This manual letter lists new and revised material for the Health Care Programs Manual. Unless otherwise noted, new and revised instructions are effective September 1, 2012.
This manual letter incorporates Bulletin #12-21-07, "Legislative changes to MinnesotaCare Effective July 1, 2012."
Manual Letter #53 also includes updates to policy regarding exemptions from Medical Assistance (MA) six-month renewals, verification of American Indian status, county transfers, cost-effective health insurance, asset verification, MA excess assets, and processing of spenddowns.
Chapter 3 - Eligibility Groups and Bases of Eligibility
Incorporates bulletin #12-21-07.
Chapter 4 - Social Security Administration (SSA) Benefits
Incorporates Bulletin #12-21-07.
Incorporates Bulletin #12-21-07.
Updates information about six-month income renewal exemptions.
Chapter 9 - Verifications Requirements
Updates information about verification of American Indian status.
Chapter 13 - State and County Residence
Adds information about county transfers and financial responsibility.
Chapter 15 - Third Party Liability
Incorporates Bulletin #12-21-07 and revises information about cost-effective insurance.
Chapter 17 - Household Composition
Incorporates Bulletin #12-21-07.
Clarifies when assets should be verified for MA Method A and updates information about reducing excess assets for MA.
Chapter 21 - Income Calculation (Community)
Incorporates Bulletin #12-21-07.
Chapter 22 - Standards and Guidelines
Incorporates Bulletin #12-21-07 and updates long-term care (LTC) allowance figures.
Chapter 24 - Medical Spenddowns
Adds clarifying information regarding the monthly and six-month spenddown calculations.
Incorporates Bulletin #12-21-07.
Revises the definitions for High Deductible Health Plan and Underinsured.
Adds a new form: MinnesotaCare Approval and Premium Information (DHS-3739).
Chapter 3 - Eligibility Groups and Bases of Eligibility
l Section 03.05.05 - Change in MinnesotaCare Eligibility.
Incorporates Bulletin #12-21-07 by replacing references to the 150% of the federal poverty guidelines (FPG) income standard with the 200% FPG income standard. The 150% FPG income standard is no longer applicable to MinnesotaCare because the income standard for MinnesotaCare Group 1 Children has increased to 200% FPG.
l Section 03.05.10 - MinnesotaCare Major Program Eligibility Type.
Incorporates Bulletin #12-21-07 by increasing the income standard for children and pregnant women under 21 with major programs LL or KK and eligibility types I1, C1, or P1 from 150% FPG to 200% FPG. Also clarifies that children and pregnant women under 21 with major programs LL or KK are eligible for eligibility types I2, C2 or P2 if their household income is greater than 200% FPG.
l Section 03.20.05 - MinnesotaCare for Pregnant Women.
Incorporates Bulletin #12-21-07 by updating a reference to the income limit of $50,000 for adults with children with household income less than or equal to 275% FPG to the new income limit of $57,500. Additionally, clarifies that pregnant women under the age of 21 are not subject to an income limit, including at initial enrollment or after the postpartum period ends.
l Section 03.20.15 - MinnesotaCare for Children Under 21
Incorporates Bulletin #12-21-07 by clarifying that children under 21 are eligible for MinnesotaCare regardless of their household income. The revision to this section also adds maximum premiums as an additional premium type for children under 21 that applies to children with household income greater than 275% FPG. Additionally, updates the income standard for children to be exempt from MinnesotaCare other health care coverage barriers from 150% FPG to 200% FPG. Lastly, the revision to this section adds temporary Medicaid Management Information system (MMIS) instructions to approve eligibility for children who are applying for MinnesotaCare on a new or inactive case with household income greater than 275% FPG.
l Section 03.20.20 - MinnesotaCare for Adults With Children.
Incorporates Bulletin #12-21-07 by increasing the income limit for MinnesotaCare adults with children with household income less than or equal to 275% FPG from $50,000 to $57,500. Additionally, adds temporary MMIS instructions needed to approve, renew, and continue eligibility for adults with children with household income greater than $50,000, but less than or equal to $57,500 and less than or equal to 275% FPG.
Chapter 4 - Social Security Administration (SSA) Benefits
l Section 04.45 - Medicare and Minnesota Health Care Programs (MHCP).
