*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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: September 1, 2012 |
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03.20.20 - MinnesotaCare for Adults With Children |
Archived: June 1, 2016 (Previous Versions) |
People who have children under age 21 in the household are considered adults with children for MinnesotaCare eligibility if they are:
l A parent. Consider stepparents to be parents regardless of whether the biological or adoptive parent lives in the household.
Note: Consider the husband of a pregnant woman to be a parent even if he has no other children living in the household.
l Relative caretakers, foster parents or legal guardians residing with one or more children in their care.
Eligibility factors and links to standard program guidelines are provided below.
Citizenship/Immigration Status.
Insurance and Benefit Recovery.
MinnesotaCare Major Program and Eligibility Types (MPETs).
Relationship to Other Groups/Bases.
See Household Composition below for guidelines on when adults must be included in a child's MinnesotaCare household.
Follow standard MinnesotaCare guidelines.
Renewals (standard guidelines)
Follow standard MinnesotaCare guidelines.
Follow standard MinnesotaCare guidelines.
Social Security Number (standard guidelines)
Follow standard MinnesotaCare guidelines.
Parents and relative caretakers who are citizens and lawfully residing noncitizens must follow citizenship verification requirements and immigration status requirements.
Parents and relative caretakers who are noncitizens may be eligible for:
l MinnesotaCare with Federal Financial Participation (FFP) if they have an immigration status that qualifies them for federally funded health care.
l State-funded MinnesotaCare if they have an immigration status that qualifies them for state-funded health care.
See Federally Funded Health Care and Federally or State-Funded Health Care to determine if a noncitizen's immigration status qualifies the person for FFP.
Legal guardians and foster parents who are not relative caretakers may be eligible for state-funded MinnesotaCare only, even if they meet the immigration status requirements for federally funded health care.
Use the Systematic Alien Verification for Entitlements (SAVE) system to validate the immigration status of eligible noncitizen applicants and enrollees.
See Funding Health Care for Noncitizens for further information about immigration status and federal funding.
Residency (standard guidelines)
Follow standard MinnesotaCare guidelines.
Follow standard MinnesotaCare guidelines.
Household Composition (standard guidelines)
Biological or adoptive parents and stepparents residing with their children or stepchildren must always be included in the same MinnesotaCare household.
Note: Children whose custody alternates equally between separated or divorced parents are considered part of both parents' households; however, the child can only be enrolled on one parent's case. Consider both parents to be adults with children. See Determining Household Size for MinnesotaCare for more information.
Relative caretakers, legal guardians and foster parents may apply with or separately from the children for whom they are responsible. However, they must include the children as part of their MinnesotaCare household to be considered adults with children.
l If they apply as one household including the children, include their income along with the children's in the gross household income for determining eligibility and premium amount.
l If they apply for the children separately, count only the children's income to determine the children's eligibility and premium amount.
Note: Applying for the children separately may result in a lower premium for some households. See Non-Parent Caretaker and MinnesotaCare Premiums for more information.
Adults who care for children under 21 who live with them but who are not the biological or adoptive parent, stepparent, legal guardian, relative caretaker, or foster parent of any of the children are not considered part of a family household. See MinnesotaCare for Adults Without Children.
See All or Nothing Rule for further information about who is required to apply as part of the same MinnesotaCare household.
See MinnesotaCare Major Program Eligibility Type (MPET) for information on determining an adult's MPET.
Asset Guidelines (standard guidelines)
The asset limit for non-pregnant adults is:
l $10,000 for a household of one.
l $20,000 for a household of two or more.
The income limit is 275% FPG, or $57,500 annual gross income, whichever is less.
Exception: Pregnant women are not subject to the $57,500 annual gross income limit and may be eligible if income is at or below 275% FPG at initial enrollment. Enrolled pregnant women cannot be terminated as a result of having excess income until after 60 days postpartum. Pregnant women under 21 do not have an income limit at initial enrollment or after the postpartum period. See MinnesotaCare for Pregnant Women and MinnesotaCare for Auto Newborns.
Deductions/Disregards (standard guidelines)
Follow standard MinnesotaCare guidelines.
