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Effective: December 1, 2006 |
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06.05ar1 - Cooperation (Archive) |
Archived: March 1, 2008 |
A key client responsibility is to cooperate in meeting certain eligibility requirements of each program. An overview of a few specific cooperation requirements are highlighted in this manual section.
For more detailed information on these topics, please see the topic’s manual chapter listed in Related Topics.
Quality Control and Quality Assurance Cooperation Responsibilities.
Medical Support Cooperation Responsibilities.
Premium Payment Cooperation Responsibilities.
Other Health Care Coverage Cooperation Responsibilities.
Quality Control is a performance evaluation and reporting system established by Congress to review federal assistance programs including MA.
Quality Assurance is a performance evaluation system established by the Minnesota Legislature to review the accuracy of MinnesotaCare (MCRE) determinations.
Medical Support is cash payments or health insurance coverage that a non-custodial parent provides or is court-ordered to provide to meet the medical needs of the non-custodial parent’s children.
Quality Control/Quality Assurance Cooperation Responsibilities
Clients must cooperate with a Quality Control (QC) and Quality Assurance (QA) review.
l Clients that fail to cooperate will be closed from programs for which they did not cooperate.
l Clients can become eligible to reapply by cooperating with QC before the end of the ineligibility period.
l GAMC does not have QC or QA reviews.
l Clients who are terminated from MA or federally funded MCRE for failure to cooperate with a QC review are also ineligible for GAMC.
Medical Support Cooperation Responsibilities
Caretakers of children who are requesting or receiving MCRE or MA must cooperate with medical support requirements. They must work with the county child support enforcement office, known as IV-D, to:
l Obtain medical support.
l Enforce of an existing order.
l Establish paternity.
Examples of cooperation include:
l Providing information about non-custodial parents.
l Establishing paternity of eligible dependent children.
l Forwarding any medical support payments received directly from the non-custodial parent to DHS.
By signing the application clients assign their rights to medical support and those of their legal dependents.
Caretakers who do not cooperate, which is determined by the county child support enforcement office, in obtaining medical support or in establishing paternity are not eligible for Minnesota Health Care Program coverage.
Note: Eligibility for the caretaker's children and the caretaker’s spouse are not affected by the caretaker’s actions.
Premium Payment Responsibilities
There are two programs under the Minnesota Health Care Program (MHCP) umbrella that require a premium payment to establish and maintain eligibility. They are:
l MinnesotaCare.
l Medical Assistance for Employed Persons with Disabilities (MA-EPD).
Other Health Care Coverage Cooperation Responsibilities
Cooperation in providing information about other health care coverage differs between programs.
l MCRE: Availability of other health care coverage may affect people's eligibility for MinnesotaCare.
l MA and GAMC: MA and GAMC clients must cooperate with cost-effective insurance requirements. Availability of other health care coverage does not affect eligibility for these programs.
General other health insurance cooperation requirements:
l People who have other health coverage must assign their rights to coverage to DHS as a condition of eligibility by signing the HCAPP or CAF.
l Adults who refuse to assign their rights or the rights of other household members for whom they are legally able to assign rights are not eligible for MA or GAMC.
Note: Children whose parents refuse to assign their rights to insurance or other third party liability are not sanctioned.
l Applicants and enrollees must provide information on other health insurance which is or may be available to them or their dependents, regardless of whether the applicant or enrollee is the policy holder.
l People must cooperate with the MCRE or county agency and the state Benefit Recovery Section (BRS) in identifying potential sources of other health coverage.
For more specific information, see the following sections: