*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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: December 1, 2011 |
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03.45.35.05 - Application Process for MFPP |
Archived: June 1, 2016 (Previous Versions) |
People apply for the Minnesota Family Planning Program (MFPP) by:
l Submitting an MFPP application (DHS-4740) to the DHS Family Planning Unit. They can get applications by:
n Calling the DHS Family Planning Unit at (651) 431-3480 (metro) or (888) 702-9968 (outside metro area).
n Downloading an application from the DHS web site.
Note: Do not require the DHS-4740 if an applicant submits an application form designed for a different population, such as the HCAPP. Contact the applicant to gather any missing information.
l Applying with certified MFPP providers who can determine and grant presumptive eligibility for MFPP.
Application Requirements for Ongoing Eligibility.
Presumptive Eligibility Determinations.
Approval or Denial of Presumptive Eligibility.
Application Requirements for Ongoing Eligibility
Require an application when:
l People apply for the MFPP for the first time.
l People whose previous application for the MFPP was denied reapply more than 45 days after the date of the previous application.
l Former MFPP enrollees reapply on or after the effective date of MFPP closure.
Require a separate application for each person requesting the MFPP.
l Process applications within 45 days from the date of receipt.
l Require applicants to sign the application by the end of the application processing period.
n Do not require the signature of a parent or guardian for applicants under age 18.
n Do not approve eligibility without a signature.
Certified MFPP providers can determine and grant presumptive eligibility for the MFPP at the point of service. People determined presumptively eligible have temporary coverage while DHS is making the eligibility determination for ongoing coverage.
Presumptive eligibility begins the first day of the month of approval and ends the last day of the next month. It is limited to once every 12 months.
To become certified, providers must:
l Complete the Certified MFPP Provider Application (DHS-4773) and submit the application, notification and agreement to DHS.
Note: DHS staff will process the application within two weeks of receipt.
l Ensure that provider staff making the presumptive eligibility determinations have taken MFPP provider training. The MFPP Provider Training Guide is available on the DHS web site.
People can look up certified MFPP providers by county or zip code at http://mhcpproviderdirectory.dhs.state.mn.us/.
Presumptive Eligibility Determinations
To determine presumptive eligibility, the provider must:
l Check EVS/MN-ITS for current MHCP eligibility and receipt of presumptive eligibility in the past 12 months.
l Provide the MFPP application, brochure and fact sheet to people who are not currently on MHCP.
l Provide the form Giving Permission for Someone to Act on My Behalf (DHS-3437A) to applicants who want an authorized representative.
l Assist people with completing the application if needed.
l Review the application to determine if the applicant has signed the application and meets the following MFPP eligibility requirements:
n Age.
n Not pregnant.
n Minnesota residency.
n Gross monthly income. If income reported on the application is under 200% FPG for the household size, the applicant meets this requirement. Providers do not determine whether a particular income source can be excluded.
Note: Providers do not review the applicant’s citizenship or immigration status or require verification of any eligibility factors. However, they may accept any verification the applicant offers and send it to the DHS MFPP unit with the application.
Approval or Denial of Presumptive Eligibility
When certified MFPP providers approve eligibility for applicants who meet MFPP eligibility requirements, the providers will:
1. Complete the MFPP Short-Term Approval Notice (DHS-4739A) and give it to the applicant along with:
l Pages A-B from the MFPP application.
l The Primary Care Resources form (DHS-4741). This form contains the locations of providers who provide primary care to people who do not have insurance.
Tell the applicant that the Short-Term Approval Notice serves as proof of eligibility during the presumptive eligibility period.
2. Complete the ”Provider Use Only” boxes on page one of the application and fax page one to the DHS Family Planning Unit at (651) 431-7532 or (800) 204-0639 by the end of the business day.
3. Mail the entire MFPP application, along with any verifications the applicant provided and the DHS-3437A if applicable, to the DHS Family Planning Unit within five working days.
When certified MFPP providers deny eligibility for applicants who do not meet MFPP eligibility requirements, the providers will:
1. Complete the MFPP Short-Term Denial Notice (DHS-4739B) and give it to the applicant along with pages A-B from the MFPP application.
2. Mail the MFPP application, along with any verifications the applicant provided and the DHS-3437A if applicable, to the DHS Family Planning Unit within five working days.
Note: Applicants may not appeal a denial of presumptive eligibility.
Certified MFPP providers must ensure applicants’ data privacy rights.
Detailed instructions for certified MFPP providers and most forms for presumptive eligibility determinations are available at www.dhs.state.mn.us/provider/mfpp. The Short Term Approval and Short Term Denial notices (DHS-4739A and 4739B) are available to providers through MN-ITS, the DHS billing system for MHCP providers.