, send the DHS-3408 to let the household know that they will continue to receive coverage.
m If it is not, send the DHS-3408 to let the household know that they will be closed in 12 months.
Use the following policy for children receiving the 12-month extension who later report a change such as decreased income or request to add a new household member before the next renewal.
Note: Adults can be added to the household when a case is over income, but not to MinnesotaCare coverage, unless the new household member causes income to decrease below the applicable standard.
Coverage for new children added to the household will end at the same time coverage ends for the rest of the children in the household.
l Re-determine the household annual gross income. If the income is:
n At or below the 275% FPG income standard, end the 12-month over income period. Send the DHS-3408 to notify the household that coverage will not end.
n Over the 275% FPG income standard and the MCHA exemption is met, end the 12-month extension period. The child is eligible for the MCHA extension. Send the DHS-3408.
n Over the 275% FPG income standard and the MCHA exemption is not met, the household remains in the original 12-month over income period.
l Reevaluate the household's income:
n At the next renewal.
n When a change in income is reported.
n At the end of the 12-month extension period.
At the end of the 12-month extension period, if the household reports that employment and income have not changed, document in case notes and close MinnesotaCare coverage for the children with 10-day notice.
If the household reports a change in employment or income, re-determine income eligibility.
l If the income continues to be above the 275% FPG income standard and the MCHA exemption is not met give the household 10-day notice and close MinnesotaCare at the end of the month.
l If the income is at or below the 275% FPG income standard or the MCHA exemption is met, send the DHS-3408 to notify the household that the children will not be closed.