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Effective: May 1, 2007 |
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17.10.15ar2 - All or Nothing Rule (Archive) |
Archived: October 1, 2009 |
Unlike the MA and GAMC programs, which allow people to choose which eligible household members want coverage, MinnesotaCare (MCRE) requires certain eligible family members to apply and/or enroll. This provision is known as the ”All or Nothing Rule.”
The All or Nothing Rule ensures that all household members have equal access to coverage. It is also a way to prevent families from choosing to insure one child and not another or from insuring only the household member with the greatest insurance need.
Other Health Insurance and the All or Nothing Rule.
When Not to Apply the All or Nothing Rule.
The All or Nothing Rule requires that:
l All eligible children in a household who do not have other health insurance must enroll if one child enrolls.
l All eligible spouses or parents in a household who do not have other health insurance must enroll if one spouse or parent enrolls.
l Parents may enroll only if the eligible children in the household who do not have other health insurance enroll.
n Parents may choose not to enroll.
n Eligible children may enroll regardless of whether the parents enroll.
Note: If a child who is required to provide or apply for a Social Security number (SSN) fails to do so, he or she is still considered an eligible child, and until the SSN is obtained, all children and all adults are ineligible.
Example:
Bob, Mary and their two children, Sam (age 10) and Anna (age 3) apply for MinnesotaCare. They do not have any other health insurance. The HCAPP lists Social Security numbers for everyone but Anna.
Action:
Bob, Mary and Sam meet all of the eligibility requirements; Anna does not meet the SSN requirement.
Do not approve coverage for Bob, Mary and Sam until a SSN is either applied for or obtained for Anna.
Note: If an adult who is required to provide or apply for a SSN fails to do so, he or she is still considered an eligible adult, and until the SSN is obtained, all adults are ineligible.
Example:
Troy, Denesha and their two children, ages 15 and 13, apply for MCRE. They do not have any other health insurance. The HCAPP lists Social Security numbers for everyone but Denesha.
Action:
Do not approve coverage for Denesha or Troy until Denesha supplies her SSN.
Coverage for the children can be approved because parents are not required to enroll with their children.
Other Health Insurance and the All or Nothing Rule
Do not require people who have other third party liability to enroll in MCRE based on the All or Nothing Rule.
Example:
Bud and Mabel, a married couple with no children in the home, apply for MCRE. They are both U.S. citizens and permanent Minnesota residents. Bud is disabled and covered by Medicare Parts A and B. Mabel has no health care coverage.
Action:
The All or Nothing Rule would require Bud to apply for MCRE if Mabel is determined eligible. However, Bud cannot enroll because he has Medicare, which is considered other health insurance. Mabel can enroll on her own, with a household size of two, and counting both her and Bud’s income and assets.
Example:
Judy and Greg apply for MCRE for their two children. Judy and Greg each have health insurance through work. Neither employer offers dependent coverage. The children have no insurance.
Action:
Both children must enroll if they meet all other eligibility requirements. The children will have a household size of four, which includes Judy and Greg and the children themselves.
Example:
Alice applies for MinnesotaCare for her son, Troy, who requires regular care for chronic ear infections. She does not want coverage for herself or her daughter, Mavis, because they have no ongoing medical needs and Alice feels she can’t afford the premium for three people. All three household members meet MCRE eligibility requirements. No one in the household has other health care coverage available.
Action:
Due to the All or Nothing Rule, Mavis is required to enroll because Troy, her brother, is eligible to enroll. Alice is not required to enroll. Troy and Mavis have a household size of three, which includes themselves and their mother.
Example:
Abe and Mary apply for MCRE for themselves and their two children, Kevin and Kyle. Mary is pregnant and covered by MA. Kevin is also on MA. Abe and Kyle are not covered on MA or GAMC because of excess income. They have no other coverage available. Mary and Kevin want to stay on MA.
Action:
Mary and Kevin are not required to enroll in MCRE because they have other coverage through the MA program.
Because Kevin has other health coverage, Kyle can enroll separately from him.
Abe is not required to enroll but may enroll separately from Mary as long as Kyle enrolls.
The household size is four.
When Not to Apply the All or Nothing Rule
Do not apply the All or Nothing Rule to people when a non-insurance eligibility factor is not met by a person that would otherwise be required to enroll based on the all or nothing rule criteria.
Ineligibility of household members due to these eligibility factors does not affect the eligibility of other members who meet eligibility requirements. These factors include but are not limited to:
l Cooperating with obtaining medical support.
n Caretakers who fail to cooperate without good cause are ineligible for MCRE.
n Do not limit eligibility for the spouse and children because the caretaker is ineligible due to cooperation with medical support.
l Cooperating with applying for MA.
n Certain people with disabilities are required to apply for MA. If they fail to do so they become ineligible for MCRE. See Disabled Adults Without Children.
n Do not limit the spouse’s eligibility because his/her spouse did not comply with the disability determination.
l Meeting citizenship and immigration requirements.
n Noncitizens who do not have a status that qualifies for MCRE are ineligible.
n If noncitizen household members have a qualifying status, do not limit their eligibility because another noncitizen household member does not have a qualifying status. See Health Care for Noncitizens.
n For U.S. citizens, apply the requirement to document citizenship and identity as follows:
m All children and all adults in the household are ineligible if a child who is required to provide documentation of citizenship and identity fails to do so.
m All adults are ineligible if an adult who is required to provide documentation of citizenship and identity fails to do so.
m See Cooperation with Documentation Requirements before denying or closing eligibility based on the All or Nothing Rule.