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Effective: July 1, 2008 |
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03.10ar2 - MA/GAMC Bases of Eligibility (Archive) |
Archived: June 1, 2011 |
Each person must have a basis of eligibility for Medical Assistance (MA). A basis of eligibility is a set of factors such as age, disability, or household composition. The bases of eligibility are based on groups for whom DHS can receive federal reimbursement, also known as Federal Financial Participation (FFP).
A basis of eligibility is not required for General Assistance Medical Care (GAMC). However, certain circumstances, such as receiving General Assistance (GA), may result in automatic eligibility for GAMC.
Eligibility Method for MA/GAMC.
While having a basis of eligibility is a primary requirement for MA, people must also meet all other program requirements, such as residency, immigration status, income, etc. These requirements may vary, depending on a person's basis of eligibility.
Example:
Paul has a parent/caretaker basis of eligibility for MA. However, his assets exceed the limit.
Action:
Deny MA if Paul cannot reduce his assets to the limit. Even though he has a basis, he does not meet the asset requirements of the program.
All children under age 21 have an MA basis of eligibility. Adults have a basis of eligibility if they are pregnant, are a parent/caretaker, or are age 65 and older, blind, or disabled.
Some people may have an automatic basis of eligibility due to eligibility for another program, or other circumstances. For example, people who receive income assistance through Minnesota Supplemental Aid (MSA) or Refugee Cash Assistance (RCA) have an automatic basis of eligibility for MA. However, they do not have to accept the MA coverage.
Assist people who meet more than one basis of eligibility in determining which basis is most advantageous. See Multiple Bases of Eligibility.
If people become ineligible under one basis, determine if they meet another basis. Leave MA open under the original basis while the determination is in process. See Change in Basis of Eligibility.
People who are eligible for may be eligible for QMB, SLMB, QI, or QWD benefits instead of or in addition to MA. See Medicare Savings Programs for an explanation of these programs.
People who meet certain disability or age requirements may be eligible for one of the waiver programs. These programs provide a waiver of some MA eligibility requirements, and covered services beyond those already provided by MA.
Noncitizens who are eligible for state-funded MA (also called NMED) due to their immigration status are subject to the same basis of eligibility and other requirements as people who are eligible for federally funded MA.
An MA basis of eligibility is also required for noncitizens who are eligible for Emergency Medical Assistance (EMA) (program EH). This program is federally funded, but has some different program requirements and fewer covered services than state-funded MA (program NM) and federally funded MA (program MA). See Hierarchy of Major Programs and Emergency Medical Assistance for more information.
Example:
Leila, age 16, is an undocumented noncitizen. She has an MA basis of eligibility as a child under 21 and has income within the MA limits.
Action:
Because undocumented noncitizens do not meet the citizenship and immigration requirements for state- or federally funded MA, deny MA eligibility for Leila. Consider EMA if she has a medical emergency.
Example:
Allen, age 40, is a noncitizen with a nonimmigrant status. He does not have any children, and is not blind or disabled. He has a medical emergency
Action:
Allen is not eligible for any health care program coverage, including EMA, because he does not have an MA basis of eligibility.
The eligibility method governs how a client’s income and assets are evaluated, including exclusions and allowable income deductions.
There are two methods used to evaluate income and assets:
l Method A is based on the rules of the former AFDC program in effect as of July 16, 1996. For MA, people using a "families with children" basis of eligibility use Method A.
l Method B is based on the rules of the Supplemental Security Income (SSI) program. For MA, people whose eligibility is based on being age 65 or older, blind, or disabled use Method B.
In some cases, Method A and Method B do not differ. When Method A and Method B have different rules, follow the instructions for the appropriate method.
Example:
Susan and Bill each pay court-ordered child support for children from previous relationships who do not live with them. Susan has a Method A basis of eligibility, which allows a deduction for court-ordered child support. Bill has a Method B basis of eligibility, which generally does not allow this deduction.
Action:
Allow Susan’s court-ordered child support payments as a deduction when computing her net income, but do not allow Bill’s court-ordered child support payments when computing his net income.
See Assets and Income for instructions on treatment of various types of income and assets.
Note: For some bases of eligibility, it is not necessary to evaluate income or assets for health care program eligibility. This includes, but is not limited to, MA bases such as auto newborn and people who receive MA automatically with MSA. MAXIS uses the term "Method X" to describe these situations.
For more information, see:
MA for Families with Children.
MA for People Who Are Age 65 or Older, Blind, or Disabled.
Programs for Specific Populations.