***This version of the Health Care Programs Manual has been replaced and is no longer in effect. This includes all PDF versions below. Please see the current Health Care Programs Manual for policy in effect as of December 1, 2006.***

MDHS Health Care Programs Manual (Eligibility Policy through 11/30/06)

Chapter 0904 - Applications

All chapters are numbered beginning with 09. The first chapter is 0901 (Table of Contents).

0904

APPLICATIONS

PDF(s) Jan 04 | Oct 02 | Mar 00

0904.03

INITIAL REQUESTS

PDF(s) Jan 04 | Oct 03 | Dec 01

0904.03.03

MINNESOTACARE ENROLLMENT SITES

PDF(s) Nov 00

0904.05

HEALTH CARE APPLICATION (HCAPP)

PDF(s) Aug 04 | Jan 04 | Jul 03 | Dec 02 | Dec 01

0904.05.03

WHEN TO REQUIRE AN APPLICATION

PDF(s) Jan 04 | Oct 03 | Dec 01

0904.05.03.03

WHO MAY APPLY

PDF(s) Jan 04 | Oct 03 | May 99

0904.05.05

WHEN NOT TO REQUIRE AN APPLICATION

PDF(s) Jan 06 | Jan 04 | Oct 03 | Oct 02 | Dec 01

0904.05.07

FORMS FOR NEW APPLICANTS

PDF(s) Mar 03 | Mar 00

0904.05.09

UPDATING THE APPLICATION

PDF(s) Jan 01

0904.07

ACCEPTING AND PROCESSING APPLICATIONS

PDF(s) Jan 04 | Oct 03 | Dec 02 | Dec 01

0904.07.01

APPLICATIONS IN ADVANCE OF INMATE’S RELEASE

PDF(s) Oct 03

0904.07.03

DATE OF APPLICATION

PDF(s) Jan 04 | Oct 03 | Dec 02 | Dec 01

0904.07.05

APPLICATION FOLLOW UP

PDF(s) Oct 03 | Jun 02 | Dec 01

0904.07.07

PENDING THE APPLICATION

PDF(s) Oct 03 | Oct 00

0904.07.09

ELIGIBILITY BEGIN DATE

PDF(s) Oct 03 | Jul 03 | Dec 02 | May 01

0904.07.09.03

RETROACTIVE MINNESOTACARE

PDF(s) Oct 03 | Apr 01

0904.09

SHARED AND TRANSFERRED APPLICATIONS

PDF(s) Jan 05 | Jan 01

0904.09.03

TRANSFERS FROM MINNESOTACARE TO MA/GAMC

PDF(s) Jan 05 | Jan 99

0904.09.05

TRANSFERS FROM MA/GAMC TO MINNESOTACARE

PDF(s) Jan 05 | May 01

0904.09.07

MINNESOTACARE WITH RETROACTIVE MA

PDF(s) Jan 05 | Oct 03 | Mar 00

0904.09.09

MIXED HOUSEHOLDS

PDF(s) Mar 00

0904.09.11

MINNESOTACARE AND MA OVERLAP

PDF(s) Oct 03 | Oct 02 | Jul 00

0904.11

AUTHORIZED REPRESENTATIVES

PDF(s) May 05 | Apr 04 | Jan 04 | Oct 03 | Apr 01

0904.13

VERIFICATION

PDF(s) Apr 06 | Jan 06 | Oct 03 | Jul 00

0904.13.01

VERIFICATION -MA/GAMC

PDF(s) Apr 06 | Oct 03 | Jan 02

0904.13.03

CASE NOTES

PDF(s) Jan 06 | Jan 00

***This version of the manual is no longer in effect as of December 1, 2006.***

Current Manual

APPLICATIONS 0904

Everyone applying for 1 or more of the health care programs for the first time must submit a written application. All MinnesotaCare applicants must use the Health Care Application Form (HCAPP), DHS 3417. See §0904.05 (Health Care Application Forms).

People who are reapplying for health care may be required to complete a new HCAPP. See §0904.05.03 (When to Require an Application) and §0904.05.05 (When Not to Require an Application).

Workers must take certain actions and meet certain time frames when processing applications. See §0904.07 (Accepting and Processing Applications).

People can request MinnesotaCare and MA or GAMC on the same application form. See §0904.09 (Shared and Transferred Applications).

Applicants or enrollees may designate someone else to act on their behalf. See §0904.11 (Authorized Representatives).

People who are mentally competent but unable to sign the application due to physical or other limitations may sign by making a distinct mark, such as an "X". Two witnesses must sign and date the application to verify that the person making the mark is indeed the person who is applying.

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***This version of the manual is no longer in effect as of December 1, 2006.***

Current Manual

INITIAL REQUESTS 0904.03

People may request health care by phone, in person, or in writing. Explain that they must complete an application and submit required information to find out if they qualify. There are several application forms depending on the applicant’s circumstances. See §0904.05 (Application Forms). Provide the appropriate application form based on available information and encourage people to return it as soon as possible. See §0904.07.03 (Date of Application). Accept any DHS-approved application form.

Do not include informational brochures or supplemental forms with any version of the HCAPP (DHS 3417 or DHS 3531). Mail or give only the HCAPP. See the MA/GAMC provisions of this section for information on which application form to provide. See §0904.05.07 (Forms for New Applicants) for a list of items that may be requested after reviewing the application.

MinnesotaCare:

Explain that some people have a choice of enrolling in MinnesotaCare through MinnesotaCare Operations at DHS or through the county agency where they live. See §0904.03.03 (MinnesotaCare Enrollment Sites). Direct people who want to apply only for MA or GAMC to their county of residence.

People who want to apply only for MinnesotaCare may submit their applications to MinnesotaCare Operations or to their county of residence if it is a MinnesotaCare enrollment site. Because county enrollment sites normally determine MA/GAMC eligibility first, applicants must inform the county agency if they wish to be considered only for MinnesotaCare.

Direct people who want to apply for MinnesotaCare to mail, fax or bring a completed Health Care application to MinnesotaCare Operations or to their county of residence (if an enrollment site) as soon as possible. Explain that MinnesotaCare Operations processes applications in the order they are received. Explain that applications submitted by fax may be used to set the date of application and determine initial eligibility, but that the original application must be mailed to the enrollment site within 30 days of the date the application was faxed. See §0904.07.03 (Date of Application) and §0904.07.05 (Application Follow Up).

For clients who request an application by mail or phone, mail the application no later than the following work day. Give the application form to clients who inquire in person. Also, advise them that the HCAPP is available on the DHS web site. See §0904.05.07 (Forms for New Applicants).

Besides advising people of their enrollment and case maintenance site options, enrollment sites must:

• Provide information about area outreach grantee locations who provide assistance with the application process. • Provide one-to-one assistance in the application process to county residents. • Assist applicants and enrollees who reside in counties that are not enrollment sites with completing the application and forwarding the application and verifications to MinnesotaCare Operations.

M.S. 256L.05 subd. 1

Minnesota Rule 9506.0030 subp. 1

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MA/GAMC:

Ask people if they want to apply for cash or food stamps or if they have a non-medical emergency. People who want to apply for cash, food stamps, or emergency assistance (with or without health care) must complete a Combined Application Form (CAF) and have an interview. If people indicate they want cash, food stamps, or emergency assistance or are not sure which programs they want to apply for, provide a CAF.

Follow the procedures in chapter 5 of the Combined Manual for people who apply for MA or GAMC on a CAF.

If people want to apply only for health care programs, explain that some people may have a choice between MA or GAMC and MinnesotaCare. Direct people who want to apply for MinnesotaCare to apply through the state agency or through a county enrollment site if they live in a county that provides this service. Because county enrollment sites normally determine MA/GAMC eligibility first, applicants must inform the county agency if they wish to be considered only for MinnesotaCare.

Provide applicants who request MinnesotaCare only with a denial notice for MA/GAMC to confirm their choice.

Provide the appropriate version of the HCAPP to people who inquire in person. Offer to mail the application to people who inquire by phone. Also, advise them that both versions of the HCAPP are available on the DHS web site in the healthcare section.

If people want to apply for MA or GAMC, explain that they may mail or fax the application to the county agency or request an in-person interview. See §0904.07 (Accepting and Processing Applications) and §0904.07.05 (Application Follow Up). Explain that applications submitted by fax may be used to set the date of application and determine initial eligibility, but that the original application must be mailed to the county agency within 30 days of the date the application was faxed. See §0904.07.03 (Date of Application).

Follow your agency’s procedures if people request an interview. Schedule interviews for pregnant women who request interviews within 5 days of receiving the application. Schedule interviews for people with medical emergencies in time to meet the emergent need.

Mail the appropriate application form no later than the next working day to people who inquire by phone or mail. Offer the option of picking up the form in person or downloading the HCAPP from the DHS web site in the healthcare section. Give the application to people who inquire in person. Explain that the date of application is the date the agency receives a signed and dated application form or another signed, dated request for health care assistance including the applicant’s name and address, including but not limited to the Request to Apply for Minnesota Health Care Programs, DHS 3417B. Health care providers may assist in setting the date of application for patients who are unable to do so at the time services are received. Explain that the date of application determines when MA or GAMC can begin. See §0904.07.03 (Date of Application) and §0904.07.09 (Eligibility Begin Date).

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***This version of the manual is no longer in effect as of December 1, 2006.***

Current Manual

MINNESOTACARE ENROLLMENT SITES 0904.03.03

MinnesotaCare:

All applicants may enroll by mailing or faxing a HCAPP to DHS. See §0904.07.03 (Date of Application) for follow up procedures for applications submitted by fax. Residents of counties who choose to be MinnesotaCare enrollment sites may enroll through their county of residence.

There are 3 types of county enrollment sites:

• Type 1: These sites offer processing of applications only. They accept and process applications from county residents who have never applied for MinnesotaCare OR who have had a break in eligibility of at least one calendar month. These sites transfer cases to MinnesotaCare Operations when:
• MinnesotaCare is approved
AND
• the initial premium payment is received
AND
• all mandatory verifications are received.

Do not transfer the case to MinnesotaCare Operations if no household members are eligible.

• Type 2: These sites offer processing of applications and continued case maintenance for county residents. • Type 3: These sites offer processing of applications and continued case maintenance for county residents who meet the definition of current contacts. To be considered a current contact, households must:
• Include at least one member who is eligible for cash, food stamps, or MA/GAMC AND at least one member applying for MinnesotaCare OR • Include at least one member who is losing eligibility for MA, GAMC, MFIP or extended MA AND who requests MinnesotaCare within 30 days of termination OR • Include at least one GAMC client who is required to apply for MinnesotaCare OR • Include at least one member who is denied for MA or GAMC and requests MinnesotaCare.

All enrollment sites must offer the services listed in §0904.03 (Initial Requests).

When people file an application at DHS or a county enrollment site, the initial enrollment site retains the case until the applicant has submitted all verifications and DHS has received the initial premium payment. Approve an applicant’s request to change enrollment sites before the eligibility determination when:

• The applicant submits the application to MinnesotaCare Operations and then requests assistance from the county enrollment site to obtain verifications. • One or more members of a household which submits an initial application to MinnesotaCare Operations later applies or is approved for MFIP, GA, MSA, MA, GAMC or Food Stamps at a county enrollment site. • An applicant requests to have the application transferred to a county enrollment site because a county social worker is helping with the application process.

Transfer pending applications in circumstances not listed above only if the appropriate county or MinnesotaCare Operations enrollment supervisors approve the transfer.

Active enrollees may request a change in enrollment site at any time, either verbally or in writing. Transfer the case file within 5 working days. See §0906.07.03.01 (MinnesotaCare Enrollment Site Transfers).

