*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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: May 1, 2012 |
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03.50 - Medical Assistance (MA) for Adults Without Children |
Archived: June 1, 2016 (Previous Versions) |
Effective March 1, 2011, adults without children have a basis for MA eligibility if they:
l are at least 21 years old and under age 65;
l have no other basis of MA eligibility;
l are not eligible for or enrolled in Medicare Part A or Part B;
l are not a "parent" as defined by the MinnesotaCare program (i.e., not residing with their children under age 21 who are biological, adoptive, or stepchildren). See MinnesotaCare for Adults with Children.
Eligibility factors and links to standard program guidelines are provided below.
Citizenship/Immigration Status.
Insurance and Benefit Recovery.
Relationship to Other Groups/Bases.
Application Process (standard guidelines)
Follow standard MA guidelines.
Eligibility for MA for adults without children is not available prior to March 1, 2011. For applications filed in April 2011 and thereafter, people may qualify for retroactive eligibility for up three months prior to the month of application. However, retroactive eligibility is not available under this basis of eligibility prior to March 1, 2011. Follow standard MA guidelines to determine the eligibility begin date for applicants who do not request retroactive coverage.
Follow standard MA guidelines.
Do not require verification of assets. Follow all other standard MA guidelines.
Follow standard MA guidelines.
Citizenship/Immigration Status (standard guidelines)
Follow standard MA guidelines.
State-funded MA is available under this basis of eligibility for nonqualified but lawfully present noncitizens. See Funding Health Care for Noncitizens for more information.
Emergency Medical Assistance is available for noncitizens who are not eligible for ongoing federally funded MA and who have an emergency medical condition. See Emergency Medical Assistance (EMA) for more information.
Follow standard MA guidelines.
Follow standard MA guidelines.
Use a household size of one or, for people who are married and living with a spouse, a household size of two.
Eligibility Method (standard guidelines)
Use Method A to determine sources of countable income.
Note: People who exceed the 75% FPG six-month income standard for MA for adults without children but are at or below the 75% FPG annual income standard for MinnesotaCare for adults without children are not eligible for MA for adults without children but are eligible for MinnesotaCare.
There is no asset limit for this basis of eligibility.
The income limit is 75% FPG. A person must have income equal to or less than 75% FPG for the six-month eligibility period. There is no monthly income eligibility under this basis of eligibility.
Deductions/Disregards (standard guidelines)
No income deductions or disregards are allowed under this basis of eligibility.
Generally, medical spenddowns are not allowed under this basis of eligibility. MA for adults without children applicants and enrollees who reside in a long-term care (LTC) facility and are subject to an LTC income calculation may have an LTC spenddown obligation. For more information, see LTC Spenddowns and Waiver Obligations.
People qualifying under this basis of eligibility are eligible for all MA covered services.
MA payment for long-term care (LTC) services is available for people who qualify for MA as adults without children and who are otherwise eligible for payment of LTC services. See MA Payment of Long-Term Care Services.
Note: People who qualify for MA as adults without children cannot receive services through the home and community-based waiver programs (Community Alternative Care (CAC), Community Alternatives for Disabled Individuals (CADI), Developmental Disabilities (DD), Elderly Waiver (EW) and Brain Injury (BI)). People must meet a disability basis of eligibility to qualify to receive services through a disability waiver program (CAC, CADI, DD, and BI) or an elderly basis of eligibility to qualify for EW.
To be eligible for MA payment of LTC services as an adult without children, a person must:
l reside in an LTCF;
l meet all MA eligibility requirements for this basis, including income at or below 75% FPG for the six-month budget period;
l require an institutional level of care;
l have equity in a home equal to or less than the home equity limit; and
l name DHS as a preferred remainder beneficiary of certain annuities owned by the person or the person’s spouse.
People with an adult without children basis of eligibility who meet the above requirements are subject to an LTC income calculation.
People who have a community spouse are not required to complete an asset assessment because there is no asset limit for this basis of eligibility. However, the county must complete an asset assessment if requested by the person or the person’s spouse. The asset assessment may be required if the person becomes eligible for MA under another basis that has an asset limit.
Asset transfers are not evaluated when a person qualifies for MA under this basis of eligibility because there is no asset limit.
See Long-Term Care (LTC) Home Equity Limit, Naming DHS a Preferred Remainder Beneficiary, and MA Payment of Long-Term Care Services for more information.
