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Effective: December 1, 2006 |
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03.10.10ar1 - Change in Basis of Eligibility (Archive) |
Archived: June 1, 2011 |
When you become aware of a change in circumstances for a Medical Assistance (MA) or General Assistance Medical Care (GAMC) enrollee, evaluate the effect of the change on the enrollee's basis of eligibility (or major program). If you need to re-determine the basis (or program), leave MA or GAMC open while the re-determination is in process as long as the enrollee is cooperating in providing necessary information.
Depending on the change, a new application may or may not be required; see Application Required and Application Not Required. The budget period for the household may continue, or it may need to be interrupted; see Certification Period.
Some of the changes that may affect basis of eligibility or major program include:
Change in Disability or Blindness Status.
Change in Household Composition.
Change in Receipt of Assistance.
There are a number of changes to eligibility that may result from a change in age.
l When a person receiving GAMC turns 65, determine MA eligibility beginning with the month of the 65th birthday.
n Approve MA effective the first of the month in which the person turns 65 if all eligibility factors are met.
n Do not require a new application.
l When MA enrollees turn 21, determine if they have another MA basis.
n If they do not, determine GAMC eligibility beginning with the month following the month of the 21st birthday.
n Do not require a new application for GAMC for enrollees who are receiving General Assistance (GA) concurrently with MA when they turn 21. Do require an application for enrollees who are eligible only for MA.
l When the only child of a parent receiving MA with a parent/caretaker basis turns 18, determine if the parent continues to meet an MA basis.
n Eligibility for a parent/caretaker basis continues if the child still meets the definition of a dependent child. If there is not a continued parent/caretaker basis, determine if the parent meets another MA basis.
n If there is no continued basis for MA, give the parent an opportunity to apply for GAMC. Require an application.
l When a disabled child turns 18, do not deem the parent’s income beginning the month after the 18th birthday.
Note: Parents of TEFRA children may be liable for parental fees through the month of the child's 18th birthday.
Change in Disability or Blindness Status
When people receiving MA with a families with children basis of eligibility are certified blind or disabled, they may have multiple bases of eligibility from which to choose.
When people receiving GAMC are certified blind or disabled:
l They are eligible for MA beginning with the first day of the month of the disability onset date according to the Social Security Administration (SSA) or State Medical Review Team (SMRT) determination, or the GAMC begin date, whichever is later.
l MA eligibility may also exist for the three months prior to application that GAMC did not cover if the applicant met all MA eligibility factors in the retroactive months.
l Do not require a new application if the person was initially approved for GAMC before the disability or blindness certification.
Example:
Julia applies for health care coverage on March 18. She has a disability that is expected to last 12 months or longer, and has an SSA disability certification application pending. She does not have an MA basis of eligibility, but does meet the eligibility requirements for GAMC.
Action:
Approve GAMC eligibility effective March 18 and send a referral to SMRT for a disability certification (pending the outcome of the SSA application).
In July, the SMRT certifies Julia disabled effective March 1.
Action:
Change the GAMC span to MA with a start date of March 1. Do not require a new application.
Example:
Sun applied and was approved for GAMC effective June 3. In August the worker learns that Sun was certified disabled by SSA effective March 1. She has requested retroactive coverage. However, she was not a Minnesota resident until May 1.
Action:
Approve MA for Sun effective May 1 if she meets all other MA eligibility factors on that date.
Change in Household Composition
When the only child of a parent who receives MA with a parent/caretaker basis leaves the household and the absence is not temporary, determine if the parent meets another MA basis. If there is no MA basis, give the parent an opportunity to apply for GAMC. Allow at least 10 days for the parent to return the application.
When a child moves in with a parent or eligible relative caretaker who receives GAMC, determine if the parent meets a parent/caretaker basis for MA. Give the parent an opportunity to apply for MA. Allow at least 10 days for the parent to return the application.
Note: If the child is open on MA, the parent or relative caretaker can be added to the child’s case without requiring an application.
Change in Receipt of Assistance
When General Assistance (GA) ends for a person who receives GAMC automatically, determine if GAMC eligibility continues. Do not require an application and do not close GAMC before determining continued eligibility. If the household fails to provide information needed to determine continued eligibility, close GAMC for the first month for which you can give ten-day notice.