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***This version of the manual is no longer in effect as of December 1, 2006.***

Current Manual

HEALTH CARE APPLICATION (HCAPP) 0904.05

The Health Care Application (HCAPP, DHS 3417) allows people to apply for any or all of the health care programs on one form. It is available for downloading on the DHS healthcare section. The HCAPP is designed for people under age 65 who do not have a disability and who want to apply only for MA, GAMC, and/or MinnesotaCare. See §0904.05.03 (When to Require an Application) and §0904.05.05 (When Not to Require an Application).

The HCAPP sets the date of application and requests information on eligibility factors. See §0904.07.03 (Date of Application).

The back cover includes the DHS address and a space for the county agency name and address. The post office will return undeliverable applications to DHS. DHS will forward the application to the appropriate site.

The Rights and Responsibilities page of the HCAPP is detachable. Applicants should retain this page.

The HCAPP contains questions needed to determine eligibility for all of the health care programs. Many questions apply to all 3 programs. Some apply only to 1 or 2 programs or to certain populations.

County agencies also use the HCAPP with the Title IV-E Foster Care Supplement to the Health Care Programs Application (DHS 3478) to determine eligibility for Title IV-E for children in placement. If the child is IV-E eligible, MA is automatic. If there is no IV-E eligibility, the agency uses the HCAPP to determine MA eligibility. See §0907.19.03.03 (MA Basis: Children in Foster Care).

The Minnesota Health Care Programs Application (HCAPP) for People Who Have a Disability and Seniors Age 65 and Older (DHS 3531) is designed for those specific populations. Provide the DHS 3531 to people who ask to apply for long term care services and other applicants who are known to have disabilities or be age 65 and over. However, do not require the DHS 3531. Accept a HCAPP or CAF. Accept the DHS 3351 from people who are requesting health care but are under age 65 and do not have disabilities if they submit one instead of a HCAPP or CAF. See §0904.05.03 (When to Require an Application) and §0904.05.05 (When Not to Require an Application).

The Minnesota Medical Assistance Breast and Cervical Cancer Coverage Group Application/Renewal, known as the MA-BC Application/Renewal Form (DHS 3525), is used for women who are screened and found to need treatment through the Sage Screening Program. See §0907.19.13 (MA for Breast/Cervical Cancer (MA-BC).

Accept all signed and dated applications. Follow up with the applicant to obtain any missing information. See §0904.07.05 (Application Follow Up).

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***This version of the manual is no longer in effect as of December 1, 2006.***

Current Manual

WHEN TO REQUIRE AN APPLICATION 0904.05.03

MinnesotaCare:

Require a HCAPP in the following situations:

• A person or household applies for MinnesotaCare for the first time. EXCEPTION: Do not require a HCAPP (DHS 3417) for MinnesotaCare when people apply for health care programs on a CAF or HCAPP for People with Disabilities and Seniors Age 65 and Over (DHS 3531). Use the CAF or DHS 3531 to determine eligibility for all health care programs. Counties that are not enrollment sites will transfer the CAF or DHS 3531 to MinnesotaCare Operations if there is no MA/GAMC eligibility OR the applicant specifically requests MinnesotaCare only. • A previously enrolled person or household reapplies 11 or more months after they last completed an application or renewal form. If the household reapplies 11 months or less after the date of the last application or renewal, update the information and determine eligibility without requiring a new application.

EXAMPLE:

Pam applies for MinnesotaCare on June 15, 1998, and is enrolled effective August 1. Her coverage is canceled effective March 1999. She calls on July 20, 1999, to request coverage. Require a new HCAPP since it has been 13 months since she last completed an application and there is no renewal form on file.

• A previously denied individual or household reapplies more than 11 months after they last submitted an application. • A person or household who applied for MA or GAMC and was denied asks to have the application transferred to MinnesotaCare more than 11 months after the MA or GAMC application date. • One or more people who request MinnesotaCare on a HCAPP are required to be in a separate household from the primary applicant if the original application is not signed by the second household and/or does not have sufficient information to determine eligibility. In that case, send an application to the second household. Instruct them to return it as soon as possible to the representative who is assigned the original application. For purposes of determining the order in which the application is processed, consider the date of application to be the date MinnesotaCare received the first application.

EXAMPLE:

Application is received for James, Judy, and their 3 sons, ages 16, 17, and 22, on March 5. The application is assigned to a worker for processing on March 20. The worker determines that the 22-year-old must be a separate household. See §0908 (Household Composition). The 22-year-old has not signed the application. Send him an application with instructions to return it as soon as possible. Do not delay processing the application for the rest of the household. Assign the returned application to the worker handling James and Judy’s case as soon as it is received. The application date for the second application will be the same as for the first application.

• People leave an existing MinnesotaCare household and request MinnesotaCare for themselves.
See §0915.05 (Removing a Person From the Household).

M.S. 256L.05 subd. 3a, 3b

Minnesota Rule 9506.0020 subp. 6

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MA/GAMC:

Use the HCAPP (DHS 3417) as the application form for MA and GAMC unless:

The household contains people with disabilities or people who are age 65 and over. Use the HCAPP for People with Disabilities and Seniors Age 65 and Over (DHS 3531). However, if a disabled or elderly applicant submits a HCAPP or CAF, accept that application. See §0904.07.05 (Application Follow Up). • The household is requesting cash or food stamps. Use the CAF. The household must have a personal interview for cash and Food Stamps. If the applicant fails to attend the interview or uses the CAF to request only health care, do not require an interview as a condition of eligibility. See §0904.05.05 (When Not to Require an Application).

Require an application in the following situations:

• An individual or household not requesting cash or food stamps applies for MA or GAMC for the first time. • An individual or household previously denied MA or GAMC reapplies more than 45 days after the date of the previous application. If the individual or household reapplies within 45 days, reinstate the denied application. • A previously enrolled individual or household reapplies after the effective date of MA or GAMC termination.
EXCEPTION:Do not require a new application if former GHO enrollees are rehospitalized within 6 months of the date of the most recent application.
• People active on a health care program request a different health care program unless they meet one of the exceptions in §0904.05.05 (When Not to Require an Application). • People receiving cash or food stamps request MA or GAMC after the agency has acted on the CAF. If pending cash or food stamp applicants request MA or GAMC in addition to or instead of the program(s) they originally requested, allow them to amend the pending CAF to include MA or GAMC. • People leave a household and request MA or GAMC for themselves and they are not person 01 on MAXIS. If the primary applicant leaves the household, request a new application signed by the primary applicant remaining in the household. • The household asks to add members when the only household member on MA is an auto newborn and the household has not completed an application or renewal form within the past 12 months.

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***This version of the manual is no longer in effect as of December 1, 2006.***

Current Manual

WHO MAY APPLY 0904.05.03.03

Require all applicants age 18 or over who are requesting health care coverage for themselves to sign the application unless the household consists only of people under 18 applying on their own behalf. In that case, require the signature of the primary applicant under 18. Also require the signature of the authorized representative if the household designates one. See §0904.11 (Authorized Representatives). Pend applications for applicants age 18 and over who do not sign the application. Send the HCAPP Signature Page (DHS 3417a) with the Request for Signatures Form Letter (DHS 3555, available only on edocs) to obtain the missing signatures. Deny eligibility for applicants age 18 and over who did not sign if they do not return the DHS 3417a by the end of the processing period.

When only one spouse of a married couple is requesting health care, do not require the other spouse’s signature. If a health care application is for children under age 18 only, require the signature of only one parent, stepparent, guardian, or relative caretaker.

EXAMPLE:

John and Barbara apply for coverage through either MA or MinnesotaCare for themselves and their 2 children. John completes and signs the application. Barbara must also sign the application. Send the DHS 3417a with the DHS 3555 to obtain Barbara’s signature. She cannot be approved for MA for herself until she returns the signature form. Neither John nor Barbara can be approved for MinnesotaCare without her signature because of the All or Nothing Rule. The children are under age 18. John’s signature is sufficient to approve either MA or MinnesotaCare for the children. If either child was age 18 or over, the child would also be required to sign.

Use the DHS 3417a to obtain the signatures of adults age 18 and over who move into an enrollee’s household and request health care coverage for themselves if they are not required to complete a new application. Provide them with a copy of the Rights and Responsibilities. See §0904.05.03 (When to Require an Application) and §0904.05.05 (When Not to Require an Application).

People under 18 who do not live with a parent, relative caretaker, foster parent, or legal guardian may apply on their own behalf. This includes minor caretakers and minors without children. The minor's parents may be liable for medical support or parental fees. See §0906.13.03 (Medical Support When to Refer) and §0906.13.09 (Parental Fees).

EXAMPLE:

Abe, age 17, lives in an apartment with an unrelated 19-year-old friend. Abe may apply for MA or MinnesotaCare on his own behalf. If he is eligible, determine if either parent is liable for medical support or parental fees.

EXAMPLE:

Elizabeth, age 16, lives with her infant son Jeremy. Elizabeth may apply for MA or MinnesotaCare for herself and Jeremy. If they are eligible, determine if Elizabeth's parents are liable for medical support or parental fees. Also make a medical support referral for Jeremy's father if applicable.

When people under 18 without children live with parents, relative caretakers, or legal guardians, the adult parent, caretaker or guardian must apply on the minor's behalf. See §0908 (Household Composition) to determine whether the adult may or must be included in the household and whether to deem the adult's income to the minor.

EXAMPLE:

Desmond, age 15, has lived with his grandmother Shirley for several years. His father Ken moves in with the household. Shirley applies for MA for Desmond. Ken does not need to sign the application. However, the household must provide information on Ken's income since it must be deemed to Desmond.

EXAMPLE:

Kristin, age 15, lives with her grandmother, Lana. Lana may apply for MA or MinnesotaCare on Kristin's behalf. See §0908 (Household Composition) if Lana is also requesting coverage.

Foster parents may apply for MA or MinnesotaCare on behalf of foster children. However, in most cases the county social service agency will apply for MA on the child's behalf. See §0908.03.05 (MinnesotaCare HH Size/Non-Parent Caretakers) if the foster parents wish to include the child in their MinnesotaCare household.

If a minor does not live with parents, guardians, relative caretakers, or in a formal placement arrangement, the person or agency legally responsible for the child must apply.

EXAMPLE:

Talia, age 10, is living with a friend of her mother, Julia, while Julia attends school out of state. This is an informal arrangement. Julia remains the child’s legal guardian and may apply for MA on Talia’s behalf.

Make a referral to the social services department in the client's county of residence if a minor appears to be abused or neglected. Local agencies should develop their own procedures for social service referrals. The social service agency will determine what action, if any, is appropriate. Do not delay or deny eligibility pending social services action.

See the program-specific sections below when minor caretakers live with parents, guardians, or relative caretakers.

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MinnesotaCare:

When a minor caretaker lives with one or both parents, require a parent to apply on behalf of the minor and the minor's child unless you have already determined that the parents' income causes ineligibility for the minor caretaker's child OR the parents refuse to apply. The minor may then apply on behalf of his or her child only. See §0908.03 (Determining MinnesotaCare Household Size).

EXAMPLE:

Lauren, age 17, and her 2-year-old daughter Sierra live with Lauren's mother, Joanne. Lauren would like MinnesotaCare for Sierra. Joanne must file an application for the entire household. If Joanne's income causes ineligibility for Sierra or Joanne refuses to provide the necessary information, Lauren may then apply for MinnesotaCare for Sierra only. Lauren may not receive MinnesotaCare for herself separately from Joanne.

When minor caretakers live with legal guardians or relative caretakers who choose to include the minor and minor's child in their own household, the guardian or caretaker must apply. Minor caretakers applying as separate households may apply on their own behalf.

