|
Effective: August 1, 2008 |
|
|
03.50.05.05ar3 - General Assistance Medical Care (GAMC) Qualifiers (Archive) |
Archived: February 1, 2011 |
To be eligible for GAMC, an applicant or enrollee must have a GAMC qualifier. People who meet all other GAMC eligibility requirements but do not have a GAMC qualifier may be eligible for Transitional MinnesotaCare instead of GAMC if they are adults without children.
Note: This requirement applies only to GAMC with full benefits. Clients who qualify for GAMC Hospital Only (GHO) do not need a GAMC qualifier.
Apply the GAMC qualifier requirement when processing GAMC eligibility at application, six-month renewal, and annual renewal.
l Approve GAMC for people who meet all eligibility criteria and have one or more GAMC qualifiers.
l Do not approve GAMC for:
n People who meet all eligibility criteria but do not have a GAMC qualifier.
n People who do not meet GAMC eligibility criteria, such as income or asset requirements (regardless of whether they have a GAMC qualifier).
Redetermine eligibility for other health care programs for these groups. Adults without children who meet all other GAMC eligibility requirements but do not have a GAMC qualifier may be eligible for Transitional MinnesotaCare.
Definition of "Homeless" for GAMC.
Verification of GAMC Qualifiers.
GAMC applicants or enrollees must have at least one of the following GAMC qualifiers:
l Receive General Assistance (GA).
l Have a payment made under Group Residential Housing (GRH).
l Have applied for and be awaiting a determination of eligibility from the Social Security Administration (SSA) for Supplemental Security Income (SSI) or Retirement, Survivors, or Disability Insurance (RSDI) income based on disability.
l Be appealing a determination of disability from SSA.
l Have applied for and be awaiting a determination of blindness or disability by the State Medical Review Team (SMRT).
l Be entitled to Medicare due to end-stage renal disease.
l Be currently enrolled in other private health insurance.
l Be incarcerated and meet criteria for continued GAMC as an incarcerated person.
l Receive treatment through the Consolidated Chemical Dependency Treatment Fund (CCDTF).
l Reside in the Minnesota Sex Offender Program (MSOP).
l Be homeless.
l Have lived in Minnesota for less than 180 days.
Definition of "Homeless" for GAMC
For GAMC, the term "homeless" is defined as lacking a fixed, regular, and adequate residence, or, having a primary residence that is any of the following:
l A public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for human beings.
l A supervised publicly or privately operated shelter designed to provide temporary living accommodations. This includes any of the following:
n Hotels or motels.
n Group or congregate shelters.
n Temporary housing for the mentally ill.
l An institution that provides temporary residence for people intending to move to a more permanent living arrangement.
People who meet the definition of homeless have a GAMC qualifier. They are eligible for GAMC if they meet all other eligibility requirements.
Example:
Adrian applies for health care at the county agency. He has been camping in a local park for the past two months. He does not have a basis of eligibility for MA.
Action:
Consider Adrian to have a GAMC qualifier because he meets the definition of homeless. Adrian must meet all other GAMC requirements to be eligible for the program.
GAMC applicants who are going to have at least one qualifier are eligible for GAMC. This means they must meet any of the following:
l Will have a qualifier in 30 days.
l Are currently working through a process to gain a qualifier.
l Will be required to pursue a qualifier as a result of the application process.
Note: The provisions for potential GAMC qualifiers apply only to GAMC applicants, not enrollees.
Examples of applicants with potential GAMC qualifiers include those who:
l Have applied and have eligibility pending for GA or GRH.
l Have end-stage renal disease and have applied for Medicare.
l Will be referred to SSA or SMRT due to potential disability as part of the application process.
l Will be pursuing cost effective insurance based on the application.
l Have private health insurance beginning within 30 days.
l Are required to report for incarceration within 30 days.
l Will have a Rule 25 chemical use assessment within the next 30 days.
l Will start treatment within the next 30 days through the CCDTF.
Follow up with applicants to ensure they are complying or pursuing the program or referral for their potential GAMC qualifier within the required time period for that program or referral. If they fail to obtain the qualifier after they are enrolled, close GAMC eligibility with 10-day notice. Redetermine eligibility for other health care programs, including Transitional MinnesotaCare.