People qualifying under this basis of eligibility are required to enroll in a managed health care plan to receive services unless they meet an exclusion from enrollment. See the Prepaid Minnesota Health Care Programs Manual Section 2.04.01 - PMAP Excluded Populations for a list of excluded populations.
Services for non-excluded people are provided on a fee-for-service basis until the person is enrolled in a managed care plan.
Follow standard MA guidelines. See Change in Basis of Eligibility and Changes in Circumstances.
l General Assistance (GA) and Group Residential Housing (GRH).
People who receive GA or GRH cash benefits may qualify for MA for adults without children. There is no automatic eligibility under MA for adults without children for GA or GRH recipients. Determine eligibility for MA separately from eligibility for GA and GRH.
l MinnesotaCare.
n MinnesotaCare for adults without children is not available to people who are eligible for MA for adults without children.
n Adults without children who apply for or are enrolled in MinnesotaCare must apply for MA if it appears they would qualify for MA for adults without children.
Exception: Married fathers who are expecting a child are eligible for MinnesotaCare and are not eligible for MA for adults without children.
n Children enrolled in MinnesotaCare who turn age 21 must be screened for MA for adults without children. Refer them to MA if they appear to qualify.
n People may enroll in MinnesotaCare and may remain enrolled in MinnesotaCare if they are or would be ineligible for MA for adults without children for reasons including, but not limited to:
m Income above 75% FPG;
Note: The income calculation and eligibility periods for MA and MinnesotaCare are different. In some cases, a person may have income for the six-month eligibility period above 75% FPG for MA, but also have annual income at or below 75% FPG for MinnesotaCare. In this circumstance, the person may enroll or remain enrolled in MinnesotaCare.
m Incarceration;
A MinnesotaCare enrollee who becomes incarcerated and resides in a correctional facility may remain enrolled in MinnesotaCare until the next renewal. Do not require MinnesotaCare enrollees who are incarcerated to apply for an MA determination, even if income has decreased below 75% FPG. For more information, see Correctional Facilities.
m New household members;
MinnesotaCare households may choose to add a new member when the person moves into the household or at the next renewal. A MinnesotaCare enrollee is not required to apply for MA if that enrollee will be ineligible for MA due to the additional household member.
m Other changes in circumstances;
MinnesotaCare enrollees who have a change in their circumstances and become potentially eligible for MA for adults without children may remain on MinnesotaCare for up to 60 days while they apply and their eligibility for MA is determined. MinnesotaCare enrollees who have submitted an application within 45 days prior to requesting MA are not required to submit a new application. See Application Not Required for more information.
l Other MA Bases of Eligibility.
n People who have another MA basis of eligibility do not have a basis of eligibility for adults without children. This includes people who:
m Have another MA basis of eligibility, but are ineligible due to having assets over the limit for that basis; or
m Fail to cooperate with providing verification for another basis of MA eligibility.
n People under age 65 who indicate they are blind or have a disability must be referred to SMRT for a disability determination and to SSA to apply for disability benefits. Require an applicant or enrollee being referred to SMRT to sign an Authorization to Disclose Information for Disability Determination (DHS-6124) before approving or renewing eligibility for MA for adults without children. Follow current policies to complete the referral to SMRT.
If the applicant or enrollee meets the eligibility criteria for MA for adults without children and has submitted a signed DHS-6124, approve or renew MA for adults without children while awaiting the results of the SMRT disability determination. People who do not cooperate with the SMRT disability determination process or with referrals to the SSA are not eligible for MA for adults without children.
People who reapply for MA for adults without children after being denied or cancelled for failure to cooperate with the SMRT or SSA, must agree to cooperate before they can be approved for MA. Contact an applicant who is reapplying for MA as an adult without children to confirm that he or she will cooperate with the SMRT or SSA disability determination before approving new eligibility if the applicant was previously denied or cancelled from MA from adults without children due to failure to cooperate with a disability determination. Accept the applicant's verbal or written statement regarding cooperating with the process. If an applicant provides the agreement to cooperate verbally, document that in case notes. Approve eligibility for MA for adults without children while the results of the SMRT or SSA disability determinations are pending as long as the person continues to meet all eligibility criteria.
l Refugee Medical Assistance.
People who are currently eligible for Refugee Medical Assistance (RMA) may be eligible for MA under this basis of eligibility effective March 1, 2011, if they meet all eligibility criteria.