MA:

Minor caretakers who live with one or more parents may apply on behalf of themselves and their children. If the minor is requesting MA, require verification of parental income. If the parent is also requesting MA, the parent must apply.

EXAMPLE:

Lauren, age 17, and her 2-year-old daughter Sierra live with Lauren's mother Joanne. Lauren is requesting MA for herself and Sierra. Lauren may apply on her own behalf. Require verification of Joanne's income since it must be deemed to Lauren. If Lauren requests MA for Sierra only, do not require verification of Joanne's income.

When minor caretakers live with legal guardians or relative caretakers, either the minor or the guardian or caretaker may apply on behalf of the minor and/or the minor's child.

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***This version of the manual is no longer in effect as of December 1, 2006.***

Current Manual

WHEN NOT TO REQUIRE AN APPLICATION 0904.05.05

MinnesotaCare:

Do not require a HCAPP in the following situations:

• A person is added to an existing MinnesotaCare household. Gather the necessary information to add the person. See §0915.03 (Adding a Person to the Household). • People reapply for MinnesotaCare after a break in coverage if 6 months or less have elapsed since they last completed an application or renewal form. If more than one month has elapsed since the last application or renewal, contact the applicant to update the information on the last form completed. See §0904.05.09 (Updating the Application).

EXAMPLE:

• Georgia applies for MinnesotaCare on January 3 and is enrolled effective May 1. Her coverage terminates effective July 1. She calls in July to reapply. Do not require a new HCAPP since it has been less than 6 months since she completed her application. Update the application since more than one month has elapsed since coverage ended.
• People who applied for MA or GAMC and were denied request MinnesotaCare within 6 months of the application date. • People who were denied or pended awaiting payment but failed to make the initial premium payment reapply 6 months or less after the date of the last application. Contact the applicant to update the information on the last application. See §0904.05.09 (Updating the Application).

EXAMPLE:

Stuart applies for MinnesotaCare on April 10, 1998, and is pended awaiting payment on April 25. No payment has been received as of August 1. He calls in September requesting coverage. Do not require a new HCAPP since less than 6 months have elapsed since he completed his application. Update the previous application.

• People who live together but must be in separate MinnesotaCare households apply on the same HCAPP. Copy the HCAPP for the second household’s case file if it contains sufficient information and signatures to determine eligibility for the second household. If it does not, send the second household a separate application to complete and sign. The application date for the second application will be the same as for the first application. • A county agency or MinnesotaCare Operations determines MinnesotaCare eligibility for people who lose MA or GAMC eligibility. Determine eligibility based on information in the case record using any form completed by the enrollee, including a CAF or CAF renewal form completed within the previous 6 months. County agencies that are not MinnesotaCare enrollment sites must send the most recent application and current renewal form, if any, to MinnesotaCare Operations. If there is no renewal form on file, send the most recent application along with current case information. The date of application is the date of the most recent application or renewal form.

M.S. 256L.05 subd. 3a, 3b

Minnesota Rule 9506.0020 subp. 6

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MA/GAMC:

Do not require an application in the following situations:

• There is a change in the basis of eligibility under a specific health care program.

EXAMPLE:

Susan receives MA as a parent/caretaker. She reports she is pregnant. Do not require an application to change the basis of eligibility to pregnant woman.

• A person on MA enters or leaves long term care, regardless of which application form they completed.

EXAMPLE:

Bertha, age 78, lives in the community. She applied for MA on the HCAPP (DHS 3417) and was approved effective May 1. In October, she enters a LTC facility. Do not require a CAF or a HCAPP for People with Disabilities and Seniors Age 65 and Over (DHS 3531). Use the Information for Long-Term Care (DHS 3543) to gather the additional information.

• An applicant submits a form designed for a different population. For example, do not require a person with a disability who submits a DHS 3417 HCAPP to complete a DHS 3531 HCAPP. Contact the applicant to gather any missing information. • People are added to the household. Gather information needed to determine the new member’s eligibility. EXCEPTION: Require an application if the household asks to add new members when the only person on MA is an auto newborn and the household has not completed an application or renewal form within the past 12 months. • People are receiving MA or GAMC automatically with MSA or GA and the cash assistance ends. Gather sufficient information to determine if eligibility for MA or GAMC continues under another basis.

EXAMPLE:

John is receiving GA. He reports he started a job and his income will exceed GA standards. Do not require a new application to redetermine eligibility for GAMC. Determine if his income will remain within GAMC limits (or if he can meet a spenddown, if necessary).

• People who live together but must be in separate MA or GAMC households apply on the same CAF or HCAPP. Copy the CAF or HCAPP for the second household’s case file if it contains sufficient information and signatures to determine eligibility for the second household. If it does not, send the second household a separate application to complete and sign. • A person receiving QMB, SLMB or QI requests MA. Note that people cannot receive QI and MA concurrently. See §0907.21.09.03 (Medicare Savings Programs: QMB), §0907.21.09.05 (Medicare Savings Programs: SLMB), and §0907.21.09.09 (Medicare Savings Programs: QI). • People meet the criteria in §0904.09 (Shared and Transferred Applications). • The following people convert from GAMC to MA:
• Pregnant women. • People with Acquired Immune Deficiency Syndrome (AIDS). • People initially approved for GAMC pending the State Medical Review Team’s disability determination. • People who did not report a disability when initially approved for GAMC but are later found to be disabled by SSA or SMRT. • People leaving an Institution for Mental Diseases. • People turning age 65.
• The following people convert from MA to GAMC:
• GA/MA recipients reach age 21. • People enter an Institution for Mental Diseases. • People are initially eligible for MA but will become eligible for GAMC within 45 days of the date of application, or are initially eligible for GAMC but will become eligible for MA within 45 days of the date of application. • MinnesotaCare enrollees request MA or GAMC if they have completed a Health Care application or renewal within the previous 45 days. • People who were approved for GAMC Hospital Only (GHO) are rehospitalized and again request GHO within 6 months of the most recent application.

DO require an application in other circumstances when people on one health care program request another program. This includes people who no longer meet a basis of MA eligibility, such as MA-only recipients who reach age 21, unless specifically listed above; GAMC recipients who acquire an MA basis unless specifically listed above; and MinnesotaCare enrollees requesting MA or GAMC if it has been more than 45 days since the most recent MinnesotaCare application or renewal.

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***This version of the manual is no longer in effect as of December 1, 2006.***

Current Manual

FORMS FOR NEW APPLICANTS 0904.05.07

Provide only the HCAPP (DHS 3239 or DHS 3417) to people who want to apply only for the health care programs (other than LTC or EW). Do not include informational brochures or supplementary forms.

Applicants and enrollees may need to complete additional forms to complete the application process, such as:

• Health Insurance Information Form, DHS 1922b. The information on this form is also included in the HCAPP. Do not require the DHS 1922b if the applicant supplies the information on the HCAPP or by other means, such as providing the information by phone or submitting copies of insurance cards. • Medical support referral forms, including:
• Important Information on Child and Medical Support Services, DHS 3163C. Medical Support Referral Form, DHS 3163B. Good Cause Form, DHS 2338.

See §0906.13.03 (Medical Support: When to Refer) for information on who must complete these forms.

• Medical Services Questionnaire (MSQ) DHS 2237. Agencies may use MSQs to gather information about current or pending third party liability. However, do not submit the MSQ to Benefit Recovery. Record the information on the MAXIS ACCI screen. See §0910.13 (Third Party Liability). • Managed care enrollment information for eligible applicants who are required or volunteer to enroll in managed care. See §0914.03.05 (Managed Care Enrollment Process) and §0914.03.05.03 (Managed Care Enrollment Presentations) for a list of information to include in managed care education and enrollment packets.

MinnesotaCare:

Follow general provisions.

MA:

See the DHS Combined Manual for a list of forms to include with the CAF.

Do not include other forms or brochures with the HCAPP. Follow general provisions for supplementary forms for applicants who apply on the HCAPP.

Do not require forms or verifications not prescribed by DHS as a condition of eligibility regardless of which application form is used.

EXAMPLE:

County A has developed a form that includes specific information about the agency’s hours of operation, other resources available in the county, instructions on how and when to reach the worker to report changes, etc. The form also includes some of the client rights and responsibilities that are incorporated on the application form. County A may send this form to applicants at the time of approval. Do not include the form with the HCAPP or require the applicant to sign and return it.

GAMC:

Follow general provisions, except that GAMC applicants must complete Required Questions for General Assistance Medical Care (GAMC) (DHS 3423). See §0906.17 (Technical Requirements --GAMC).

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***This version of the manual is no longer in effect as of December 1, 2006.***

Current Manual

UPDATING THE APPLICATION 0904.05.09

MinnesotaCare:

Do not require a new application for people who reapply following a denial or termination if the household has completed an application or renewal form within the last 11 months. See §0904.05.05 (When Not to Require an Application). Update the information on the last application or renewal form if more than one month has elapsed since the form was completed, OR if the household was denied for failure to provide information. See §0904.07.07 (Pending the Application).

If a terminated household who reapplies has not completed an application within the past 11 months but has submitted a renewal within the past month, use the renewal form as the application.

Update applications by phone whenever possible. If you cannot reach the household by phone, request the information by mail either through a letter or memo or by sending copies of the pages of the application that require updates.

Review the information on the last application with the household. Ask the household if they have experienced a change in any eligibility factors, including:

• Residence and address. See §0906.05 (State Residence) and §0914.03.07 (Health Plan Changes). • Household composition. See §0908 (Household Composition). • Other health coverage. See §0910 (Other Health Coverage). Require a HIIF if the household reports a change in other coverage. • Income. See §0911 (Income). Require verification if the household reports a change in income.

Document results of the update in the case record. Use the updated information to determine the household’s eligibility and premium amount.

Minnesota Rule 9506.0040 Subp. 2

MA/GAMC:

No provisions. See §0904.05.03 (When to Require an Application).

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***This version of the manual is no longer in effect as of December 1, 2006.***

Current Manual

ACCEPTING AND PROCESSING APPLICATIONS 0904.07

Although the two versions of the HCAPP (DHS 3417 and DHS 3531) and the CAF are each designed for specific populations, accept any DHS-approved health care application. See §0904.05 (Health Care Application Forms).

MinnesotaCare:

People may mail, fax, or bring the application to MinnesotaCare Operations or to a county agency. If a county agency that is not a MinnesotaCare enrollment site receives an application for someone who is requesting only MinnesotaCare, the county agency will forward the application to MinnesotaCare Operations.

If MinnesotaCare Operations receives an application from someone who is requesting only MA or GAMC, forward it to the person’s county of residence.

Minnesota Rule 9506.0030 Subp. 1

M.S. 256L.05 Subd. 1

MA/GAMC:

In most cases, people file applications for MA or GAMC with their county of residence. When the county of financial responsibility is different from the county of residence, people may file the application with the county of financial responsibility. People may file applications at other locations in the following situations:

• People requesting only MA or GAMC may mail an application to MinnesotaCare Operations. If MinnesotaCare Operations receives an application for someone requesting only MA or GAMC, MinnesotaCare Operations will forward the application to the county of residence. • Residents of Regional Treatment Centers (RTCs) may file applications with the RTC reimbursement officer. The RTC reimbursement officer will take the application and forward it to the county of residence for processing. • Authorized representatives applying on someone’s behalf may apply in the client’s county of residence, the authorized representative’s county of residence, or the county of financial responsibility if different. See §0904.11 (Authorized Representatives) and §0906.07 (County Residence).

Forward the case to the client’s county of residence after processing.

• Children and pregnant women who are applying only for MA may apply at locations other than the county agency. Some hospitals and clinics are mandatory outstation locations. Accept applications filed at outstation locations in your own and other counties.