Example:
Hannah (age 28) applies for health care. She does not have an MA basis of eligibility. Hannah indicates on her application that she is disabled and recently left her job due to her condition. The worker will be referring Hannah to both SMRT and SSA for a disability determination. Hannah does not have a GAMC qualifier, but does have a potential qualifier.
Action:
Approve GAMC based on Hannah's potential qualifier. If she fails to provide information for the SMRT determination or to apply for SSA benefits within the referral time period, close GAMC eligibility with 10-day notice. Redetermine eligibility for other health care programs.
GAMC eligibility due to a potential GAMC qualifier applies only to applicants. Do not approve GAMC for people who are already enrolled in a MHCP unless they actually have a GAMC qualifier.
Verification of GAMC Qualifiers
Require verification of GAMC qualifiers that cannot be verified internally through county systems or processes. Do not require the client to provide proof of the following:
l Receipt of General Assistance (GA).
l Receipt of GRH payments.
l A pending SMRT determination.
l Medicare.
l Incarceration.
l Treatment through the CCDTF.
l Residence in MSOP.
l Homelessness.
l Residence in Minnesota for less than 180 days.
Require verification for applicants who state they are pursuing or will have a GAMC qualifier if it cannot be verified internally through county computer systems or processes. Require verification of:
l Current other private health insurance.
l Application for SSI or RSDI disability benefits if the applicant has been referred to SSA previously and failed to follow through with the process.
l Any claim to a GAMC qualifier that meets either of the following:
n Conflicts with information previously provided by the applicant or enrollee.
n Cannot be otherwise verified internally through county computer systems or processes.
GAMC enrollees are no longer eligible for GAMC if they meet either of the following:
l Lose their GAMC qualifier before the end of the six-month certification period.
l Do not have a GAMC qualifier at the time of their next six-month or annual renewal.
To remain eligible for GAMC, enrollees must have a GAMC qualifier and continue to meet all other GAMC eligibility criteria.
Example:
Sonny receives GA and is enrolled in GAMC. In the third month of the certification period, Sonny reports a change that makes him ineligible for GA. Sonny continues to meet all other GAMC eligibility criteria, but he no longer has a GAMC qualifier.
Action:
Close Sonny’s GAMC eligibility with 10-day notice. Redetermine eligibility for other health care programs, including Transitional MinnesotaCare.
Example:
Javier moves to Minnesota on September 15. He applies for health care coverage on September 20. He meets all GAMC eligibility criteria except for residency. However, since he has lived in Minnesota for less than 180 days, he does have a GAMC qualifier. Once he meets the 30-day GAMC residency requirement, he will be eligible for GAMC.
Action:
Approve GAMC eligibility for Javier on October 15 when he meets the GAMC residency requirement. His six-month certification period is October through March.
Javier submits his six month renewal on March 20. He still meets all GAMC eligibility criteria. He has now lived in Minnesota for 180 days, and does not have another GAMC qualifier.
Action:
Approve Transitional MinnesotaCare eligibility for Javier for April through September.
Enrollees who move from GAMC to Transitional MinnesotaCare in the middle of a six-month certification period have Transitional MinnesotaCare eligibility for the remainder of the certification period unless they regain a GAMC qualifier.
When Transitional MinnesotaCare enrollees who meet all other GAMC eligibility criteria obtain a GAMC qualifier:
l Approve GAMC effective the first day of the month in which they have or report the qualifier, whichever is later.
l Close Transitional MinnesotaCare with adequate notice. 10-day notice is not required since GAMC provides more benefits than Transitional MinnesotaCare.
Example:
Carey is enrolled in Transitional MinnesotaCare. He reports a decrease in income and applies for General Assistance (GA). His GA is approved for October 1. Carey now has a GAMC qualifier and meets automatic GAMC eligibility criteria as a GA recipient.
Action:
Approve GAMC for Carey effective October 1 (when his GA eligibility begins). Close his Transitional MinnesotaCare effective September 30.
For further information, see