Follow standard MinnesotaCare guidelines.
Covered Services (Prepaid MHCP Manual)
MinnesotaCare adults with children have some benefit limitations, deductibles, and co-payments which vary depending on household income. They may have one of two benefit sets:
l Basic Plus - This includes people whose total household income is over 215% but less than or equal to 275% FPG (or $57,500, whichever is less). This group has a $10,000 annual limit on inpatient hospital benefits (but no inpatient co-payments).
l Basic Plus Two - This includes people whose household income is equal to or less than 215% FPG. This group does not have an annual limit on inpatient hospital benefits (and also has no hospital co-payments).
They also have co-payments for some services, including emergency room visits, prescriptions and eyeglasses, regardless of income. See the MHCP Provider Manual for more information.
Follow standard MinnesotaCare guidelines.
Parents, legal guardians, and relative caretakers must cooperate with medical support requirements as a condition of eligibility.
l Legal guardians and relative caretakers who refuse to cooperate with medical support for wards or relative children for whom they apply may not reapply separately for themselves.
l Children's eligibility is not affected by a parent, legal guardian, or relative caretaker's failure to cooperate.
Note: Do not require foster parents to cooperate with medical support requirements.
Legal guardians and foster parents may qualify only for state-funded MinnesotaCare. No federal financial participation (FFP) is available for these enrollees, regardless of income level or immigration status.
Note: For a person who is both a parent/relative caretaker and a legal guardian or foster parent, use the federally funded parent or relative caretaker status for MinnesotaCare eligibility.
Example:
Phyllis is her granddaughter Naomi’s legal guardian, and is applying for
MinnesotaCare for them as a household.
Action:
Use the relative caretaker status of ”grandparent” when determining Phyllis’
eligibility and funding.
When adults lose parent or caretaker status, give 10-day notice to change eligibility effective the first available month after the change. See Change in MinnesotaCare Eligibility.
Also consider MA for Parents/Caretakers.
Determine MA eligibility for MinnesotaCare applicants and enrollees who lose parent or caretaker status and report income at or below 75% of the federal poverty guidelines (FPG). Follow agency current policy to either determine eligibility for MA or to transfer the application to the appropriate agency for a complete MA determination. Send the Notice to Apply for Medical Assistance (DHS-3404).
MinnesotaCare enrollees may remain enrolled in MinnesotaCare for up to 60 days from the first day of the month following the referral for MA. MinnesotaCare can also continue if the enrollee is cooperating with the process, but the MA determination takes longer than 60 days or if the enrollee is determined ineligible for MA. Close or deny MinnesotaCare for the next available month for enrollees who fail to submit an application for MA or are denied MA for adults without children due to failure to complete or cooperate with the MA determination process.
MinnesotaCare applicants who do not cooperate with the MA eligibility determination process are not eligible for MinnesotaCare until they cooperate with the MA requirements. Applicants who reapply for MinnesotaCare after failing to cooperate with an MA determination must complete the MA determination before they can enroll in MinnesotaCare, unless they no longer appear to qualify for MA for adults without children.
Follow the instructions below to approve, renew, or continue MinnesotaCare eligibility for adults with children with household income greater than $50,000, but less than or equal to 275% FPG and less than or equal to $57,500:
1. Update all applicable MMIS person and case-based screens.
2. Enter a Major Program of FF or JJ with an Eligibility Type of M2 or A2 with a P43 span on RELG for each eligible adult applying for MinnesotaCare. for adults with children renewing coverage or reporting a change between renewals, update RELG to reflect a Major Program of FF or JJ and an Eligibility Type of M2 or A2, if not already entered.
3. Update MMIS information for any other household members, if applicable.
4. On RINC, enter a household income of $49,999.
5. Enter case notes with the following header: *** MCRE Waiver Workaround: Adults With Children Over $50,000 ***.
After the workaround has been applied, do not change the household income unless the household reports a change in income that decreases the household income to be less than $50,000, the adults lose parental status due to a change in household composition or all adults lose MinnesotaCare eligibility because of another eligibility factor. In these circumstances, discontinue use of the workaround and update RINC to reflect the correct household income.