Counties with outstation locations must work with the outstation site to ensure that applications are available. No interview is required. See §0904.07.05 (Application Follow Up). Outstation staff may assist applicants in completing the forms and obtaining verifications, or county agencies may supply staff on request.

• Authorized providers may accept applications and determine presumptive eligibility for MA for Breast and Cervical Cancer (MA-BC). See §0907.19.13 (MA for Breast and Cervical Cancer MA-BC). • Providers may assist applicants who are unable to request health care at the time of admission to a facility in submitting a request for assistance to the county agency. See §0904.07.03 (Date of Application).

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***This version of the manual is no longer in effect as of December 1, 2006.***

Current Manual

APPLICATIONS IN ADVANCE OF INMATE’S RELEASE 0904.07.01

People scheduled for release from correctional institutions may apply for health care 45 days before their scheduled release date. Department of Corrections (DOC) case managers assist the inmate in completing the HCAPP and the Individual Discharge Information Sheet (IDIS) (DHS 3443). The case manager sends the HCAPP and IDIS to the county in which the inmate resided before entering the correctional system unless the previous county of residence is unknown or the inmate came from another state. In those cases, the case manager sends the HCAPP and IDIS to the county in which the inmate plans to live.

Review the application to determine if verifications are needed. If the inmate anticipates receiving earned or unearned income, accept a statement of estimated income to determine eligibility. If other verifications are needed, send a verification checklist and pend the application.

When verifications are received, or if no verifications are needed:

1. Determine eligibility for MA first. If ineligible for MA, determine eligibility for GAMC. If there is no eligibility for GAMC, refer for a determination of MinnesotaCare eligibility. 2. Enter the correctional facility’s address as the mailing address. If eligibility exists, approve the application according to the program-specific instructions in this section. 3. Enter a worker comment on the approval notice stating eligibility starts the date of release. The MA ID card and approval notice will be mailed to the correctional facility. The facility will give the card to the inmate on the date of release. 4. If the inmate fails to provide a new address within 30 days of the release date, update the mailing address to the address of the field service agent listed on the IDIS. Terminate coverage for the first available month with 10-day notice. This will allow the field agent to assist with providing required information to continue coverage. Reinstate eligibility if appropriate when the needed information is received.

MinnesotaCare:

Pend the application if verifications are needed. The case will auto-deny if verifications are not received within 30 days.

If verifications are received or none are needed, determine eligibility. If the applicant meets all eligibility factors, pend awaiting payment immediately to allow billing to occur.

MA:

Approve eligible applicants effective the first day of the month of release.

GAMC:

Approve eligible applicants effective the date of release.

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***This version of the manual is no longer in effect as of December 1, 2006.***

Current Manual

DATE OF APPLICATION 0904.07.03

The date of application determines the order in which MinnesotaCare Operations processes applications. It also determines the earliest possible beginning date of coverage for MA or GAMC. See §0904.07.09 (Eligibility Begin Date).

Record the application receipt date on the application form. Use of a date stamp is recommended.

MinnesotaCare:

The date of application is:

HCAPP SUBMITTED TO MINNESOTACARE OPERATIONS OR A COUNTY AGENCY

• The date a signed and dated HCAPP (DHS 3417 or DHS 3531) containing at least the applicant’s name and address is received by MinnesotaCare Operations or by a county agency, regardless of whether the county agency is a MinnesotaCare enrollment site. Accept faxed applications to set the application date and determine initial eligibility. • County agencies transfer applications to DHS when the county agency is not an enrollment site, or when a type 3 enrollment site receives applications from people who are not current contacts. See §0904.03.03 (MinnesotaCare Enrollment Sites) for a description of enrollment site types.

CAF SUBMITTED TO COUNTY AGENCY

• The date of application is the date a signed and dated CAF Page I is submitted to a county agency for applicants who request MA or GAMC on a CAF. If there is no MA or GAMC eligibility OR the applicant specifically requests MinnesotaCare only on a CAF, use the CAF to determine MinnesotaCare eligibility. Do not require a HCAPP. County agencies that are not MinnesotaCare enrollment sites will forward the CAF to MinnesotaCare Operations if there is no eligibility for MA or GAMC.

ACTIVE MA OR GAMC CASE CLOSED

• County agencies that are MinnesotaCare enrollment sites will determine MinnesotaCare eligibility for enrollees who lose MA or GAMC because of income or assets using available information in the case file. The date of the MinnesotaCare application is the date of the most recent application, annual renewal, or 6-month renewal. • County agencies that are not MinnesotaCare enrollment sites transfer cases for enrollees who lose MA or GAMC because of income or assets to MinnesotaCare Operations. See §0904.05.05 (When Not to Require an Application). The date of application is the date of the most recent application or renewal form on file.

RENEWAL SUBMITTED IN THE 11 MONTHS BEFORE REAPPLICATION

• If a terminated household reapplies within 11 months of submitting a renewal form, the date of application is the date the renewal form was received.

Pend unsigned applications and return them to the household for signature.

MinnesotaCare Operations processes applications in the order received. Applications forwarded from the county agency are placed in order according to the date the county received them.

Process MinnesotaCare applications received by DHS or a county enrollment site within 30 days of the application date. Process applications forwarded to DHS from county agencies within 30 days of the date MinnesotaCare receives the application from the county. In all cases, the eligibility begin date is the first of the month following receipt of the initial premium payment, unless a household member is hospitalized on that date. See §0904.07.09 (Eligibility Begin Date).

M.S. 256L.05 subd. 4

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MA:

The date of application is the date a county agency, MinnesotaCare, an RTC reimbursement officer, or a designated outstation receives a signed and dated request including at least the applicant’s name and address. The request may be a CAF Page I, either version of the HCAPP, the Request to Apply for Minnesota Health Care Programs (DHS 3417B), or any other written request containing the required information. Applicants or their authorized representatives must submit a CAF or HCAPP completed to the best of the applicant’s ability before eligibility can be determined.

The date of application for MA-BC for women approved for presumptive eligibility is the date the provider grants presumptive eligibility. The date of application for women not approved under presumptive eligibility is the date the county agency receives the MA-BC Application/Renewal Form (DHS 3525). See §0907.19.13 (MA for Breast/Cervical Cancer (MA-BC).

Although the two versions of the HCAPP are designed to meet the needs of specific populations, accept any DHS-approved health care application.

Process MA applications within the following time frames:

• 15 days for a pregnant woman. If the woman requests an in-person interview, schedule the interview within 5 days of the date of application. Determine eligibility within 10 days of the date of the interview. • 60 days for people whose eligibility is based on disability. • 45 days for all other applicants.

For applications received from MinnesotaCare, the processing time frames begin the date the county agency receives the application.

GAMC:

The date of application is the date a county agency, MinnesotaCare, an RTC reimbursement officer, or a designated outstation receives a signed and dated request including at least the applicant’s name and address. The request may be a CAF Page I, either version of the HCAPP, the Request to Apply for Minnesota Health Care Programs (DHS 3417B), or any other written request containing the required information. Applicants or their authorized representatives must submit a CAF or HCAPP completed to the best of the applicant’s ability before eligibility can be determined.

If applicants are unable to submit a written request for GAMC because of illness or incapacity, a health care provider may submit the request on their behalf. If the applicant is unable to supply basic identifying information such as name and address, the provider may use a unique identifier, such as the patient ID or chart number, to submit the request. Accept all applications or written requests submitted by providers to set the date of application. Assume that the applicant was unable to submit the request. The provider does not have to be the applicant’s authorized representative. The applicant or an authorized representative must submit a completed application before eligibility can be determined. It is the applicant or authorized representative’s responsibility to complete the application and supply all necessary information and verifications.

For after hours, weekend and holiday hospital admissions, accept provider requests that were faxed or delivered to the county agency on the date of admission, even if no county staff was available to receive the request. In-person delivery would include methods such as placing the request in a designated after hours mail drop.

Process GAMC applications within 45 days.

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***This version of the manual is no longer in effect as of December 1, 2006.***

Current Manual

APPLICATION FOLLOW UP 0904.07.05

All of the health care programs require that applications be processed as soon as possible, and within a certain number of days from the date of application. See §0904.07.03 (Date of Application). Processing standards are the maximum time allowed to process the application. Do not treat this time as a waiting period.

Processing the application means gathering and reviewing all the information you need to determine eligibility. During the processing period:

• Review the application for completeness. Do not require that all questions on the HCAPP be answered to determine if people are eligible. • Contact the applicant to complete any missing items or clarify information on the application. • Verify mandatory items. See §0904.13 (Verification) and §0904.13 .01 (Verification--MA/GAMC). • Request the original application if the application was submitted by fax. • Determine eligibility for each person requesting coverage. • Send a notice approving, pending, or denying coverage. See §0916 (Notices) and §0904.07.07 (Pending the Application).
o If the application is complete and includes all required verifications, approve or deny eligibility within the time frames in §0904.07.03 (Date of Application). If the original application was submitted by fax and includes all information and verifications needed to determine eligibility, approve the case. The household must submit the original application within 30 days of the date of the fax for eligibility to continue. If the household does not submit the original application within 30 days, send 10-day notice to terminate coverage for the first available month. o If you do not have enough information to determine eligibility, pend the application following §0904.07.07 (Pending the Application). If the original application was submitted by fax, notify the household that they must submit the original application as well as the other missing information before eligibility can be determined.

Also see the program-specific sections below.

MinnesotaCare:

Review the application and any verifications included with it as soon as it is assigned to you. If an applicant requests a personal interview, schedule it as soon as possible. Enter initial application data on MMIS within 2 working days. If the application is complete and contains all required verifications, process the application using standard processing procedures. Enter the necessary information on MMIS. If there is eligibility, enter the case as pending awaiting payment. See PEND AWAITING PAYMENT in §0902.27 (Glossary: Non-Citizen...) and §0904.07.07 (Pending the Application). If no one qualifies, deny the application.

If you cannot determine eligibility based on the information on the application, determine if you can get the necessary information by phone. If so, attempt to call the applicant. If the applicant provides the necessary information or clarification, process the application as soon as possible.

If you need information that you cannot get by phone or you are unable to reach the client and the information on the application is not sufficient to determine eligibility, send a pending notice with a verification request explaining what you need. See §0904.07.07 (Pending the Application).

When you receive all the information you need, process the application as soon as possible. Enter the case as pending awaiting payment if one or more members of the household qualifies. If no one qualifies, deny the application.

M.S. 256L.05 subd 2, subd 4

Minnesota Rule 9506.0030 subp 2a

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MA/GAMC:

Do not require a personal interview as a condition of eligibility. If the applicant requests an interview or is applying for health care with another program that requires an interview, go over the application forms with the applicant during the interview. Obtain and clarify missing information. Request mandatory verifications.

Schedule a personal interview upon request. Because LTC and EW eligibility determinations can be especially complex, counties may strongly encourage the applicant or authorized representative to meet with a worker, but may NOT require them to do so as a condition of eligibility. If the client or authorized representative requests an interview, the interview may be conducted by the servicing county, financially responsible county, or county where the authorized representative lives.

Enter available application information from the HCAPP, CAF, or LTC application on MAXIS within 2 working days of receiving the application, regardless of whether your agency is the county of residence. If you forward the application to another county, pend it on MAXIS first.

If the applicant is requesting only health care and no personal interview is scheduled, review the application forms and any verifications included with it for completeness as soon as you receive them. If you have enough information to determine eligibility for everyone requesting coverage, process the application. Enter the necessary information on MAXIS and MMIS and approve or deny for each person.

If you do not have enough information to determine eligibility for everyone, follow up with the applicant by phone or mail. If you need additional verifications, you may call the applicant and ask him/her to send the items or you may request them by mail. Pend the application following §0904.07.07 (Pending the Application).

