Current through Register Vol. 49, No. 13, September 23, 2024
Subpart
1.
Medical assistance eligibility required for PMAP
participation.
Only persons who have been determined eligible for medical
assistance under parts
9505.0010 to
9505.0140 shall be eligible to
participate in the prepaid medical assistance program.
Subp. 2.
Medical assistance categories
ineligible for PMAP.
A person who belongs to a category listed in items A to N is
ineligible to enroll in a health plan under the prepaid medical assistance
program:
A. a person who is eligible
for medical assistance on a spenddown basis as defined in part
9500.1451, subpart 17a;
B. [Repealed,
L
1995 c 207 art 6
s
124]
C. a person who is a resident of a state
institution;
D. a person who is
receiving benefits under the Refugee Assistance Program, established at United
States Code, title 8, section 1522(e);
E. a person who is eligible for medical
assistance through an adoption subsidy;
F. a person who is determined eligible for
medical assistance due to blindness or disability as certified by the Social
Security Administration or the state medical review team, unless the recipient
is 65 years of age or older;
G. a
person who is eligible for medical assistance but currently has private health
insurance coverage through a health maintenance organization licensed under
Minnesota Statutes, chapter 62D;
H.
a person who resides in Itasca County but who lives near the county border and
who chooses to use a primary care provider located in a neighboring
county;
I. a person who is a
qualified medicare beneficiary, as defined in United States Code, title 42,
section 1396(d), who is not otherwise eligible for medical
assistance;
J. a person who is
terminally ill as defined under part
9505.0297, subpart
2, item N, and who, at the
time of notification of mandatory enrollment in PMAP, has a permanent
relationship with a primary physician who is not part of any PMAP health
plan;
K. a person who is in foster
placement;
L. a child who prior to
enrollment in a health plan is determined to be in need of protection under
Minnesota Statutes, sections
626.556
to
626.5561,
is identified to the state by the county social service agency, and is
receiving medical assistance covered services through a provider who is not a
participating provider in PMAP;
M.
a child who prior to enrollment in a health plan is determined to be severely
emotionally disturbed under Minnesota Statutes, sections
245.487
to
245.4889,
and is:
(1) coded as severely emotionally
disturbed on the Minnesota welfare information system;
(2) receiving county mental health case
management services; and
(3) under
the primary care of a mental health professional as defined in Minnesota
Statutes, section
245.4871, subdivision
27, who is not a participating provider in PMAP; or
N. a person who, at the time of notification
of mandatory enrollment in PMAP:
(1) has a
communicable disease;
(2) the
prognosis of the communicable disease is terminal illness, however, for the
purpose of this subitem, "terminal illness" may exceed six months;
(3) the person's primary physician is not a
participating provider in any PMAP health plan; and
(4) the physician certifies that disruption
of the existing physician-patient relationship is likely to result in the
patient becoming noncompliant with medication or other health
services.
Subp.
3. [Repealed,
L
2014 c 291 art 10
s
14]
Subp.
4.
Elective enrollment.
An individual categorically excluded from PMAP under subpart
2, item G, may enroll in PMAP
on an elective basis if the private health insurance health plan is the same as
the health plan the consumer will select under PMAP.
Individuals categorically excluded from PMAP under subpart
2, items K, L, and M, may
enroll in the prepaid medical assistance program on an elective basis.
Program requirements are the same for elective and mandatory
PMAP enrollees under Minnesota Statutes, section
256B.69.
