Current through Register Vol. 49, No. 13, September 23, 2024
Subpart 1.
Referral of applicants and
enrollees potentially eligible for medical assistance to local social service
agency.
The commissioner shall refer applicants and enrollees who are
potentially eligible for medical assistance without a spend-down to the local
social service agency. The commissioner shall determine potential eligibility
by considering:
A. age;
B. household income or assets;
C. pregnancy;
D. illness, injury, or incapacity indicating
a disability;
E. household
composition; and
F. employment
status of household members.
Subp.
2.
Enrollment of applicants and enrollees potentially
eligible for medical assistance.
A. If
an applicant who is potentially eligible for medical assistance without a
spenddown meets the other conditions of eligibility for MinnesotaCare, the
commissioner shall enroll the applicant in MinnesotaCare upon receipt of the
initial premium payment.
B. An
applicant or enrollee who is potentially eligible for medical assistance
without a spenddown may continue to be covered by MinnesotaCare until
determined eligible for medical assistance, provided:
(1) the applicant:
(a) applies for medical assistance within 60
days from the date MinnesotaCare coverage begins; and
(b) cooperates with the local social service
agency in determining eligibility for medical assistance; or
(2) the enrollee:
(a) applies for medical assistance within 60
days after the first day of the month following the month of referral to the
local social service agency; and
(b) cooperates with the local social service
agency in determining eligibility for medical assistance.
C. An applicant who is determined
eligible for medical assistance without a spenddown may be eligible for a
refund of the applicant's MinnesotaCare premium payments, depending on family
size.
Subp. 3.
Coordination of coverage for hospital inpatient services under
MinnesotaCare and medical assistance.
Coverage for inpatient hospital services for enrollees shall be
coordinated between MinnesotaCare and medical assistance as provided in this
subpart.
A. The commissioner shall
notify enrollees who have received inpatient hospital services and who are
determined to have a basis of eligibility for medical assistance, in writing,
that an application for medical assistance must be completed.
B. By the last day of the third month
following the inpatient hospital admission, an enrollee who has received
written notice under item A must apply for medical assistance and must
cooperate with the local social service agency in determining eligibility for
medical assistance.
C. If an
enrollee is determined eligible for medical assistance with a spenddown:
(1) the enrollee is covered by medical
assistance during the months of inpatient hospitalization;
(2) the enrollee must pay:
(a) the MinnesotaCare premium during the
months of inpatient hospitalization;
(b) inpatient hospital costs included in the
enrollee's spend-down that are not paid for by MinnesotaCare; and
(c) services not covered by MinnesotaCare or
medical assistance;
(3)
the enrollee is not responsible for any hospital payments reduced under
Minnesota Statutes, section
256L.03,
subdivision 3, paragraph (c);
(4)
MinnesotaCare shall pay inpatient hospital costs up to the enrollee's
spend-down limit or the MinnesotaCare $10,000 annual benefit limit for adults,
whichever is less; and
(5) medical
assistance shall pay the enrollee's inpatient hospital costs above spenddown
amounts.
D. An enrollee
who is not eligible for medical assistance may:
(1) remain enrolled in MinnesotaCare;
and
(2) unless the enrollee is a
child, pay ten percent of the hospitalization charge, up to an annual maximum
of $1,000 per person or $3,000 per family, and any hospitalization charges that
exceed the $10,000 annual limit on MinnesotaCare benefits for inpatient
hospital services.
An enrollee who is not eligible for medical assistance may be
eligible for retroactive general assistance medical care under Minnesota
Statutes, section
256D.03,
subdivision 3, paragraph (b).
Subp. 4.
Disenrollment.
A. The commissioner shall disenroll an
enrollee and the enrollee's family when the enrollee fails to apply for medical
assistance or cooperate with determining eligibility, as required under
subparts
2 and
3. MinnesotaCare coverage
terminates the last day of the calendar month following the month in which the
medical assistance application was due.
B. An enrollee, and the enrollee's family, if
disenrolled for failure to comply with subpart
2, may reenroll after
cooperating with the medical assistance eligibility determination and being
determined ineligible for medical assistance without a spenddown.
C. An enrollee, and the enrollee's family, if
disenrolled for refusal to comply with subpart
3, item B, may not
reenroll.
D. The commissioner shall
disenroll an enrollee who is determined eligible for medical assistance without
a spend-down. MinnesotaCare coverage terminates the last day of the calendar
month in which the department receives notice of the enrollee's medical
assistance eligibility.
Subp.
5.
Continuing health plan participation.
An enrollee in a managed care health plan who becomes eligible
for medical assistance or general assistance medical care shall remain in that
health plan if the health plan has a contract with the department to provide
health services in that geographic area to recipients of medical assistance or
general assistance medical care.
Statutory Authority: MS s
256.9352;
256.9363;
256L.02;
256L.12
