*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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: November 1, 2012 |
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03.05.05 - Change in MinnesotaCare Eligibility |
Archived: June 1, 2016 (Previous Versions) |
MinnesotaCare eligibility is evaluated at each renewal and when changes occur or are reported between renewals. Eligibility may change if enrollees:
l Have a break in MinnesotaCare coverage for one month or more.
l Have a change in income.
l Have a change in the number of people in their household.
l Have a change in parental status.
l Turn age 21.
l Have a change in citizenship/immigration status.
l Become pregnant. See Enrollee Becomes Pregnant for more information on this change.
l Are terminated from foster care or released from a juvenile residential correctional facility in which they resided on their 18th birthday. See MinnesotaCare for Certain Children Exiting Foster Care or a Juvenile Residential Correctional Facility for more information on this change.
A change in eligibility may result in a change in the enrollee’s eligibility group, major program, or eligibility type (MPET).
Refer to the MMIS User Manual (MinnesotaCare Reference Codes: Major Programs and Eligibility Types) for additional information on system coding.
This section explains how to redetermine eligibility when an enrollee has a change between renewals.
Change in Number of People in Household.
Re-evaluate eligibility for people who have a break in coverage and do not maintain continuous enrollment. If they reapply after a break in coverage, determine eligibility based on their current circumstances.
Example:
In 2003, Ada and her parents enrolled in MinnesotaCare. In 2004, Ada and
her parents ended their MinnesotaCare coverage. They reapply in 2006.
Action:
Determine Ada’s eligibility based on the household's income and composition
at the time of re-application.
Act immediately on any reported income change, whether it is a decrease or increase. If it is a decrease that results in more favorable eligibility (for example, lower premium or better benefit set), change eligibility effective the next month. If it is an increase that results in less favorable eligibility, act on the change for the next available month. The next available month for MinnesotaCare is the first month for which a ten-day notice can be given.
Note: Verification of an income change is not required between renewals.
l Change the eligibility of children who initially enrolled with income over 200% FPG if their household income drops to 200% FPG or below. Their eligibility group and major program will remain the same (assuming no other eligibility changes), but their eligibility type will change.
Example:
Stuart is a child under 21 who lives with his parents. Household income
is above 200% FPG. His mother calls on May 25 to report that the household
income has decreased. It is now below 200% FPG. The household's next renewal
is due for August.
Action:
Act on the income decrease right away. Change Stuart’s eligibility effective
June 1.
l Non-pregnant adults with children who report income changes may change eligibility types. Their eligibility group and major program will remain the same (assuming no other eligibility changes). This change will be effective either the next month or the next available month.
n If they are moving to a more beneficial benefit set, the change is effective the next month.
n If they are moving to a less beneficial benefit set, the change is effective the next available month.
Example:
Greta is enrolled as a parent with household income between 215% and 275%
FPG. She is a U.S. citizen. Greta reports an income decrease on March
8. Her income is now less than 215% FPG.
Action:
Change Greta's eligibility effective April 1.
Example:
Norman is enrolled as a parent with household income less than 215% FPG.
He is a U.S. citizen. He reports an income increase on October 27. His
income is now over 215% FPG.
Action:
Change Norm's eligibility effective December 1 (the next available month).
Change in Number of People in Household
Re-evaluate eligibility when there is a change in the number of people in the household. An increase or decrease in household size may affect eligibility even if there are no changes to household income. See Adding a Household Member and Removing a Household Member for further information.
Example:
Leah and her four-year-old daughter, Una, are both enrolled in MinnesotaCare. Their household income is above 200% FPG but at or below 215% FPG. Both are U.S. citizens. In July, Leah's seven-year-old son, Aidan, leaves his father's household and moves in with Leah and Una. The increase in household size results in household income below 200% FPG.
Action:
Change Una's eligibility for the next month, since she is now a child under age 21 with household income at or below 200% FPG. Leah's benefit set will not change.
Change eligibility effective the first month for which you can give 10-day notice for parents who lose their parental status due to no longer having children under 21 in the home. Screen for MA for adults without children and transfer to the appropriate agency for a complete MA determination if the enrollees are citizens or noncitizens who qualify for federally funded health care and their income is at or below 75% FPG. If the enrollees' income exceeds the limit for adults without children (250% FPG), close coverage for the end of the month following the month in which excess income is determined.
Example:
Mary and Joe are parents. On September 30, they report that their children
have left the household. Their income is above 75% FPG and at or below
250% FPG.
Action:
Since Mary and Joe no longer have children under 21 in their household,
redetermine their eligibility as adults without children. They remain
eligible for MinnesotaCare because their income is above 75% FPG and at
or below 250% FPG. Change their eligibility effective November 1.
Example:
Manny is a parent. On September 5, the worker notes that Manny’s only child,
Donny, is turning 21 in October. Manny’s income
is above 250% FPG, but at or below 275% FPG.
Action:
Since Manny will no longer have a child under 21 in his household, redetermine
his eligibility as an adult without children. Manny is no longer
eligible for MinnesotaCare effective November 1 because his income exceeds
250% FPG.
Redetermine eligibility if sponsor deeming was not applied because the household included a pregnant woman and the household reports the pregnancy ended and there is no child in the home. Count sponsor income and assets in the household income and asset total for the month following the end of the woman's 60-day postpartum period.
Example:
Colette and Francois are married and apply for MinnesotaCare. Colette is
enrolled in MinnesotaCare as a pregnant woman and Francois is eligible
as a parent. they are sponsored noncitizens; however, their sponsor's
income and assets do not deem to their household because of Colette's
pregnancy. On April 25, Colette reports that she has had a miscarriage.
Action:
Count sponsor income and assets in the household income total and change
eligibility to adults without children effective July 1 for Colette and
Francois. Request a copy of the Affidavit of Support because Colette no
longer has a pregnant woman status and there are no other children under
age 21 in the household. Obtain a release of information from the client
prior to contacting the sponsor to request income and asset verification.
Determine their ongoing eligibility and premium amount by including the
sponsor's verified income in their total household income..
If adults without children gain parental status, change their eligibility effective the next month. Adults without children are considered adults with children if they meet one of the following:
l Their biological or adoptive child, stepchild, or legal ward under 21 moves into the household.
l They are relative caretakers or foster parents who apply with a child under 21 in their home for whom they have primary responsibility.
l They are the husband of a pregnant woman.
Example:
Monica is enrolled as an adult without children. She reports on August
28 that her 12-year-old son, who was living with his grandmother, has
returned to live with her and she would like to add him to her case. Her
income is 175% FPG for a household of two and she is a U.S. citizen.
Action:
Change Monica’s eligibility effective September. See Adding
a Household Member.
Re-evaluate the eligibility of 21-year-olds for the next available month (the first month for which 10-day notice can be given) following their 21st birthday.
l Assign them to the appropriate eligibility group, major program and eligibility type depending on their current circumstances (see MinnesotaCare Eligibility Groups and MinnesotaCare Major Program Eligibility Type).
l Create a new MinnesotaCare case if necessary. A new application may be required; see When to Require an Application.
l Make any necessary changes for other members of the 21-year-old’s MinnesotaCare household.
Example:
Donny is enrolled as a child under 21 with income over 200% FPG, and is
part of his father Manny’s MinnesotaCare household. Donny
turns 21 on October 2. He has already signed the household's current application,
so a new application is not required.
Action:
Effective November 1, consider Donny an adult
without children, and, if he meets all eligibility criteria, create a
separate MinnesotaCare case for him. See Removing
a Household Member for more information about how to remove Donny
from his father's case and establish a new case.