Incorporates Bulletin #12-2107 by increasing the income standard needed to be met by Medicare beneficiaries under 21 to qualify as underinsured for MinnesotaCare from 150% FPG to 200% FPG.
l Section 07.30 - Case Notes.
Incorporates Bulletin #12-21-07 by replacing a reference to the 150% FPG income standard with the 200% FPG income standard. Also, adds underinsured children to the list of other health care coverage information that should be included in MinnesotaCare case notes.
l Section 08.35 - Six-Month Renewals.
Removes information that incorrectly indicates that enrollees of the General Assistance program automatically receive MA.
Chapter 9 - Verifications Requirements
l Section 09.20 - Verification of American Indian Status.
Clarifies that documentation verifying American Indian status of a parent is sufficient verification of a biological child's American Indian status, even if the parent is not part of the child's MinnesotaCare household. The revision to this section also provides a link to the U.S. Department of the Interior Indian Affairs website for current information about federally recognized American Indian tribes.
Chapter 13 - State and County Residence
l Section 13.25.10 - County Transfers.
Adds placement in the Minnesota Sex Offender Program (MSOP) as a situation in which it would be appropriate for the county of financial responsibility to continue servicing a case when a client moves to another county.
Chapter 15 - Third Party Liability
l Section 15.05 - MinnesotaCare Other Health Care Coverage Barriers.
Incorporates Bulletin #12-21-07 by increasing the income standard for children under 21 to be exempt from MinnesotaCare other health care coverage barriers from 150% FPG to 200% FPG.
l Section 15.05.05 - Types of Other Health Care Coverage for MinnesotaCare.
Incorporates Bulletin #12-21-07 by updating the income standard for children under 21 to have Medicare coverage and still receive MinnesotaCare to 200% FPG.
l Section 15.05.15 - MinnesotaCare Underinsured Children.
Incorporates Bulletin #12-21-07 by increasing the income standard for children under 21 to be underinsured from 150% FPG to 200% FPG.
l Section 15.05.20 - Employer Subsidized Insurance (ESI)
Incorporates Bulletin #12-21-07 by increasing the income standard for children under 21 to be exempt from MinnesotaCare's ESI policy to 200% FPG..
l Section 15.10.05 - Cost-Effective Health Care Coverage - MA.
Removes language from an example that required a client to agree to use funds in a health savings account (HSA) in order for a high deductible health plan (HDHP) with an associated HSA to be evaluated for cost effectiveness.
l Section 15.10.05.05 - Determining Cost Effectiveness.
Removes language indicating that premiums for High Deductible Health Plans (HDHP) that have an associated health savings account (HSA), health reimbursement account (HRA), medical savings account (MSA), flexible spending account (FSA), voluntary employees' beneficiary account (VEBA), or a similar medical expense account are not reimbursable because they are not considered cost effective unless a client agrees to use the funds in the medical expense account to reduce the deductible or co-insurance. Workers need to evaluate these policies for cost-effectiveness as they would for policies for which premiums are reimbursable..
Chapter 17 - Household Composition
l Section 17.10.05 - Three-Generation Households.
Incorporates Bulletin #12-21-07 by removing language that indicates children under 21 may be ineligible for MinnesotaCare as a result of excess income. Because MinnesotaCare children under 21 are no longer subject to an income limit, the three-generation household policy is reconfigured to create eligibility for children at a lower premium who would otherwise have to pay the maximum premium. The revision to this section also requires workers to consider other insurance barriers for which children with household income equal to or less than 200% FPG are exempt when evaluating household composition options for a three-generation household.
l Section 17.10.10 - Non-Parent Caretaker.
Incorporates Bulletin #12-21-07 by replacing references to the 150% FPG income standard with the 200% FPG income standard as it applies to MinnesotaCare children under 21. Also, removes language indicating children under 21 may be ineligible for MinnesotaCare as a result of excess income.
l Section 19.20 - Verification of Assets.
Clarifies assets must be verified at renewal with the exception of excluded or unchanging assets for MA Method A for parents and relative caretakers.
l Section 19.35.10 - MA Excess Assets.
Clarifies clients can also reduce their assets to qualify for MA by paying the following month's cost of care at a long-term care facility (LTCF) if the amount of excess assets, when added to the following month's long-term care spenddown, is less than the following month's cost of care at the LTCF.
Chapter 21 - Income Calculation (Community)
l Section 21 - Income Calculation (Community).
