Current through Register Vol. 49, No. 13, September 23, 2024
Subpart
1.
General eligibility requirements.
Except as provided in subparts
2,
3, and
5, an applicant or enrollee
must:
A. be a permanent resident of
Minnesota;
B. be ineligible for
medical assistance without a spenddown, including medical assistance for
pregnant women, except that an enrollee who receives inpatient hospital
services may be eligible for medical assistance with or without a spenddown
during the months of hospitalization;
C. not simultaneously be covered by general
assistance medical care and MinnesotaCare;
D. not currently have other health coverage
nor have had other health coverage during the four months immediately preceding
the date coverage begins;
E. not
have access to employer-subsidized health coverage during the 18 months
immediately preceding the date coverage begins;
F. identify potentially liable third-party
payers and assist the department in obtaining third-party payments;
G. have gross annual income that does not
exceed the amounts in Minnesota Statutes, section
256L.15, subdivision 2;
and
H. comply with the family
enrollment requirements in subpart
4.
Subp. 2.
Exceptions to general
eligibility requirements.
A. Subpart
1, items D and E, do not
apply to an applicant who is terminated from medical assistance, general
assistance medical care, or coverage under a regional demonstration project for
the uninsured funded under Minnesota Statutes, section
256.73,
the Hennepin County assured care program, or the Group Health, Inc., community
health plan if the department receives a MinnesotaCare application before the
last day of the month following the month in which termination
occurred.
B. Subpart
1, item E, does not apply
under the following circumstances:
(1) if the
employer-subsidized health coverage was lost for reasons that would not
disqualify the applicant from receiving reemployment benefits under Minnesota
Statutes, section
268.095,
and the applicant has not had access to employer-subsidized health coverage
since the loss; or
(2) to children
of an individual whose employer-subsidized coverage was lost for reasons that
disqualify the individual for reemployment benefits if the children have not
had access to employer-subsidized coverage since the disqualifying
event.
Subp.
3.
Children in families with income at or below 150 percent
of the federal poverty guidelines.
A child in a family with income at or below 150 percent of the
federal poverty guidelines is eligible for MinnesotaCare from the first day of
the month in which the child's first birthday occurs to the last day of the
month in which the child becomes 18 years old if the child:
A. meets the requirements under subpart
1, items A to C and F to H;
and
B. is not otherwise insured for
the covered health services. A child is not otherwise insured for covered
health services when subitem (1), (2), or (3) applies:
(1) the child lacks coverage in two or more
of the areas listed in units (a) to (e):
(a)
basic hospital coverage;
(b)
medical-surgical coverage;
(c)
major medical coverage;
(d) dental
coverage;
(e) vision
coverage;
(2) coverage
requires a deductible of $100 or more per person per year; or
(3) a child with a particular diagnosis lacks
coverage because the child has exceeded the maximum coverage for that diagnosis
or the policy of coverage excludes that diagnosis.
Subp. 4.
Family
enrollment.
Families must comply with items A to F.
A. Parents who enroll must enroll all
eligible children and dependent siblings.
B. Children and dependent siblings may be
enrolled without parents enrolling, unless other insurance is
available.
C. If one parent in a
household enrolls, both parents in the household must enroll, unless other
insurance is available.
D. If one
child in a family is enrolled, all children in the family must be enrolled,
unless other insurance is available.
E. If one spouse in a household is enrolled,
the other spouse in the household must enroll, unless other insurance is
available.
F. Except as provided in
item B, families cannot enroll only certain uninsured members.
Subp. 5.
Continuous
eligibility.
An enrollee remains eligible for MinnesotaCare regardless of
age or the presence or absence of children in the household as long as the
enrollee:
A. maintains permanent
residency in Minnesota;
B. meets
all other eligibility criteria, except subpart
1, item G;
C. pays the full cost of coverage if gross
annual family income after initial enrollment exceeds the limits in Minnesota
Statutes, section
256L.15, subdivision 2;
and
D. is continuously enrolled in
MinnesotaCare or medical assistance. To be continuously enrolled, an enrollee's
reapplication must be received by the department before the last day of the
first calendar month following the date of notice of termination of coverage
from MinnesotaCare or medical assistance.
Subp. 6.
Annual redetermination
required.
The commissioner shall annually redetermine continued
MinnesotaCare eligibility for each enrollee.
Subp. 7.
Enrollee cooperation with
annual redetermination.
Enrollees must annually provide the information needed to
redetermine eligibility before the anniversary date of initial eligibility. The
anniversary date of initial eligibility is the yearly recurrence of the first
day of the month following the date of enrollment in MinnesotaCare.
Statutory Authority: MS s
256.9352;
256L.02
