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Effective: May 1, 2012 |
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07.20.25ar6 - Eligibility Begin Date (Archive) |
Archived: November 1, 2012 |
The date eligibility begins depends on several factors, including:
l The date of application.
l Premium payment (if applicable).
l Whether or not retroactive coverage is requested or available.
l The date all eligibility factors have been met.
See MHCP and Incarcerated Individuals for information on the begin date for a client who applies for health care before being released from incarceration.
Eligibility Begin Date - MinnesotaCare (MCRE).
Eligibility Begin Date - Medical Assistance (MA).
Eligibility Begin Date - MA for Breast and Cervical Cancer (MA-BC).
Eligibility Begin Date - MA for Employed Persons With Disabilities (MA-EPD).
In most cases, people cannot be open on more than one health care program in the same month. See Programs Overlap for more information on exceptions to this policy.
If people are open on another program and request a new program:
l Ensure that the applicant understands they cannot remain open on both programs and that their coverage may change.
l The begin date of the new program must be coordinated with the closing date of the first program.
Eligibility Begin Date - MinnesotaCare
For MinnesotaCare, the eligibility begin date is the first day of the month following the month in which the agency receives the initial premium payment.
Note: The payment must be received by noon on the last working day of the month for eligibility to begin the following month.
Coverage begins the day after the person is discharged from the hospital for people who are hospitalized on the date coverage would otherwise begin.
Clients added to a MinnesotaCare household may have different begin dates depending on the situation. See Adding a Household Member.
Clients moving from MA to MinnesotaCare may be eligible for retroactive MinnesotaCare. See Retroactive MinnesotaCare.
For MA, the eligibility begin date is different for the following coverage requests:
1. Retroactive eligibility requested.
The earliest possible begin date is the first day of the month three months before the month of application.
n People must meet all of the eligibility factors, including having an MA basis of eligibility and state residency, in each of the retroactive months.
n Determine eligibility for each month in the retroactive period for which people request coverage.
n People may be eligible for some but not all months in the retroactive period.
Example:
Georgia, age 23, applies for MA on March 25. She is pregnant and does not have a disability. Her estimated date of conception is February 15. Her income exceeds 200% FPG but is under 275% FPG. She is requesting retroactive coverage to December.
Action:
Approve retroactive coverage beginning February. Georgia cannot have retroactive coverage for December or January because her only MA basis of eligibility in those months is an adult without children and her income exceeds 75% FPG. February is the earliest month she qualifies for MA with a pregnant woman basis of eligibility and income within 275% FPG..
n If any household members have pending, but not active, MCRE spans during the retroactive months, they may be eligible for MA for those months. Notify the MCRE representative when approving MA.
2. Retroactive eligibility not requested.
n The begin date of eligibility is either the first day of the month of application or the date on which all eligibility factors are met, whichever is later.
Example:
Abe applies for health care on June 20. He does not meet all eligibility factors until July 21, the second month of the processing period.
Action:
Approve MA for Abe effective July 1.
n People do not have to be eligible in the month of application. Eligibility may begin at a later date if the applicant meets all eligibility factors by the end of the processing period.
Example:
Elmer applies for MA on November 25. He will be 65 on December 10. His income exceeds 75% FPG but is less than 100% FPG. He has countable assets of $2,500. He is requesting MA effective December 1.
Action:
Approve eligibility effective December 1 if Elmer meets all eligibility factors. He meets an adults without children MA basis for November, but is not eligible because his income exceeds 75% FPG. Elmer is eligible in December because he meets an age 65 or older MA basis and has income under 100% FPG.
n Eligibility can also begin mid-month when applicants meet certain exceptions.
A person who moves to Minnesota from another state after the first day of the month does not establish residence until the date the person is physically present in the state with the intent to make Minnesota his or her home. See State Residence for MA and MinnesotaCare.
Example:
Mavis moves to Minnesota from Kansas on May 10. On May 20 Mavis applies for MA.
Action:
Approve Mavis for MA in Minnesota on May 10 if she meets all other eligibility factors.
n Process a person’s application up to approval prior to his or her move to Minnesota if the person is elderly or disabled and cannot live outside of an institution, such as a Long-Term Care Facility (LTCF) or an ICF/DD. Contact the institution to notify them that the person will be eligible for MA the day of admission to the institution. Approve eligibility when the institution notifies the county that the client was admitted.
Example:
Noah, who is severely developmentally disabled, lives in an ICF/DD in Ohio. Noah’s sister lives in Minnesota and has filed an MA application in County A where there is an ICF/DD close to her home. Noah cannot live outside of the ICF/DD.
Action:
Process Noah’s application up to approval prior to his move to Minnesota and notify the institution that he is eligible for MA upon admission. Approve MA on the day the institution confirms that Noah moved to the ICF/DD.
Eligibility Begin Date - MA-BC
The earliest date of eligibility for Medical Assistance for Breast and Cervical Cancer (MA-BC) is the later of either:
l Three months before the date of application; or
l The first day of the month in which the woman was screened under the Sage Screening Program.
Note: Women who are granted presumptive eligibility for MA-BC must be found eligible for ongoing MA-BC before retroactive eligibility is granted.
Eligibility Begin Date - MA-EPD
For Medical Assistance for Employed Persons with Disabilities (MA-EPD) follow Eligibility Begin Date - MA to determine the possible eligibility begin date.
l Do not approve eligibility for people until the premium is paid.
l Applicants requesting retroactive coverage must pay the premium for each retroactive month before coverage can be approved for that month. See MA-EPD Premiums.