Allow at least 10 days for the applicant to respond to the request for more information. If the applicant fails to respond, deny the application for failure to provide required information at the end of the processing period or 10 days, whichever is later. You must give the applicant 10-day notice of the proposed denial. See §0916 (Notices).

If you receive all the information you need, process the application right away. Enter the necessary information on MAXIS and MMIS and approve or deny for each person.

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***This version of the manual is no longer in effect as of December 1, 2006.***

Current Manual

PENDING THE APPLICATION 0904.07.07

Enter applications on MAXIS or MMIS when they are received. See the program specific sections. This is known as pending the application on the system.

All 3 health care programs also have processes to pend applications when the agency cannot determine eligibility within the processing period. MinnesotaCare also pends applications when the agency needs additional information to determine eligibility and when people are eligible but have not yet sent the first premium payment.

MinnesotaCare:

Enter information for each person in MMIS when the application is received. Check to see if each person has a PMI number. See PERSON MASTER INDEX (PMI) NUMBER in §0902.29 (Glossary: Pension...). Ensure that a PMI number is assigned for each person who does not have one. Assign a provider number and a case number. MMIS will show the case status as pending rep review (PRR) until you determine eligibility.

If you determine that anyone in the household is eligible, enter a pending awaiting payment span for each eligible person. MMIS will determine the premium amount and generate the initial premium notice. The household has 4 months from the date the case is pended awaiting payment to make the first payment. MMIS automatically activates the case when the first payment comes in and is credited to the system. If the household does not send the initial payment within 4 months, MMIS denies the case for no payment. The household must contact MinnesotaCare and provide updated information if they want MinnesotaCare after MMIS has denied the case for initial premium not received. A new application is not required if the household makes the request within 11 months of the initial application. See §0904.05.05 (When Not to Require an Application) and §0904.05.09 (Updating the Application).

If you need more information to determine eligibility, enter a pending/incomplete span on MMIS with a begin date of the 1st of the following month. Enter the appropriate pending reason codes on the RIND screen. MMIS will generate a pending notice listing the information needed to complete the application. If MMIS still shows eligibility for any household member as pending/incomplete at the time of the following month’s billing run, MMIS will generate a notice informing the household that they must submit missing information for those member(s) in 30 days. The notice will include all reasons listed on RIND. If MMIS still shows any applicant as pending/incomplete on the next month’s billing date, MMIS will send a notice denying the application.

EXAMPLE:

Teresa submits an application on March 12. The representative reviews the application on March 26 and determines that Teresa needs to supply income verification. The representative enters the pending information on MMIS with a pending span begin date of April 1. MMIS generates a pending notice requesting the income verification. If the case is still pending/incomplete on May 15, MMIS sends a notice advising Teresa that her application will be denied unless she submits the required information by June 15. If the case is still pending/incomplete on June 15, MMIS sends a denial notice.

M.S. 256L.05 subd. 2, subd. 4

Minnesota Rule 9506.0030 subp. 2a

MA/GAMC:

If an applicant submits only a CAF Part I, pend the application on PND1 on MAXIS. Follow the CAF instructions in the DHS Combined Manual and POLI TEMP. Although MA and GAMC do not require a personal interview, MAXIS will auto deny the application after 30 days for failure to attend the interview because the CAF I does not indicate which program(s) applicants are requesting.

If an applicant submits any other written request for health care programs (a signed, dated HCAPP or other written request that meets the requirements in §0904.07.03 (Date of Application), pend the application on PND2. In this case the agency knows the applicant is requesting only health care and a personal interview is not required. If you receive a partially completed application, contact the applicant to supply missing information. If the applicant fails to cooperate in supplying missing information within 45 days, deny the request for failure to follow through with the application process.

If you receive a complete HCAPP or a CAF II requesting only MA/GAMC, enter the application on PND2. Send a pending notice if you have not determined eligibility by the end of the processing period. See §0904.07.03 (Date of Application). The notice must explain the reason for the delay.

If the delay is due to the applicant’s failure to provide information, send a pending notice 10 days before the last day of the processing period. The notice must say that the agency will deny the application unless the applicant provides the information within 10 days of the date of the notice. If the client fails to respond, send a denial notice. However, do not deny if the applicant is attempting to cooperate but is having difficulty obtaining the information. Help the applicant obtain the information. If the applicant must pay a fee for a particular document and cannot afford it, pay for the document using MA or GAMC administrative funds.

For additional information on pending the application, see TEMP Manual TE02.07.243 and TE02.07.244 (REPT/PND2, MAPP, MAPS (Parts I and II) and TE02.08.006 (Reviews: Missing Verifications).

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***This version of the manual is no longer in effect as of December 1, 2006.***

Current Manual

ELIGIBILITY BEGIN DATE 0904.07.09

For MinnesotaCare, the eligibility begin date depends on the date the agency receives the 1st premium payment. Some MinnesotaCare applicants can qualify for retroactive coverage. See §0904.07.09.03, (Retroactive MinnesotaCare). For MA and GAMC, the eligibility begin date depends on the date of application, the date all eligibility factors are met, and for MA, whether eligibility is retroactive.

In most cases, people cannot be open on more than one health care program in the same month. When an applicant is already open on one program and requests a different program, the begin date of the new program must be coordinated with the termination date of the first program. When processing an application, always check MMIS to see if any members of the household are active on another health care program. Check the status of each household member. If people are open on another program, ensure that the applicant understands they cannot remain open on both programs and that their coverage may change. Coordinate opening and closing dates with the other program. See §0904.09 (Shared and Transferred Applications).

MinnesotaCare:

The eligibility begin date is the first day of the month following the month in which the agency receives the initial premium payment. The payment must be received by noon on the last working day of the month for eligibility to begin the following month.

For people who are hospitalized on the date coverage would otherwise begin, coverage begins the day after the person is discharged from the hospital.

M.S. 256L.05 subd. 3

MA:

The earliest possible begin date is the first day of the month 3 months before the month of application for people who request retroactive coverage. People must meet all of the eligibility factors, including having an MA basis of eligibility, in each of the retroactive months. Determine eligibility for each month in the retroactive period for which people request coverage. People may be eligible for some but not all months in the retroactive period.

EXAMPLE:

Georgia, age 23, applies for MA-PW on March 25. Her estimated date of conception is February 15. February is the earliest possible month of MA-PW eligibility. She is requesting retroactive coverage to December. She did not meet an MA basis of eligibility in December or January. GAMC does not allow retroactive coverage. Georgia is not eligible for December and January. Determine MA eligibility beginning in February.

Check MMIS to see if any household members had active MinnesotaCare spans during the retroactive months. For household members who were active on MinnesotaCare, the earliest begin date is the 1st of the month after MinnesotaCare is closed.

If any household members had pending, but not active, MinnesotaCare spans during the retroactive months, they may be eligible for MA for those months. Notify the MinnesotaCare representative when you approve MA.

For people who are not requesting or are not eligible for retroactive coverage, the begin date of eligibility is the first day of the month of application or the date all eligibility factors are met, whichever is later. People do not have to be eligible in the month of application. Eligibility may begin at a later date if the applicant meets all eligibility factors by the end of the processing period.

EXAMPLE:

Elmer applies for MA on November 25. He will be 65 on December 10. He does not meet an MA basis for November. He has countable assets of $2500. He has no medical bills for November and does not wish to reduce to $1000 for GAMC eligibility. He is requesting MA effective December 1. Approve the November 25 application effective December 1 if Elmer meets all eligibility factors.

Deny the application if you are unable to confirm eligibility by the end of the processing period.

The earliest date of eligibility for MA-BC is 3 months before the date of application or the first day of the month in which the woman was screened under MBCCCP, whichever is later. Women who are granted presumptive eligibility for MA-BC must be found eligible for ongoing MA-BC before retroactive eligibility is granted. See §0907.19.13 (MA for Breast /Cervical Cancer (MA-BC).

The earliest date of eligibility for MA-EPD is the first day of the month 3 months before the month of application for people who request retroactive coverage. Eligibility cannot be approved for people who have a premium until the premium is paid. Applicants who request retroactive coverage must pay the premium for each retroactive month before coverage can be approved for that month. See §0913.01.03 (MA-EPD Premiums).

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GAMC:

The earliest possible begin date for GAMC with full benefits is the date of application or the date all eligibility factors are met, whichever is later. Retroactive coverage is not available for applications received on or after 10/1/03.

The earliest possible begin date for GAMC Hospital Only (GHO) is the date of application or the date all eligibility factors including hospital admission as an inpatient are met, whichever is later.

People do not have to be eligible for full GAMC or GHO in the month of application. Eligibility may begin at a later date if the applicant meets all eligibility factors by the end of the processing period. People with planned hospitalizations, such as elective surgery, may apply for GHO up to 45 days in advance. Do not approve coverage until you confirm that the admission has taken place.

People who met an MA basis of eligibility in any of the 3 months before the month of application may be eligible for retroactive MA coverage in those months.

EXAMPLE:

Eleanor applies for GAMC on March 25. She is requesting retroactive coverage to December. She lives with her daughter, Amy, who turned 18 on December 10 and is not in high school. Eleanor met an MA-AFDC related basis in December since Amy met the definition of a dependent child. Eleanor does not have an MA basis beginning in January. Determine MA eligibility for December only. Determine GAMC eligibility beginning March 25. Eleanor is not eligible for January, February, or March 1-24 coverage because she did not meet an MA basis in those months and GAMC does not allow coverage before the date of application.

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***This version of the manual is no longer in effect as of December 1, 2006.***

Current Manual

RETROACTIVE MINNESOTACARE 0904.07.09.03

MinnesotaCare:

People who are terminated from MA or GAMC are eligible for retroactive MinnesotaCare if they:

1. Apply for MinnesotaCare within 30 days after the MA/GAMC termination. Consider enrollees to have met this requirement if:

• Their MA or GAMC closes due to excess income or assets, or because a GHO enrollee is discharged from the hospital. County agencies that are MinnesotaCare enrollment sites must determine MinnesotaCare eligibility for these enrollees without requiring a new application. County agencies that are not MinnesotaCare enrollment sites must refer the case to MinnesotaCare Operations for a mandatory MinnesotaCare determination using the most recent renewal form or application. See §0904.05.05 (When Not to Require an Application) and §0904.07.03 (Date of Application).

OR

• People who are closed for reasons other than excess income or assets submit a HCAPP no more than 1 month after MA or GAMC ends. When processing a new HCAPP, check the MMIS RELG screen to see if there is an MA/GAMC span that will be ending or has ended no more than 1 month before receipt of the HCAPP. If so, consider the application timely.

If the application was filed between 30 and 60 days of MA/GAMC termination, send a denial of retroactive MinnesotaCare if the applicant requested retroactive coverage on the HCAPP or by any other written request. Consider the applicant to have requested retroactive coverage if the HCAPP shows a request for coverage to begin any time before and/or including the month of application. No denial notice is needed if the application was filed less than 30 or more than 60 days after MA/GAMC termination.

2. Return all requested MinnesotaCare verifications by the end of the month following the month in which verifications are requested . The Retroactive MinnesotaCare Notice (DHS 3446) explains that the applicant has 30 days from the date of request to submit verifications. However, MMIS will not deny retroactive MinnesotaCare for lack of verifications until the end of the month following the request.

3. Are eligible for ongoing MinnesotaCare. Send the Retroactive MinnesotaCare Notice (DHS 3446) to clients who request MinnesotaCare within 30 days of MA/GAMC termination and are:

• Verified eligible for ongoing MinnesotaCare. Send the DHS 3446 when you determine eligibility. These applicants have met the verification requirement for retroactive MinnesotaCare.

