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Effective: July 1, 2009 |
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17.20ar3 - Adding a Household Member (Archive) |
Archived: October 1, 2009 |
The process and timeline for adding someone to a household depends on the health care program.
When to Add a Person to a MCRE Household.
Adding Coverage for a Current MinnesotaCare Household Member.
Steps to Adding a MCRE Household Member.
When to Add a Person to an MA/GAMC Household.
Adding a Current MA/GAMC Household Member to Coverage.
Steps to Adding an MA/GAMC Household Member.
When to Add a Person to a MCRE Household
When a new person moves into the household, add the new household member at one of the following times:
l At the time of the next renewal, at the latest.
n Document in case notes if the household chooses not to add the new person until the next renewal. Do not add new people to the household size and do not include their income or assets until the next renewal.
l Any time prior to the next renewal, at the household's request.
Example:
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.
Action:
Because of Fred’s parental relationship to Crystal, he must be added to the household. Marge may choose to add Fred to her MinnesotaCare case now or wait until her next renewal.
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 heath care coverage. If he is otherwise eligible and refuses coverage, cancel Marge's coverage.
Example:
Julie, age 16, lives with her parents. She reports that she got married and her new husband, Brad, moved in with her and her parents.
Action:
Julie is now an emancipated minor and should be closed on her parents' case and opened on a new MinnesotaCare case with Brad. Julie may choose to either:
n Remain on the case with her parents until their next renewal, at which point she must apply separately with Brad.
n Add Brad any time between the marriage and the next renewal. This would require Julie to be closed on her parents' case and opened on a separate MinnesotaCare case with Brad. See Removing a Household Member.
Adding Coverage for a Current MinnesotaCare 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 Verification of access to Employer Subsidized Insurance (ESI) if the individual meets the criteria requiring verification.
l Verification of citizenship and identity or immigration status.
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.
Note: Do not require an application or addendum to add the person to coverage.
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.
Example:
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.
Action:
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.
Example:
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.
Action:
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.
Steps to Adding a MCRE Household Member
The following steps should be taken at the time a new household member is being added to the MinnesotaCare household.
Reminder: If the household chooses to wait until renewal to add the new member, do not take any of these steps until processing the renewal.
The steps are:
1. Determine if the new household member must be counted in the MinnesotaCare household size.
Note: Contact the household if you need more information on the person's relationship to other household members.
2. If the new person is counted in the MinnesotaCare household, determine if the new member is requesting coverage.
n If the new person is not requesting coverage determine if the new member:
m Should be enrolling according to the All or Nothing Rule.
m If the new household size results in a decreased premium.
a) If yes, the new premium amount is effective the month the person is added to the household size.
b) If there is no change in income, MMIS will automatically re-bill a lower premium for future months.
c) If 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:
Note: The household must provide all required information, except medical support forms, before the new member can be added.
n Income.
n Assets.
n Social Security Number if the person is requesting coverage or the All or Nothing Rule requires them to apply.
Note: Do not require a SSN for a child under age two.
n Citizenship or immigration status if the person is requesting coverage or the All or Nothing Rule requires them to apply.
n Pregnancy, if applicable.
n Third party liability (TPL) information.
n Medical support and good cause information if the person being added is a minor child for whom a medical support referral is required.
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: If the new member's income causes the household's total income to exceed the MinnesotaCare standard. See MinnesotaCare Excess Income.
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 automatically eligible beginning the first day of the month of birth.
n Infants born to a woman who is not enrolled in MinnesotaCare for the month of delivery are not automatically eligible. If other family members are enrolled and the newborn is eligible, eligibility begins the first day of the month of birth.
Example:
Eric is born on January 5. His mother is not enrolled in MinnesotaCare but two siblings are active.
Action:
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.
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.
When to Add a Person to an MA/GAMC Household
People who move into an existing household are eligible to be added to the household size, and deeming will be effective, the first full month that they live with the existing household.
Exception: Auto newborns have a separate process when adding them to the household. Refer to auto newborn for more information on this process.
Example:
Erwin married Genna on July 1 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.
Action:
Erwin will be added to the household size for August, because he moved in on July 1. Deeming of his income and assets to Genna will also begin for August.
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.
Adding an MA/GAMC Current Household Member to Coverage
A person who is not currently enrolled but has already been counted in the household size may request coverage at any time.
He or she may have eligibility begin the date he/she requests coverage and up to three months retroactive. Follow application rules to determine whether or not the client can have retroactive coverage.
Request the information and verifications needed to determine eligibility.
Note: Do not require an application or addendum to add the person to coverage.
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.
Example:
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.
Action:
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 retro active months from October. Request any information and/or verification not currently on file which is needed to determine Austin’s eligibility.
Steps to Adding an MA/GAMC Household Member
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 or GAMC household based on household composition rules.
n Go to Step 2 to if the person must be added to the household.
n If the person does not need to be added to the household set up the person on his or her own case if he/she is requesting coverage.
2. Determine if the new household member is requesting MA or GAMC and the effect the added person has on other household members’ eligibility.
n If the new household member is requesting MA or GAMC, request all information and verifications needed to determine eligibility for the person.
Do not require an application or addendum.
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.
n If the new household member is not requesting MA or GAMC, determine if deeming of assets and income rules apply.
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 Completion of a Household Report Form (DHS-2120).
m Income verification.
m Asset verification, if applicable.
m Verification of other health coverage the new member has that covers any members of the existing household.
3. Determine the new member's eligibility.
a. If eligibility is requested for the month of entry into the new household and any retroactive months, determine eligibility separately for the client based on his or her previous household living arrangements.
b. If eligibility is requested for the month following entry (the first full month the client is in the new household) into the new household, determine eligibility based on 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 or disenrolled from 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:
n The household certification period.
n Household sizes.
n Spenddowns.
n Asset limits.
Example:
Janet and her seven-year-old child, Amy, are currently on MA. Roger, Amy’s father, moves into the household in April 1. Roger and Janet are not married. Roger requests coverage April 8 to begin retroactively for February.
Action:
1. Roger must be counted in Amy’s household size due to a parental relationship.
2. Roger is requesting MA coverage. Request information and verifications needed to determine eligibility.
3. Roger can be added to Amy’s household size as of May. His eligibility for February through April will be determined on a separate case based on his living arrangements during those months, and will not include Amy in his household size.
4. As of May, when Roger is added to Amy’s household, Amy’s household size will increase to three, and Roger’s income will begin being deemed to Amy.