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Effective: December 1, 2006 |
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03.05.05ar1 - Change in MinnesotaCare Eligibility Group (Archive) |
Archived: February 1, 2008 |
All MinnesotaCare enrollees are assigned to one of four numeric eligibility groups. Group status is evaluated at each renewal. People maintain their group status between renewals unless they:
l Have a break in MinnesotaCare coverage for one month or more.
l Have a change in income.
l Have a change in parental status.
l Turn age 21.
MinnesotaCare enrollees who become pregnant (and their spouses) may also experience a change in group status between renewals. For more information on these changes, see Enrollee Becomes Pregnant.
Re-evaluate group status 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. Based on the household’s income at the time of enrollment, Ada was assigned to Group One. In 2004, Ada and her parents ended their MinnesotaCare coverage. They reapply in 2006.
Action:
Determine Ada’s group status based on the household income 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 a more favorable group status, change the enrollee to the new group effective the next month. If it is an increase that results in a less favorable group status, act on the change for the next available month.
l Children who initially enroll as Group Two gain Group One status if their household income drops to 150% FPG or below. They will retain Group One status as long as they remain continuously enrolled and income remains below 150% FPG.
Example:
Stuart is enrolled as a Group Two child with his parents. His mother calls on May 5 to report that the household income has decreased. On May 10 she verifies the new income, which is now below 150% FPG. The household's next renewal is due for August.
Action:
Change Stuart’s status to Group One effective June 1.
l Group Two non-pregnant adults with children who report income changes will move to Group Four effective either the next or the next available month if their new income and their citizenship/immigration status meet Group Four criteria. For example:
n If they are moving from an A2 to an M4 status, they are moving to a more beneficial benefit set so the change is effective the next month.
n If they are moving from an M2 to an M4 status, they are moving to a less beneficial benefit set so the change is effective the next available month.
Example:
Greta is enrolled as a Group Two parent with household income of 240% FPG, and is a U. S. citizen. (FFA2) Greta reports an income decrease on March 8. On March 15, she verifies that household income is now 170% FPG. (FFM4)
Action:
Assign Greta to Group Four effective April 1.
l Group Four non-pregnant adults with children who report income changes will move to Group Two effective either the next or the next available month if their new income and their citizenship/immigration status meet Group Two criteria. For example:
n If they are moving from an A4 to an M2 status, they are moving to a more beneficial benefit set so the change is effective the next month.
n If they are moving from an M4 to an A2 status, they are moving to a less beneficial benefit set so the change is effective the next available month.
Example:
Norman is enrolled as a Group Four parent with household income of 160% FPG, and is a U.S. citizen. (FFM4) He reports an income increase on October 27. Income is now over 200% FPG. (FFA2)
Action:
Assign Norman to Group Two effective December 1 (the next available month).
See system coding for a description of the various group status codes noted above.
Group Two or Group Four parents who lose their parental status due to no longer having children under 21 in the home become Group Three effective the first month for which you can give 10-day notice. If their income exceeds the limit for adults without children (175% FPG), close coverage the end of the month following the month in which excess income is determined.
Example:
Mary and Joe are Group Two parents. On September 30, they report that their children have left the household. Their income is 90% FPG.
Action:
Since Mary and Joe no longer have children under 21 in their household, re-determine their eligibility as adults without children. Because their income does not exceed 175% FPG, they are eligible with Group Three status effective November 1.
Example:
Manny is a Group Two parent. On September 5, the worker notes that Manny’s only child, Donny, is turning 21 in October. Manny’s income is 230% FPG.
Action:
Since Manny will no longer have a child under 21 in his household, re-determine his eligibility as an adult without children. If his income did not exceed 175% FPG, he would change to Group Three status. However, because his income does exceed 175% FPG, Manny is no longer eligible for MinnesotaCare effective November 1.
If Group Three adults gain parental status, change them to Group Two or Group Four status effective the next month. Group Three adults gain Group Two status 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.
Exception: Parents and relative caretakers gain Group Four status if they meet the specific citizenship/immigration status and income criteria noted in MinnesotaCare Eligibility Groups.
Example:
Monica is enrolled as a Group Three adult. She reports 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 and she is a U.S. citizen.
Action:
Change Monica’s status to Group Four. See Adding a Household Member.
Re-evaluate the group status of 21-year-olds for the first available month (the first month for which ten-day notice can be given) following their 21st birthday.
l Assign them to the appropriate group depending on their current circumstances (see MinnesotaCare Eligibility Groups).
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 Group Two child, and is part of his father Manny’s MinnesotaCare household. Donny turns 21 on October 2.
Action:
Effective November 1, change Donny to Group Three status, and create a separate MinnesotaCare case for him.
Example:
Emily and her parents all have Group Two status. Emily reaches age 21. Last month she reported and verified that she is pregnant.
Action:
Remove Emily from her parents’ MinnesotaCare household and create a separate case for her. Since she is pregnant, she retains her Group Two status. Make the necessary changes for her parents’ household. If Emily was the only child, her parents will change to Group Three status.