***This version of the Health Care Programs Manual has been replaced and is no longer in effect.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

The terminology used to describe people with disabilities has changed over time. The Minnesota Department of Human Services ("Department") supports the use of "People First" language. Although outmoded and offensive terms might be found within documents on the Department's website, the Department does not endorse these terms.

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

Chapter 0908 - Household Composition

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

Chapter 0908

0908

HOUSEHOLD COMPOSITION

PDF(s) Jul 98

0908.03

DETERMINING MINNESOTACARE HOUSEHOLD SIZE

PDF(s) Oct 03

0908.03.05

MINNESOTACARE HH SIZE/ NON-PARENT CARETAKERS

PDF(s) Mar 03

0908.05

DETERMINING MA/GAMC HOUSEHOLD SIZE

PDF(s) Mar 03 | Jan 03 | Apr 02

0908.07

HOUSEHOLD COMPOSITION: DEEMING

PDF(s) May 05 | Jan 05 | Aug 04 | Jul 98

0908.09

WHO MUST BE EXCLUDED FROM THE HOUSEHOLD

PDF(s) Jul 04 | Jan 99

0908.11

ALL OR NOTHING RULE

PDF(s) May 05 | Aug 04 | Oct 00

0908.13

TEMPORARY ABSENCE -- MINNESOTACARE - PART 1

PDF(s) Mar 03

0908.13.01

TEMPORARY ABSENCE -- MINNESOTACARE - PART 2

PDF(s) Jan 99 | Jul 98

0908.13.03

TEMPORARY ABSENCE -- MA/GAMC

PDF(s) Jul 98

0908.15

NURSING FACILITIES AND ICF-MR LEAVE DAYS

PDF(s) Jul 98

***This version of the manual is no longer in effect as of December 1, 2006.*** Current Manual.

HOUSEHOLD COMPOSITION 0908

Household composition determines the household size. It also affects whose income and assets to count, income standards and eligibility, and the MinnesotaCare premium amount.

Although household composition rules vary by program, all programs consider the parental and marital relationships of people who live together in determining who must be considered in the household.

Parental relationships exist between parents and their biological or adoptive children. See the program specific sections for the maximum ages at which children are included in their parents' household.

Children under age 18 who would otherwise be included in their parents' household may be excluded if they are emancipated minors. To be considered emancipated, a person under age 18 must be married or formerly married, serving in the armed forces, or emancipated by court order. In practice, court-ordered emancipation is rare in Minnesota.

Marital relationships exist between two people in a marriage legally recognized in Minnesota.

Some programs consider legal guardianship in determining household composition. A legal guardian is a person who has been court-appointed or accepted as a guardian under Minnesota statute. Generally, a legal guardian is appointed when parental rights have been terminated or a child's parents have died. It is not the same as a legal custodian, who is a person granted legal custody of a minor child by the court but who does not have legal guardianship. Request copies of guardianship papers if you are uncertain of a non-parent caregiver's legal status.

Some programs consider sibling relationships in determining household composition. Consider full or half-siblings to have a sibling relationship. Also consider stepsiblings for MinnesotaCare.

In some cases people who do not have coverage under the program are included in the household size. MA and GAMC determine eligibility on an individual basis and allow people to request coverage for some household members and not others. MinnesotaCare requires certain people to be included in the household size but may exclude people who don't meet specific eligibility requirements from coverage.

See the following sections:

§0908.03

Determining MinnesotaCare Household Size.

§0908.05

Determining MA/GAMC Household Size.

§0908.09

Who Must Be Excluded From the Household.

§0908.11

All or Nothing Rule.

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

DETERMINING MINNESOTACARE HOUSEHOLD SIZE 0908.03

Include the following people in the MinnesotaCare household:

• Parents, spouses, stepparents, and children ages birth to 21 who live in the same household. Except for temporary absences, children must live in the household at least 50% of the time to be included. See §0908.13 (Temporary Absence--MinnesotaCare - Part 1) and §0908.13.01 (Temporary Absence--MinnesotaCare - Part 2).

Consider adopted children to be members of the household beginning on the first day of the month in which they are placed for adoption.

See §0908.03.05 (MinnesotaCare HH Size/Non-Parent Caretakers) for instructions on determining the household size when foster parents and relative caretakers, or legal guardians apply for children in their home.

Emancipated minors and their spouses and children must be separate households. See §0908.09 (Who Must Be Excluded From the Household).

Count an unborn child (or children, if a multiple pregnancy is verified) in a pregnant woman's household size.

Count the following people in the same household:

• All people who have a parental OR a marital relationship. If 2 people in the same household both have a parental or marital relationship to a 3rd household member, those people will be in the same household even if they do not have a parental or marital relationship with each other. Paternity does not need to be legally established for a parental relationship to exist. Accept applicants' and enrollees' statements on the health care application unless there is contradictory information.

