17.20 Adding a Household Member

*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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. ***

Adding a Household Member

The process and timeline for adding someone to a household depends on the health care program.

When a new person moves into the household, add the new household member when the change is reported.

Marge reports that her boyfriend, Fred, moved in with her and her daughter Crystal. Fred is Crystal's father. He does not want coverage for himself.

Because of Fred’s parental relationship to Crystal, he must be added to the household when Marge reports the change.

Note: Due to the All or Nothing Rule, when Fred is added to the case, he must enroll in MinnesotaCare if he is eligible and does not have other health care coverage. Cancel Marge's coverage if he is otherwise eligible and refuses coverage.

Julie, age 16, lives with her parents. She reports that she got married on June 10. A few months later her new husband, Brad, moved in with her and her parents.

Julie became an emancipated minor when she got married and must be closed from her parent’s case effective the end of the month following the month in which she reported the change. Julie must complete a new application because there is no application on file with her signature. Julie completes a new application immediately and is open on her own case. See Removing a Household Member.

A person who is not currently enrolled but has been counted in the MinnesotaCare household size may request coverage at any time.

Eligibility may begin the first day of the month following the date the household member requests coverage.

Request the following information and verifications needed to determine the household member’s eligibility if not already in the case file.

l Do not require verification of income when an existing household member requests coverage between renewals. The individual’s income should already be included in the household income. Do not require verification of income changes that occur between renewals.

Exception: Require an application if the only active household member is an auto newborn and there is no application or renewal on file in the previous 11 months.

Larry and Summer are married and have three children. In June, the household applies for MinnesotaCare. Larry and the children are eligible for MinnesotaCare. Summer is not eligible due to the four-month rule. She had health insurance through her previous employer that ended in April. Summer requests MinnesotaCare coverage again on August 12.

Summer is already a household member whose income and assets are counted for the MinnesotaCare household. Summer’s coverage may begin September 1. Request verification of citizenship and identity for Summer if not already on file.

Maria and her two children apply for MinnesotaCare in January. Maria is not eligible for MinnesotaCare due to her immigration status. In March, Maria contacts MinnesotaCare to report that she is now a legal permanent resident and would like to be added to coverage.

Maria is already a household member whose income was counted to determine her children’s eligibility. Maria may request coverage to begin April 1. Request verification of Maria’s immigration status.

The following steps should be taken at the time a new household member is being added to the MinnesotaCare household.

Note: Contact the household if you need more information on the person's relationship to other household members.

2. If the new person must be counted in the MinnesotaCare household, determine if the new member is requesting coverage.

a) there is no change in income, MMIS will automatically re-bill a lower premium for future months.

b) there is a change in income, MMIS will automatically adjust the premiums. MMIS will adjust higher premiums for the next billing cycles and lower premiums for the next available month.

3. Request all information needed to add the new person to the MinnesotaCare household including:

n Social Security Number or an application for an SSN if the person is requesting coverage.

n American Indian status, if the new household member is an American Indian, for purposes of exempting the household from MinnesotaCare premiums.

n Medical support and good cause information if the person being added is a minor child for whom a medical support referral is required.

Note: The household must provide all required information, except medical support forms, before the new member can be added.

4. Determine the new household member's eligibility if applying for coverage or required to apply for coverage based on the All or Nothing Rule.

5. Enter all information on MMIS to add the person to the household size and the person's income to the household income.

Note: See MinnesotaCare Excess Income if the new member's income causes the household's total income to exceed the MinnesotaCare standard.

6. Add the person to coverage, if applicable. MMIS will automatically enroll the person being added in the same health plan as the rest of the household.

n Infants born to a woman enrolled in MinnesotaCare for the month of delivery (auto newborn) are eligible beginning the first day of the month of birth.

n Infants born to a woman who is not enrolled in MinnesotaCare or MA for the month of delivery are not automatically eligible. Eligibility begins the first day of the month of birth if other family members are enrolled and the newborn is eligible.

Eric is born on January 5. His mother is not enrolled in MinnesotaCare but two siblings are active.

Eric is not eligible as an auto newborn. If he meets eligibility requirements, his eligibility will begin January 1, the first day of the month of birth. He will receive fee-for-service coverage for January.