OR

• Pended for more information. Send the DHS 3446 with the Verification Request Form (DHS 3271).

Applicants pended for more information remain potentially eligible for retroactive MinnesotaCare if they return verifications by the due date and are determined eligible for ongoing MinnesotaCare. If applicants return verifications by the due date but the verifications indicate ineligibility, deny ongoing and retroactive MinnesotaCare.

If verifications are not returned by the due date, MMIS will deny retroactive MinnesotaCare.

4. Pay the initial and optional (retroactive) MinnesotaCare premiums by the end of the month following the month of premium billing. The Retroactive MinnesotaCare Notice (DHS 3446) explains that the applicant has 30 days from the date of billing to pay the premium. However, MMIS will not deny retroactive MinnesotaCare for nonpayment until the end of the month following the request.

MMIS will deny retroactive MinnesotaCare if the initial premium is not received by the end of the month following the initial premium billing. Ongoing MinnesotaCare will remain pending for up to 3 additional months on MMIS.

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If the initial premium is received by the end of the month following the billing month, MMIS will send the optional premium notice if the household meets all requirements for retroactive coverage. The enrollee must pay the optional premium by the end of the month following the optional billing month to receive retroactive coverage. If the premiums are received, MMIS will approve retroactive MinnesotaCare from the date that MA or GAMC closed to the date ongoing MinnesotaCare began. Enrollees must accept retroactive coverage for all months in this period.

If the optional premium is not received by the due date, MMIS will deny retroactive MinnesotaCare. Ongoing MinnesotaCare remains active.

EXAMPLE:

Carol’s extended MA ends effective July 1. She is not eligible for regular MA because of income. Her county of residence is a MinnesotaCare enrollment site. She meets the requirement of requesting MinnesotaCare within 30 days of MA termination. The county worker has all information required to determine MinnesotaCare and determines that Carol and her children are eligible. The worker approves the case as pending awaiting payment on July 6 and sends Carol the DHS 3446. Carol must pay her initial premium by the end of August (the month following the month of approval) to be considered for retroactive MinnesotaCare.

Carol’s premium is received on July 23. Ongoing MinnesotaCare will begin August 1. MMIS computes Carol’s retroactive premium for July and sends the optional premium notice on July 25. Carol must pay the optional premium by the end of August to have coverage for July.

EXAMPLE:

Colleen submits a HCAPP to MinnesotaCare Operations on July 10. The worker checks the MMIS RELG screen and finds that Colleen’s MA ended June 30. She meets the requirement of requesting MinnesotaCare within 30 days of MA termination. The MinnesotaCare worker learns from the county worker that Colleen’s MA closed because she failed to return her renewal. The MinnesotaCare worker needs new income information to determine eligibility. There is not enough information to approve the case with delayed verifications. The worker pends the case for more information on July 15 and sends the DHS 3446 with the request for income information. Colleen must return the verifications by the end of August to be considered for retroactive MinnesotaCare.

The worker receives the verifications on August 3 and determines that Colleen is eligible. The worker approves the case as pending awaiting payment. Colleen’s initial premium payment must be received by the end of September to qualify for retroactive MinnesotaCare.

Colleen’s initial premium is received on September 7. Ongoing MinnesotaCare will begin October 1. MMIS computes the retroactive premium amounts for July, August and September and sends the optional premium notice on September 8. Colleen must pay the retroactive premiums by the end of October to have coverage for the retroactive months. She may not pay for only 1 or 2 months in the retroactive period.

If Colleen does not pay the optional premium for the 3 retroactive months by the end of October, MMIS will deny retroactive MinnesotaCare. Ongoing MinnesotaCare will remain active if current premiums are paid.

MMIS will generate a letter informing enrollees that coverage during the retroactive period will be fee-for-service. Enrollees who received services during the retroactive period should contact the provider and ask the provider to bill the state directly.

MMIS will base the optional premium on current household size and income. The premium amount includes all household members eligible for retroactive coverage. Apply the All or Nothing Rule if households request coverage for only some members. See §0908.11 (All or Nothing Rule).

EXAMPLE:

Jane’s MA ends on June 30 for herself and her daughter Jill. They are determined eligible for MinnesotaCare on July 10. They meet all requirements for retroactive MinnesotaCare. MMIS computes the retroactive premium for both Jane and Jill. Jane contacts her worker and says she wants retroactive coverage only for Jill. Jane did not have any bills since MA ended. The worker contacts the MMIS User Services Help Desk to request an adjustment. MMIS will not generate a replacement premium notice. The worker informs Jane of the retroactive premium amount for Jill only.

Jane cannot request retroactive coverage for only herself because parents who do not have other insurance or access to ESI cannot be covered unless eligible children are covered.

Household members who are added to an active case after losing MA or GAMC do not have to pay a premium for retroactive coverage. See §0915.03 (Adding a Person to the Household).

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***This version of the manual is no longer in effect as of December 1, 2006.***

Current Manual

SHARED AND TRANSFERRED APPLICATIONS 0904.09

The HCAPP allows people to apply for MA/GAMC and MinnesotaCare on the same form. Applications may be transferred or shared between county agencies and MinnesotaCare Operations when:

• People apply for MinnesotaCare through MinnesotaCare Operations and ask to have the application transferred to MA/GAMC if they are ineligible for MinnesotaCare. See §0904.09.03 (Transfers From MinnesotaCare to MA/GAMC). • People request health care through a county agency that is not a MinnesotaCare enrollment site and are determined ineligible for MA/GAMC. See §0904.09.05 (Transfers From MA/GAMC to MinnesotaCare). • People submit an application to MinnesotaCare Operations or to a county agency that is not a MinnesotaCare enrollment site requesting MinnesotaCare with retroactive MA or GAMC. See §0904.09.07 (MinnesotaCare With Retroactive MA/GAMC). • Disabled adults without children who are required to apply for MA submit an application to MinnesotaCare Operations and ask to have the application transferred. See §0907.15 (MinnesotaCare Adults Without Children). • GAMC applicants and enrollees who are mandatory MinnesotaCare referrals apply for or renew GAMC eligibility at a county agency that is not a MinnesotaCare enrollment site, or who apply at a county enrollment site but request to have MinnesotaCare eligibility determined at MinnesotaCare Operations. See §0907.25.09 (GAMC: Mandatory MinnesotaCare Referrals).

The HCAPP does not provide a place for applicants to designate which health care programs they are requesting. If counties that are not MinnesotaCare enrollment sites receive a HCAPP, determine eligibility for MA/GAMC. Transfer the application to MinnesotaCare Operations if the applicant is ineligible for MA/GAMC. Use the Inter-Agency Case Transfer Form (DHS 3195).

In most cases, do not transfer the application from MA/GAMC to MinnesotaCare or from MinnesotaCare Operations to county agencies if the reason for denial is the applicant’s failure to provide verification or to respond to attempts to contact them to follow up on the application.

EXCEPTION:

Transfer the application when the reason for denial is the client’s failure to provide information in the following circumstances:

• The applicant contacts you after receiving the denial notice and specifically asks to have the application transferred. Explain that they will need to provide appropriate verifications to the other program before eligibility can be determined. • You know that the other program will not need the missing information.

EXAMPLE:

Household requests MinnesotaCare through MinnesotaCare Operations and asks that the application be transferred if they do not qualify. They provide all required information except information about past insurance. MinnesotaCare cannot determine eligibility without this information and has been unsuccessful in obtaining it for the applicant. Because MA/GAMC needs information on current insurance only, and the household has no current insurance, transfer the application.

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County agencies that are Type 1 or Type 2 MinnesotaCare enrollment sites do not transfer applications to MinnesotaCare Operations unless a mandatory GAMC referral requests to have eligibility determined at MinnesotaCare Operations. The county agency determines eligibility for both programs. If applicants want to apply for MinnesotaCare only at a Type 1 or Type 2 enrollment site, they must notify the county agency verbally or in writing that they do not want eligibility determined for MA/GAMC. County agencies that are Type 3 MinnesotaCare enrollment sites transfer applications for MinnesotaCare only to MinnesotaCare Operations if the household does not meet the definition of current contact. See §0904.03.03 (MinnesotaCare Enrollment Sites) and §0906.07.03.01 (MinnesotaCare Enrollment Site Transfers) for information on case transfers in these situations.

If counties that administer multiple health care programs receive an application requesting all programs, determine eligibility for MA/GAMC first unless the applicant has requested a determination for MinnesotaCare only. If the applicant is ineligible for MA/GAMC or has a spenddown, determine eligibility for MinnesotaCare. If the applicant is eligible for MA/GAMC with a spenddown and MinnesotaCare, consult with the client to determine program choice.

In most cases, people who are terminated from MA or GAMC due to excess income or assets do not need to submit a new application to have MinnesotaCare eligibility determined. See §0904.05.05 (When Not to Require an Application).

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***This version of the manual is no longer in effect as of December 1, 2006.***

Current Manual

TRANSFERS FROM MINNESOTACARE TO MA/GAMC 0904.09.03

MinnesotaCare:

If you deny coverage for someone who has requested transfer to MA/GAMC, forward the original HCAPP and all other forms and information obtained during the application process to the applicant’s county of residence with the Inter-Agency Case Transfer Form (DHS 3195). Retain copies of all information except medical bills. Add an insert to the client’s denial notice explaining that the application has been transferred.

When a disabled adult without children who receives SSI, RSDI, or other disability-based benefits applies for MinnesotaCare, determine if the person must be referred to apply for MA. See §0907.15 (MinnesotaCare Adults Without Children). If yes:

• If the HCAPP indicates a request to transfer the application to the county if there is no MinnesotaCare eligibility, send the original application and other available information to the applicant’s county of residence. Send a notice advising the applicant that you have transferred the application and that the applicant must cooperate in the MA determination. Determine MinnesotaCare eligibility for up to 60 days while the MA application is pending. • If the HCAPP indicates a request for MinnesotaCare only, send a notice advising the applicant of the requirement to apply for MA. Give the applicant a choice between having the HCAPP transferred or contacting the county directly. The notice will inform applicants that they must cooperate with the MA determination and that they will have to complete a new HCAPP if they choose to contact the county directly. The notice will advise them to contact MinnesotaCare if they want the application transferred. If they request transfer, send the original application and other available information to the county of residence.

MA/GAMC:

Review the application to determine if the applicant needs to complete additional questions that are not required for MinnesotaCare. Send MAXIS SPEC/LETR, HCAPP Referred from MinnesotaCare. If the applicant needs to answer additional questions on the HCAPP, obtain the answer by phone or send copies or the original missing pages to the applicant to complete. Do not return the entire application.

The application date is the date MinnesotaCare received the application. See §0904.07.03 (Date of Application).

Pend the application on PND2. The processing period begins the date your agency receives the application. If the application processing period is already over or it is within 10 days of the end of the processing period, MAXIS will generate a pending notice. Add worker comments explaining that you have just received the application. SPEC/LETR, HCAPP Referred from MinnesotaCare, also explains the processing period.

The date MinnesotaCare received the HCAPP cannot be entered on MAXIS in the following situations:

• There is an existing MAXIS case for cash or Food Stamps with a more recent application date.

EXAMPLE:

John applied for MinnesotaCare on October 5. MinnesotaCare denied coverage on November 15 due to other health insurance and transferred the application to the county for GAMC. John has a pending application for Food Stamps on MAXIS with an application date of November 10. Enter a GAMC application date as follows:

• If Food Stamps is pending or active, enter November 10 as the GAMC application date. This is the earliest date MAXIS will accept. • If Food Stamps was denied and the MAXIS case is inactive, use reapplication procedures to enter the GAMC application date. Enter an application date of November 11 (1 day after the Food Stamp application date).
• There is an existing MAXIS case with an MA/GAMC application date earlier than the HCAPP date.