Incorporates Bulletin #12-21-07 by updating the income limit for MinnesotaCare adults with children with household income less than or equal to 275% FPG to $57,500. Also, adds that MinnesotaCare children under 21, including autonewborns, are not subject to an income limit.
l Section 21.15 - MinnesotaCare Excess Income.
Incorporates Bulletin #12-21-07 by updating the income limit for MinnesotaCare adults with children with household income less than or equal to 275% FPG from $50,000 to $57,500. Also, clarifies that MinnesotaCare children under 21, including autonewborns, cannot be closed for excess income.
Chapter 22 - Standards and Guidelines
l Section 22 - Standards and Guidelines.
Incorporates Bulletin #12-21-07 by removing a reference to Minnesota Comprehensive Health Association (MCHA) premiums because they are no longer needed to determine eligibility for MinnesotaCare children under 21.
l Section 22.05.25 - 150% FPG.
Incorporates Bulletin #12-21-07 by removing information relating to MinnesotaCare major programs and eligibility types previously associated with the 150% FPG income standard. The income standard is no longer used by MinnesotaCare.
l Section 22.05.40 - 200% FPG.
Incorporates Bulletin #12-21-07 by clarifying that 200% FPG is the maximum income limit for MinnesotaCare Group One status, which includes children and pregnant women under 21 with major program LL or KK and eligibility type I1, C1, or P1. The revision to this section also adds that there is no income limit for MinnesotaCare Group Two status, which includes children and pregnant women under 21 with household income greater than 200% FPG who qualify for major program LL or KK and eligibility type I2, C2 or P2.
l Section 22.05.55 - 275%FPG.
Incorporates Bulletin #12-21-07 by updating the income limit for MinnesotaCare adults with children with household income less than or equal to 275% FPG to $57,500. Information about MinnesotaCare major programs LL and KK with eligibility types I2 and C2 are removed from this section because they are no longer subject to an income limit. Additionally, adds that MinnesotaCare clients with major programs LL or KK and eligibility type P2 are subject to the 275% FPG income limit at initial enrollment with the exception of those under the age of 21.
l Section 22.20 - MinnesotaCare Premium Amounts.
Updates the maximum premium amounts for MinnesotaCare enrollees for periods of July 1, 2011, to June 30, 2012, and July 1, 2012, to June 30, 2013.
l Section 22.45 - LTC Allowances.
Updates the utility allowance figures effective for the period of October 1, 2012, to September 30, 2013.
The following section was archived because the information included in the section is no longer applicable.
l Section 22.15 - Minnesota Comprehensive Health Association.
Chapter 24 - Medical Spenddowns
l Section 24.10.05 - Monthly Spenddowns (automated).
Clarifies that providers should not re-bill claims that were already paid because those claims are automatically reprocessed in the next claims cycle after the change is made.
l Section 24.10.10 - Six-Month Spenddown.
Clarifies that providers should not re-bill claims that were already paid as those claims are automatically reprocessed in the next claims cycle after the change is made. Also instructs workers to update the existing RSPD screen in MMIS so that reprocessed claims will appear on the RSLG screen. The update to the section also clarifies that if the satisfaction date is changed to an earlier date, claims that have already been processed and denied will not reprocess automatically. In this circumstance, providers should only resubmit denied claims.
l Section 25.05 - MinnesotaCare Premiums.
Incorporates Bulletin #12-21-07 by adding that children under 21 with household income greater than 275% FPG must pay the maximum premium based on the number of children enrolled.
Updates the definition of high deductible health plan to include current figures for the maximum annual deductible and other out-of-pocket expenses.
Incorporates Bulletin #12-21-07 by updating the definition of underinsured to reflect the increased income standard of 200% FPG to qualify as underinsured.
l DHS-3739: MinnesotaCare Approval and Premium Information Letter (new).
Workers must manually send this letter to MinnesotaCare clients for which the temporary MMIS workaround in Section 03.20.15 is used to approve eligibility for children under 21 with household income greater than 275% FPG. The letter explains to clients that the children listed are eligible for MinnesotaCare at the maximum premium. The letter further clarifies that system limitations prevent MinnesotaCare from billing the first premium at the maximum amount. Clients are notified of the initial premium amount they must pay to start coverage for the children listed and the higher premium they will be billed for future premiums.