*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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. ***
Effective: June 1, 2011 |
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17.25 - Removing a Household Member |
Archived: June 1, 2016 (Previous Versions) |
There are several circumstances when one or more household members must be removed from an existing case. The circumstances are the same across the programs, but there are some differences in how to handle the process based on the specific program.
Removing an Incarcerated Person - MinnesotaCare.
Do not remove a person from a household when the household member no longer wants coverage or is removed from coverage for failure to cooperate with a program requirement. Continue to include the person in the household composition and continue deeming requirements.
Note: For MinnesotaCare determine if other members’ eligibility is affected by the end of coverage for this household member based on the All or Nothing Rule.
Example:
Steve, his wife and their children receive MA. On June 12 Steve reports he began receiving health insurance through his employer and that family coverage is not available. Steve declines to provide information on the insurance to determine if it is cost effective and requests his MA closed.
Action:
Close Steve’s coverage for July 1. Continue to include him in the household size for his wife and children, and continue to deem income and assets based on deeming rules.
Remove a person from the household when:
l A person moves out of the household.
l A person leaves the household for one full calendar month or more, and the absence does not fit a temporary absence condition.
l A minor child becomes emancipated.
l A child turns age 21.
l A household member dies.
l A person remains in the household but no longer has a parental or marital bond with another household member.
When a household reports a change that requires one or more members to be removed from the household, take the following steps:
1. Ask whether the household member being removed wishes to be considered for eligibility on a separate case.
Note: Do not open a separate case unless the person requests or applies for coverage.
Request any additional information or verifications needed to determine eligibility and:
n Send a Health Care Application (HCAPP) (DHS-3417) to the person if an application or renewal is not on file with the person’s signature.
n Update the person’s information based on his or her new circumstances if an application or renewal with the person's signature is on file.
2. Remove the person from the household and close coverage for the person.
n MinnesotaCare: Remove the person effective the end of the month following the month in which the change is reported.
Exception: A written request from the person being removed is required if the existing household requests to have the person removed before the end of the month following the month in which the change is reported.
The client may request a premium refund if the request for removal by the end of the current month is prior to the capitation payment being paid.
Example:
Julie, age 16, is enrolled in MinnesotaCare with her parents. On June 20, Julie reports that she got married to Brad on June 10. She would like to continue her MinnesotaCare coverage. Julie did not sign the prior application. Julie is now an emancipated minor and must be removed from her parents’ household.
Action:
Remove Julie from her parents’ household effective July 31, the end of the month following the month in which the change is reported.
Send a HCAPP to Julie, and request required information and verifications. Brad has a marital relationship with Julie and may need to apply for coverage based on the All or Nothing Rule. See Adding a Household Member.
Example:
Marianne calls on December 5 to report her husband, Jerome, left the home on November 30. Marianne asks to have Jerome removed at the end of December so her January premium can be reduced.
Action:
Advise Marianne that Jerome will be removed from her case at the end of January unless Jerome provides a written statement to end his coverage earlier. Jerome must provide the statement prior to December’s capitation date.
Contact Jerome to find out if he would like his coverage to continue for his own household. Request information and verifications, and an application if a signed application or renewal is not on file.
Example:
George calls on December 28 to report his wife Suzanne left the home on December 26.
Action:
Advise George that Suzanne will be removed from his case at the end of January, the month following the month in which the change is reported. It is not possible to remove Suzanne for January, even if she submits a written request, because January’s capitation payment has been paid.
n MA: Remove the person from the household the first full month after the person leaves the household.
Exception: See Beginning or Ending LTC Income Calculation when a member of the household enters a LTCF or begins receiving services through the Elderly Waiver (EW).
Example:
Rob and Laura receive MA for themselves and their son. Rob and Laura divorce and Rob moves out on August 10.
Action:
Remove Rob from Laura's household beginning September 1. Offer Rob an opportunity to apply for MA for himself as a separate household. Do not require a new application if he has signed the most recent application or renewal if he requests coverage as a separate household.
Example:
Nadine, age 20, receives MA as part of her parents’ household. Nadine turns 21 on April 3. She continues to live with her parents.
Action:
Remove Nadine from her parents’ household for May 1. Offer her an opportunity to apply for MA for herself as a separate household. Do not require a new application if she has signed the most recent application or renewal if Nadine requests coverage as a separate household.
3. Review the following sections and update the remaining household member’s eligibility as needed based on the program in which the household member is enrolled:
n Deeming of Assets and Income.
n Major program and eligibility type.
n Spenddown.
n MA-EPD Premiums and Medicare Part B premium reimbursement.
n Managed Care.
Update eligibility for the next available month with 10-day notice.
Note: MMIS will adjust the premium for the first available month for which capitation has not been paid if removing a person results in a decreased MinnesotaCare premium. Do not request manual adjustments.
4. Establish a new case if people being removed from an existing case are eligible.
Note: Deny eligibility on the new case for those people removed from a household who are requesting coverage but are not eligible.
n MinnesotaCare - The effective date of coverage for the new case is the first day after the month in which the initial premium payment is received.
n MA - The effective date of coverage for the new case is the next available month after they were removed from the old household, even if reported untimely.
Removing an Incarcerated Person - MinnesotaCare
People who are incarcerated while enrolled in MinnesotaCare may remain enrolled until the time of the next scheduled renewal.
Allow the incarcerated member to request MinnesotaCare on a separate case if the existing household requests to have the incarcerated member removed before the renewal.
l Send the incarcerated person the Separation from Household Letter (DHS-3409) and a HCAPP. Obtain the address of the penal institution if there is no forwarding address.
l Allow the person 10 days to return the application. If eligibility exists, send a request to the MMIS Help Desk to set the renewal date for the new case to coincide with the existing household’s scheduled renewal.