EXAMPLE:

Mark applied for MinnesotaCare on October 5. MinnesotaCare denied coverage on November 11 due to other health coverage and transferred the application to the county for MA. When the county worker attempted to enter the application date on MAXIS, she discovered that Mark had submitted a separate MA application to the county on November 10. MAXIS will not allow entry of the October 5 date.

Leave the existing November 10 MA application date. If Mark is requesting retroactive MA for July, you will receive a warning edit when you enter a budget period beginning more than 3 months before the November application date. Transmit past the warning edit and enter the correct application date in MAXIS case notes and on the RELG screen in MMIS.

• The application date is earlier than the date previously active MA or GAMC was closed on MAXIS.

EXAMPLE:

Mary’s MA was closed on MAXIS effective November 11. She submitted an application to MinnesotaCare on October 28. MinnesotaCare denied coverage on November 15 and transferred the application to the county for MA. MAXIS will not allow entry of the October 28 application date because MA was still active. If Mary is eligible for MA, use the REIN function to approve the application. FIAT a new eligibility version for November.

If Mary is not eligible for MA, the MAXIS case will remain closed. Generate a manual notice denying the new application. Enter the correct application date in MAXIS case notes and on the MMIS RELG screen.

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***This version of the manual is no longer in effect as of December 1, 2006.***Current Manual

TRANSFERS FROM MA/GAMC TO MINNESOTACARE 0904.09.05

MinnesotaCare:

When a county transfers an application to MinnesotaCare, the county agency will forward the complete original application with the Inter-Agency Case Transfer Form (DHS 3195) and appropriate forms and verifications. The application will be assigned for processing based on the original date of application. See §0904.07.03 (Date of Application).

When you receive the application to process, review the application and the accompanying forms and verifications. Determine if the client needs to answer additional questions or provide more verifications. Contact the client by phone or mail to get the additional information. If the applicant needs to answer additional questions, obtain the answers by phone or mail the necessary pages of the application to the applicant for completion. Do not return the entire application.

• Process the application following §0904.07.05 (Application Follow Up) and §0904.07.07 (Pending the Application).

M.S. 256L.05 subd. 2, subd. 4

Minnesota Rule 9506.0030 subp. 2a

MA/GAMC:

If you deny MA or GAMC, forward the complete original application with the Inter-Agency Case Transfer Form (DHS 3195) to MinnesotaCare Operations if your county is not a MinnesotaCare enrollment site. Include the following if applicable:

• Tax forms and related schedules for self-employed applicants. • Wage verification including pay stubs or employer statements. • Pregnancy verification. • Notes or letters from the client. • Original Health Insurance Information Form (HIIF, DHS 1922b) if this information is not on the HCAPP. • Third party liability information. • Original child support forms including good cause documentation, if applicable. See §0906.13 (Assigning Rights to Medical Support).

Do not transfer the case file. Do not include old applications or items you know are not required for MinnesotaCare eligibility. Follow your agency’s procedures for retaining copies of the transferred information.

Add worker comments to the denial notice stating that you have transferred the application to MinnesotaCare.

Transfer applications and renewals from GAMC applicants and enrollees who meet mandatory MinnesotaCare referral criteria if your agency is not a MinnesotaCare enrollment site, or your agency is a MinnesotaCare enrollment site but the client requests to have eligibility determined at MinnesotaCare Operations. See §0907.25.09 (GAMC: Mandatory MinnesotaCare Referrals).

Determine MinnesotaCare eligibility when people become ineligible for MA or GAMC due to income or assets. This can occur at the time of renewal, income review or when an enrollee reports a change. If your county is not a MinnesotaCare enrollment site, refer the case to MinnesotaCare Operations within 5 working days. Include the complete most recent application and renewal form as well as current case information listed above.

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***This version of the manual is no longer in effect as of December 1, 2006.***Current Manual

MINNESOTACARE WITH RETROACTIVE MA 0904.09.07

Applicants who request ongoing MinnesotaCare with retroactive MA may submit the HCAPP to MinnesotaCare or their county of residence. If MinnesotaCare Operations receives an application requesting retroactive coverage, immediately send the original HCAPP with the Inter-Agency CaseTransfer Form (DHS 3195) and any verifications included with the HCAPP to the applicant’s county of residence. Work with the county agency to process the applications simultaneously.

Follow policies governing program overlap. In most cases people cannot be covered by more than one program in the same month.

MinnesotaCare:

Notify the county worker when you are ready to pend awaiting payment. The county worker will coordinate the MA closing date to avoid a lapse in coverage to the extent possible.

M.S. 256L.04 subd. 9

MA:

When county agencies receive an application requesting retroactive coverage, determine eligibility for both retroactive and ongoing MA. County agencies that are not MinnesotaCare enrollment sites should transfer the HCAPP if the applicant is ineligible for MA. County agencies that are MinnesotaCare enrollment sites will determine MA eligibility first. Determine MinnesotaCare eligibility if the applicant is ineligible for MA.

GAMC:

No provisions.

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***This version of the manual is no longer in effect as of December 1, 2006.*** Current Manual

MIXED HOUSEHOLDS 0904.09.09

The HCAPP does not ask people to specify which health care program(s) they are requesting for each household member. Follow the provisions in §0904.09 (Shared and Transferred Applications) when some household members are ineligible for the program for which eligibility is first determined.

MinnesotaCare Operations will determine eligibility for MinnesotaCare for the entire household. Transfer the application to the appropriate county agency if some members are eligible for MinnesotaCare but others are not and the household requests to be considered for MA/GAMC.

County agencies that are MinnesotaCare enrollment sites will determine eligibility for MA or GAMC and will determine MinnesotaCare eligibility for ineligible household members. County agencies that are not MinnesotaCare enrollment sites will transfer applications for ineligible household members to MinnesotaCare Operations.

***This version of the manual is no longer in effect as of December 1, 2006.*** Current Manual

MINNESOTACARE AND MA OVERLAP 0904.09.11

People cannot receive ongoing coverage from more than one health care program. In some situations, people may receive overlapping MinnesotaCare and MA for a limited period. Allow overlapping coverage when:

• MinnesotaCare enrollees eligible with benefit limits (programs XX, BB, FF or JJ) are found eligible for ongoing MA (program MA or NM). MMIS will prevent overlap with program FF. Close programs XX, BB and JJ for the first available month. • See §0907.21.07.05 (MA for Employed Persons With Disabilities) for information on MinnesotaCare enrollees who are found eligible for MA-EPD. • MinnesotaCare enrollees with an MA basis of eligibility apply for MA for hospital bills not covered by MinnesotaCare. See §0913.21.07 (MinnesotaCare Inpatient Hospitalization). • MinnesotaCare enrollees apply for and are found eligible for MA for services not covered under MinnesotaCare.

Both MinnesotaCare and MA cover some pregnancy terminations. In some cases, the procedure may be covered by MA but not MinnesotaCare. MinnesotaCare enrollees may apply for MA to cover these costs. Determine if the woman is eligible for MA-PW. Open and close MA on MAXIS and MMIS in one action. Allow overlapping coverage for the month of the service only. Leave MinnesotaCare open unless the enrollee requests ongoing MA. To ensure that these enrollees have expanded benefits during the 60-day post partum period, open program LL or KK for the 2 months following the month of pregnancy termination. Do not change the eligibility type for children under 21 on program LL or KK from C1/C2 to pregnant woman eligibility type P1/P2 as they already receive full MA benefits.

MinnesotaCare does not cover certain services such as long term care or waivered services for adults who are not pregnant women (programs XX, BB, FF or JJ). Allow coverage to overlap when MinnesotaCare enrollees apply for and are found eligible for MA to cover these services. Close MinnesotaCare for the first available month if the client needs ongoing MA. If the client received short term MA services and wishes to remain on ongoing MinnesotaCare, open and close MA in one action.

See the MMIS User Manual, MinnesotaCare Coordination of Coverage for more information.

MinnesotaCare and GAMC may not overlap. This includes people who are changing from GAMC Hospital Only (GHO) to MinnesotaCare Limited Benefit (MLB) or the reverse. In some cases, MMIS may require both programs to remain open for one month if changes occur after capitation or 10-day notice cutoff.

If it is not possible to close GAMC Hospital Only (GHO) before the approval month for MinnesotaCare, contact the MMIS User Services Help Desk to back date the GHO closing span before approving MinnesotaCare.

EXAMPLE:

Kwame is hospitalized from November 20-23. He is approved for GHO for those dates on November 28. He is then determined to qualify for retroactive MinnesotaCare Limited Benefit (MLB) starting December 1. It is not possible to close the GHO span until December 31. Contact the MMIS User Services Help Desk before approving MinnesotaCare.

EXAMPLE:

Eloise receives MLB. She enters the hospital on March 28 and voluntarily cancels MinnesotaCare the same day. April capitation has already been paid. MinnesotaCare will close at the end of April. Eloise is still hospitalized on April 1, so she requests GHO. MMIS will allow GHO and MLB to overlap for April only.

See Bulletin #99-21-1 (Prevention of Overlapping GAMC and MinnesotaCare Eligibility) dated August 13, 1999, and the MMIS User Manual for more information.

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***This version of the manual is no longer in effect as of December 1, 2006.*** Current Manual

AUTHORIZED REPRESENTATIVES 0904.11

People may authorize a representative to help with contacts with the county agency or MinnesotaCare. In most cases, authorized representatives have the same responsibilities and rights as applicants or enrollees. Authorized representatives may contact the agency, attend interviews, complete forms, provide documentation, appeal agency decisions, and receive forms, notices, and pay premiums if the applicant or enrollee wishes them to do so.

Authorized representatives must be at least 18 years old and have sufficient knowledge of the applicant or enrollee’s circumstances to provide necessary information. County or MinnesotaCare employees who determine eligibility cannot be authorized representatives.

People may designate an authorized representative by filling in the person’s name, address, phone number, and relationship in the appropriate place on the application. The authorized representative designation remains in place until revoked by the household or the authorized representative. The authorized representative and the applicant must both sign the application unless the applicant is unable to sign. Once the authorized representative has been designated, applicants/enrollees age 18 and over who have signed a previous application or renewal are not required to sign renewals. The authorized representative’s signature is sufficient. The authorized representative may respond to requests for information on the applicant’s behalf and may discuss the case with the enrollment representative. The designation on the application authorizes the exchange of information. Do not request a Consent Form in addition.

NOTE: Accept a written request, which could include but is not limited to, the DHS-3417B (Request to Apply for MN Health Care Programs). The written request might only be signed by the authorized representative. This written request does set the date of application even if the client later completes and signs a Minnesota Health Care Programs application.

If the client is unable to designate an authorized representative, the agency may allow a person who can act responsibly for the client to act as an authorized representative. This applies to people who are incapacitated or incompetent, including children who are unable to act on their own behalf.

If an active household wishes to designate an authorized representative after the initial application, provide the form Giving Permission for Someone to Act on My Behalf (DHS 3437). County agencies and MinnesotaCare must also accept the appropriate signed pages of the application or externally created statements that designate an authorized representative. External statements must be in plain language and include the following:

• The name of the authorized representative. • The agencies information may be shared with, and who the authorized representative will work with to provide information • The purpose of the information provided by the authorized representative

Accept a designation of Power of Attorney in place of another authorized representative designation if the person holding the Power of Attorney will serve as the authorized representative. A Power of Attorney is a legal document granting specified authorities to a person. If the client wishes to designate someone other than the person holding the Power of Attorney as their authorized representative for the health care programs, require a designation on the application or another written statement meeting the requirements of this section.