Tim, like Eric, was born on January 5. However, Tim’s mother, as well as his siblings, was enrolled in MinnesotaCare when he was born.

Tim is eligible as an auto newborn. His eligibility will begin January 1, the first day of the month of birth. He will be enrolled into the same managed care plan as his mother.

n Children placed in the home of an enrolled family for adoption are eligible to be added the first day of the adoption placement month.

n For all other people being added to the household size, the effective date of coverage is the first day of the month following the determination of eligibility for the new household member.

People who move into an existing household are added to the household size and deeming effective the first full month that they live with the existing household.

Exception: There is a separate process for adding auto newborns an existing household. Refer to auto newborn for more information on this process.

Erwin married Genna on July 5 and they moved in together the same night. Genna has been enrolled in MA for the past year. Genna reports on July 10 that Erwin moved in and that he is not requesting coverage.

Erwin will be added to Genna's household size for August, because he moved into Genna's household in July. Deeming of his income and assets to Genna will also begin for August.

If the existing household gives the new member a basis of eligibility, the basis of eligibility is will be effective the first of the month the member moves into the household.

Genna and her daughter Susan are on MA. Genna marries Susan’s father, Erwin, and he moves into the household July 10. Erwin previously lived by himself in Minnesota. Erwin requests coverage for June, July and ongoing.

In June, Erwin is a household size of one and does not qualify for MA unless he meets a basis of eligibility. Starting July 1, Erwin remains a household size of one and he gains a parent basis of eligibility. Beginning August 1, Erwin is added to the existing household, creating a household size of three for each person and parental and spousal deeming of income and assets begins.

An MHCP household may report that an incarcerated individual will move in upon release from the facility. There is a shortened application process for incarcerated MA enrollees if they are incarcerated for less than 12 months. See MHCP and Incarcerated Individuals for information.

A person who is not currently enrolled but has already been counted in the household size may request coverage at any time.

The person may have eligibility begin the date he or she requests coverage and up to three months retroactive. Follow application rules to determine whether or not the client can have retroactive coverage. See Certification Period to determine if a new certification period is needed for any retroactive months.

Exception: Require an application if the only active household member is an auto newborn and there is no application or renewal on file in the previous 12 months.

Rory and Austin are married. In June they apply for Rory and their two children. Rory and the children are eligible for MA. Austin requests coverage in October.

Austin is already a household member whose income and assets are being deemed to other household members, as appropriate. Austin may request coverage to begin in October or up to three retroactive months prior to October. Request any information and verification not currently on file needed to determine Austin’s eligibility.

Take the following steps when you become aware of new household members other than auto newborns:

1. Determine if the new person must be added to the MA household's case based on household composition rules.

n Set up the person on his or her own case if the person does not meet the household composition rules to be added to the existing household's case and is requesting coverage.

2. Determine if the new household member is requesting MA and the effect the added person has on other household members’ eligibility.

n Request all information and verifications needed to determine eligibility if the new household member is requesting MA.

Exception: Require an application if the only active household member is an auto newborn and there is no application or renewal on file in the previous 12 months.

If deeming is required, begin deeming the new person’s income and assets effective the first full month they live with the existing household. Request the following:

m Verification of other health coverage the new member has that covers any members of the existing household.

a. Determine eligibility based on his or her previous household living arrangements for months prior to entry into the new household..

b. Determine eligibility based on the previous household living arrangements for coverage requested for the month of entry into the new household. However, if entering the new household gives the client a new basis of eligibility, that new basis of eligibility can be used beginning the first day of the month of entry into the household.

c. Determine eligibility based on the new household composition for the month following entry into the new household (the first full month the client is in the new household).

m The new member is subject to the same spenddown type as the rest of the existing household.

m Determine if the new member must be enrolled in a managed care health plan. See the Prepaid MHCP Manual for more information.

4. Determine the effect of adding the new member on the eligibility of other household members. This may include changes in:

Note: Send a SIR webmail message to dhs.made@state.mn.us if the addition of the household member changes an MA-EPD enrollee’s premium. See MA-EPD Premiums for more information.

Chapter 17 - Household Composition	Effective: December 1, 2011
17.20 - Adding a Household Member	Archived: June 1, 2016 (Previous Versions)