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Effective: February 1, 2008 |
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03.25.15ar3 - Medical Assistance (MA) for Children Under 21 (Archive) |
Archived: July 1, 2008 |
All children have a basis of eligibility for MA through the month of their 21st birthday. See the following sections for specific eligibility guidelines for children who are:
l Ages 0-1, whose mothers were MA- or MinnesotaCare-eligible for the month of birth (auto newborns).
l In foster care placement.
l Receiving adoption assistance.
Eligibility factors are listed below with any information that is unique for this group. Links to standard program guidelines are included as well.
Citizenship/Immigration Status.
Insurance and Benefit Recovery.
Relationship to Other Groups/Bases.
Other Groups/Bases to Consider.
Application Process (standard guidelines)
Children under 18 who do not live with a parent, relative caretaker, foster parent, or legal guardian may apply on their own behalf. This includes minor caretakers and minors without children.
Children who are applying only for MA may apply at outstation locations other than the county agency, such as some hospitals and clinics.
Follow standard MA guidelines.
Renewals (standard guidelines)
Follow standard MA guidelines.
Do not require verification of age.
Social Security Number (standard guidelines)
Follow standard MA guidelines.
Children who are noncitizens with an undocumented or non-immigrant status are not otherwise eligible for MA, but may be eligible for Emergency Medical Assistance (EMA). Other children who are noncitizens but cannot get federally funded MA due to their immigration status may be eligible for state-funded MA (program NMED).
Residency (standard guidelines)
Follow standard MA guidelines.
When new MA coverage is requested for a child (including infants under age two), ask the parent or caretaker about health insurance that may be available to the child and pursue cost-effective insurance premium payments if appropriate.
l If you are unable to reach a parent or caretaker by phone, mail the Minnesota Health Care Programs Health Insurance Information form (DHS-1922B) with a cover letter (DHS-4599).
l Record all pertinent information in case notes.
Note: Do not take an adverse action against a child if the parent or caretaker fails to cooperate.
Household Composition (standard guidelines)
If a child does not live with a biological or adoptive parent:
l Use a household size of one, even if the child lives with siblings.
l Do not count non-parent relative caretakers, including stepparents, in the child's household size.
Do not include parents or their other children in the child's household size if the child is emancipated. This includes children who meet any of the following:
l Are or have been married.
l Are on active duty in the armed services.
l Have been declared emancipated by a court.
Use Method A for income.
Asset Guidelines (standard guidelines)
There is no asset limit for children under age 21.
l Ages 0 to 2: 280% FPG.
l Ages 2 through 18: 150% FPG.
l Ages 19 and 20: 100% FPG.
MA for children ages 0 to 2 with income at or below 275% FPG is funded with MA federal financial participation (FFP). MA for children ages 0 to 2 with income above 275% and at or below 280% FPG is funded by SCHIP if the child has no other health coverage. If the child has other health coverage, MA is paid with state-only funds.
DHS sorts the expenditures for children ages 0 to 2 into the correct funding sources based on their income level and the presence or absence of other health coverage. No action or special coding is required by workers.
l Ages 0 to 2: Work expense deduction for pregnant women and infants.
l Ages 2 through 18:
l Ages 19 and 20:
n 17% earned income disregard.
Spenddowns (standard guidelines)
Children ages 0-20 with excess income may be eligible by spending down to 100% FPG. Redetermine net income for children ages 0-18 using the:
l 17% earned income disregard.
Children under 21 do not have co-payments or dental limits.
Managed care unless otherwise excluded.
If a child under 18 does not live with a parent the child's parents may be liable for medical support or parental fees.
If children in any of the age groups are receiving inpatient hospital services on their second, 18th, or 21st birthday, continue MA until the end of the hospitalization if they meet all other eligibility criteria.
Children under 21 who are blind or disabled may be able to choose which basis of eligibility to use.
Exception: Children who are eligible under the TEFRA option, or who receive services through the CAC, CADI, DD, or TBI waiver programs must use a blind or disabled basis of eligibility.
See Multiple Bases of Eligibility.
Determine MA eligibility in place of automatic GAMC for General Assistance (GA) recipients who are ages 18-20.
Also consider MinnesotaCare for Children Under 21.
Workers who have contact with families during the application process are encouraged to inform families that the Child and Teen Checkups Program (C&TC) is an MA benefit, and that the county C&TC agency will contact them with more information.