Potential authorized representatives for children in foster care or pre-adoptive placements include but are not limited to, social workers or other representatives of the agency that has legal custody and control of the child.

County agencies or MinnesotaCare may disqualify authorized representatives who knowingly provide false information or who are unable or refuse to provide required information. If you disqualify an authorized representative, allow the applicant or enrollee to designate a new one.

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MinnesotaCare:

Any household member who is at least 18 years old may complete the household’s application. Households may also designate family members who do not reside with the household or others who meet the criteria in the general provisions to act as authorized representatives.

If the applicant answers YES to the question on the HCAPP which asks if the applicant wants the person acting on his/her behalf to receive forms, notices, and premium notices, enter the authorized representative’s name, address and indicators on the AREP screen on MMIS.

M.S. 256L.05 subd.1a

MA/GAMC:

Regional Treatment Center (RTC) reimbursement officers cannot act as authorized representatives.

MAXIS automatically sends all notices of action to the authorized representative. If clients indicate on the HCAPP or by another means that they want the authorized representative to receive other forms such as report forms and explanations of medical benefits, enter a Y on STAT/AREP in the "Forms to AREP?" field.

If you disqualify an authorized representative based on the criteria in the general provisions, determine whether to make a vulnerable adult referral to social services.

Providers may assist applicants in submitting requests for health care. The provider does not have to serve as the applicant’s authorized representative. See §0904.07.03 (Date of Application).

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***This version of the manual is no longer in effect as of December 1, 2006.*** Current Manual

VERIFICATION 0904.13

Verification means 3rd party or other documentation of an eligibility factor. The most common sources of verification are documents in the client’s possession, such as pay stubs and immigration documents, and written verification from 3rd parties such as employers. Do not request 3rd party verification without the client’s signed permission. The signed release must identify the source and the specific information to be requested. Verifications for ongoing cases should be retained according to your agency’s retention policy. Your agency’s policy should be based on and concurrent with the retention schedule from DHS. In most ongoing cases, verification can be destroyed after three years. However, some verifications may need to be retained throughout the life of the case file. For example, alien identification cards, birth certificates, divorce decrees, employment information, and asset information should be retained throughout the life of the case up until three years after the case has closed. If records are being scanned for electronic filing purposes, the original documents are retained until the scanned documents are verified and backed up. Any verification that has been received verbally needs to be clearly case noted. See Bulletin #02-85-01 (County Human Services Records Retention Schedule.)

Do not require more than one type of verification for the same eligibility factor. For example, do not require an employer’s statement and pay stubs for the same period if one source contains all the required information. For MinnesotaCare, consider W-2s and tax forms to be a single type of verification.

Assist clients in obtaining verification if the client is unable to provide it. If neither the client nor the agency is able to obtain outside verification, accept the client’s written statement.

Verify information for which verification is not mandatory ONLY if ALL of the following conditions exist:

• The information is necessary to determine eligibility or the amount of the premium or spenddown. • The information is inconsistent with other information the agency has (or with a client's own statements). • The client cannot satisfactorily explain an inconsistency.

Document the following information in the case record:

• A description of the inconsistency. • An explanation of why verification was necessary. • A description of the verification.

MinnesotaCare:

Verify the following:

• ESI. Verify access to ESI for all employed applicants and enrollees at the time of application and renewal, and whenever a job change is reported. See §0910.11.01 (Verification of ESI). • Immigration status for people who are requesting coverage who indicate they are non-citizens. Do not require verification of U.S. citizenship. See §0906.03 (Citizenship and Immigration Status) and §0906.03.03 (Qualified Non-Citizens). • Social Security Number (SSN). Require a number for each adult and child who is requesting coverage or who is required to be included in the household under the all or nothing rule according to the instructions in §0906.11 (Social Security Number--MinnesotaCare). Do not require copies of social security cards or other documents for people who report a number. Require proof of application for an SSN for any person who does not have one. • Pregnancy. See §0907.09 (MinnesotaCare Pregnant Women) for a list of acceptable verifications. If an enrollee reports she is pregnant, change her status to pregnant woman pending verification. See §0915.13 (Enrollee Becomes Pregnant). • Earned income and unearned income. Require verification of earned and unearned income is the 30 days before application. For unearned income, accept bank statements, copies of checks, award letters or court orders. For people who are not self-employed, accept pay stubs, employer statements obtained with the client’s signed permission, the previous year’s tax forms or other documentation verifying current earnings. Request pay stubs or employer statements verifying earnings for employed clients who submit no verification of earnings with the application or renewal or who submit verifications that do not reflect current employment. Do not require additional verification if the client submits documentation reflecting current employment with the application or renewal.

EXAMPLE:

Mae submits her annual Renewal Form. She includes her previous year’s tax forms and W-2s. The W-2 for her current employer reflects 5 months of earnings. Use the W-2 to determine Mae’s earnings for the coming year. Do not require additional verification.

If Mae did not have a W-2 from her current employer, you would request other verification of current earnings.

Request the most recent year’s tax forms for self-employed people. Accept business records from people who have had a significant change since the most recent tax forms or who did not file taxes. See §0911.09.03 (Self-Employment Income).

See §0911.11 (Computing Countable Income--MinnesotaCare) and §0911.11.01 (Computing Income--MinnesotaCare - Part 2) for instructions on computing countable earned income.

For seasonally employed people, accept verification of earnings for the most recent 30-day period in which the person was seasonally employed, the most recent year’s tax forms and W-2s or other documentation reflecting the current seasonal earnings. See §0911.09.09 (Seasonal Income) for policy on computing annual income for seasonally employed people.

Verify countable earned income of all household members. Do not require verification of earnings of dependent children under age 19 who are students. See §0911.09.05 (Dependent Child Income).

• Good cause for non-cooperation with medical support enforcement. See §0906.13.07 (Good Cause Determination).

M.S. 256L.04 subd. 2b, 10

M.S. 256L.05 subd. 2

M.S. 256L.09 subd. 4

Minnesota Rule 9506.0020 subp. 1a, 1f, 1g

Minnesota Rule 9506.0030 subp. 2a

M.S. 13.46 subd. 2(a)

45 CFR part 431.17

See §0904.13.01 (Verification - MA/GAMC) for MA and GAMC verifications.

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***This version of the manual is no longer in effect as of December 1, 2006.*** Current Manual

VERIFICATION - MA/GAMC 0904.13.01

See §0904.13 (Verification) for general provisions and MinnesotaCare verifications.

MA:

Verify the following:

• Immigration status for people who are requesting coverage who indicate they are non-citizens. Do not require verification of U.S. citizenship. See §0906.03 (Citizenship and Immigration Status) and §0906.03.03 (Qualified Non-Citizens). Follow the time frames in §0906.03.11 (Verification of Immigration Status). • Social Security Number (SSN). Do not require social security cards or other documents showing the number. Require proof of application for an SSN for people who do not have one. See §0906.11.01 (Social Security Number--MA/GAMC). • Blindness and disability for people claiming a blind or disabled basis of MA eligibility. See §0906.15 (Disability Determinations). • Good cause for non-cooperation with medical support enforcement. See §0906.13.07 (Good Cause Determination). • Eligibility for state and Title IV-E adoption assistance. See §0907.19.03.05 (MA Basis: Adoption Assistance). • Pregnancy. See §0907.19.05 (MA Basis: Pregnant Women) for information on types of verification and time lines. • Enrollment in Medicare Part A when required for eligibility for QMB, SLMB, QWD, or QI. See §0907.21.09 (MA Basis: Medicare Supplement Programs). • All countable assets at application, 6 month income/asset renewal and annual renewal. Do not verify excluded assets. See §0909.05.03 (Verification of Assets).

EXCEPTION:

For spousal asset assessments, verify all assets at the time of the assessment, application, and first recertification.

• Reduction of assets on medical bills for a retroactive period. See §0909.29 (Excess Assets--Applicants). • Earned and unearned income. Require verification of earned and unearned income in the 30 days before application. Require verification of actual income received in each retroactive month for people requesting retroactive coverage. Examples of verification sources include pay stubs and employers’ statements, tax forms, copies of checks for some types of unearned income, award letters, and court orders. See the specific income sections in §0911 (Income) for more information. • Allowable self-employment expenses. Request the most recent year’s tax forms. Accept business records for people who did not file taxes or who report a significant change. See §0911.09.03 (Self-Employment Income). • See §0907.21.07.06 (MA-EPD: Employment Definition) for specific requirements for verifying earnings and self-employment income for MA-EPD. • Medical expenses to meet spenddown. See §0913.21 (Allowable Medical Bills to Meet Spenddown), §0913.21.03 (Determine Net Medical Expenses), and §0913.21.05 (MinnesotaCare Expenses to Meet Spenddown). • Long Term Care Consultation (LTCC). See the long term care sections in §0913 (Premiums and Spenddowns).

GAMC:

Verify the following:

• Immigration status for non-citizens. See §0906.03.11 (Verification of Immigration Status). • Social Security Number (SSN). See §0906.11.01 (Social Security Number--MA/GAMC). • State residence. See §0906.05.07 (State Residence--GAMC). • Liquid assets if total reported assets are within $300 of the asset limit. See §0909.05.03 (Verification of Assets). • Earned and unearned income. Require verification of earned and unearned income in the 30 days before application. Examples of verification sources include pay stubs and employers’ statements, tax forms, copies of checks for some types of unearned income, award letters, and court orders. See the specific income sections in §0911 (Income) for more information. • Allowable self-employment expenses. Request the most recent year’s tax forms. Accept business records for people who did not file taxes or who report a significant change. See §0911.09.03 (Self-Employment Income).

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***This version of the manual is no longer in effect as of December 1, 2006.*** Current Manual

CASE NOTES 0904.13.03

It is important to utilize the case note function in MAXIS and MMIS for documenting case history and retaining important information that was used in determining health care eligibility.

Case Notes should document actions that are not evident from viewing MMIS or MAXIS or the physical case file. Case Notes should include what verifications were requested, provide an explanation of how verified information was used, and also to document what calculations were made.

A written record of this information is mandatory for compliance with state and federal record retention policies as well as for legal purposes such as appeals and audits.

MinnesotaCare:

MMIS does not record case history. Document case history through the use of case notes. Include the following information:

• Household’s choice of enrollment site. • Household size. • Household members requesting MinnesotaCare coverage. • Household members not requesting MinnesotaCare coverage. • A description of how current household income was verified and calculated and whether there have been any changes. Document whether household income is below 150% FPG, 175% FPG, and 275% FPG. • Other health insurance coverage including current access to ESI. Document begin and end dates of other coverage, begin and end dates of access to ESI, and whether ESI access was verified. • Medical support issues, including decisions on good cause claims. • Immigration documentation. • Date a denied household member may be eligible in the future (for example, household members who have a 4- or 18-month wait due to other coverage). • Premium amount. • Phone calls, office visits and correspondence with a client or authorized representative. • Contacts with state/county staff or grantee agencies. • Changes in household composition, address, state residency, income, employment, insurance, pregnancy, births, deaths, name changes, benefit set, major program changes and any other factors affecting eligibility. • How and when changes were verified for factors requiring verification. • Managed care health plan changes. • Any other information needed to document case history.

MA and GAMC:

MAXIS documents case history. Use case notes to summarize client contacts and to explain or elaborate on eligibility factors or changes.

For more information see TEMP manual

TE02.08.093 (Case Note I: Intro/HH Comp)

TE02.08.094 (Case Note II: Assets/Income)

TE02.08.095 (Case Note III: Claims/Systems/Transfers) and

TE02.08.096 (Case Note IV: Basis of Elig/Changes/Other).

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