EXAMPLE:

Bob and Sue are an unmarried couple who live with their daughter. Because both Bob and Sue have a parental relationship to the daughter, they are included in the same household even though they have no parental or marital relationship with each other.

EXAMPLE:

George and Martha are a married couple who each have a child from a previous marriage living with them. Because George and Martha have a marital bond, and each has a parental bond with the children, include everyone in the same household.

EXAMPLE:

Debra and Mark are an unmarried couple who live together and are expecting a child. They do not anticipate a multiple birth. Debra is a household of 2. Mark is a separate household of 1 because he and Debra do not have a marital bond. Until the baby is born, he does not have a parental bond. When the baby is born, they will become a combined household of 3.

EXAMPLE:

Marsha lives with her two minor children and her friend Tim, who is not the children's father. Marsha and the children are a household of 3. Tim is a separate household of 1 because he does not have a marital or parental bond with another household member.

Follow the steps below to determine eligibility for a 3-generation household (grandparent(s), minor parent(s) and child(ren) of the minor parent(s). The household may include both parents of the third generation child.

1. Determine eligibility for the entire household. If all members are eligible, treat as a single household. 2. Determine eligibility separately for the third generation child(ren) using only the income of the minor parent(s) and the child(ren), if the third generation child(ren) are ineligible because:
• Total household income under step 1 is over 275% FPG.
OR
• Total household income under step 1 is over 150% FPG and the minor parent’s child(ren) are underinsured.
OR
• The grandparents refuse to cooperate in providing information needed to determine the 3rd generation child(ren)’s eligibility under step 1.

Set up a separate case for the third generation child(ren).

If the other parent of the third generation child(ren) also lives in the household but is not married to the minor parent include the second parent and his/her income in the calculations in steps 1 and 2 above. If total household income including any income of the second parent is equal to or less than 275% FPG, treat as a single household. If the third generation child is ineligible under step 1 or step 2, determine eligibility separately for the second parent and the third generation child. Include the minor parent in the household size and include his/her income in the eligibility calculation, but deny coverage for the minor parent .

EXAMPLE:

Anne lives with her unmarried 16-year-old daughter Sara and Sara’s 1-year-old son Jacob. Because Sara has a parental relationship with both Jacob and Anne (she is Anne’s daughter and Jacob’s mother), all 3 are included in the same household even though there is no parental relationship between Jacob and Anne. Total household income is under 275% FPG and no one in the household has other insurance or access to ESI. All 3 household members are determined to be eligible. Include all 3 on a single case.

EXAMPLE:

Bob and Grace live with their 19-year-old daughter Linda, her 1-year-old daughter Rachel, and Rachel’s father Justin. Linda and Justin apply for MinnesotaCare for themselves and Rachel. Total household income, including Bob and Grace, is over 275% FPG. Redetermine eligibility for Rachel and Justin only using a household size of 3 and Linda, Justin and Rachel’s income, if any. Linda is not eligible because her parents’ income must be counted for her.

M.S. 256L.01 Subd. 3a and subd. 13

Minnesota Rules 9506.0010 subp. 11 and 17

MA/GAMC:

See §0908.05 (Determining MA/GAMC Household Size).

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

MINNESOTACARE HH SIZE/NON-PARENT CARETAKERS 0908.03.05

MinnesotaCare:

Also see §0908.03 (Determining MinnesotaCare Household Size).

Include the following people applying as a single household:

• Foster parents and the children for whom they have primary responsibility. • Relative caretakers age 18 and over and the children for whom they have primary responsibility. See RELATIVE CARETAKERS in §0902.33 (Glossary: Quality...) for a list of eligible relative caretakers.

Consider stepparents to be parents regardless of whether the biological or adoptive parent lives in the household. Stepparents must always apply with and be counted in the stepchild(ren)’s household.

Consider relative caretakers who are also legal guardians of the children in their care to be relative caretakers when determining their major program and benefit set. See §0906.03.13 (MinnesotaCare Major Programs).

A legal guardian, foster parent or relative caretaker may apply as a family or may apply separately for the child(ren) for whom they are responsible. If the legal guardian, foster parent, or relative caretaker applies with the children, include their income along with the child's in the gross family income for determining eligibility and premium amount. If a legal guardian, foster parent, or relative caretaker applies for the child(ren) separately, count only the children’s income to determine the child(ren)’s eligibility and premium amount.

If a legal guardian, foster parent, or relative caretaker applies separately for more than one sibling in their care:

1. Determine eligibility for the children as a single household. If the children are eligible with a gross family income at or below 150% FPG, treat them as a single household.

2. Determine eligibility separately for each child if their combined gross income is at or above 150% FPG. Create a separate case for each child if:

Separate cases would result in a lower total premium for the children, and all remain eligible

OR

Separate cases allow for a greater number of children to be eligible due to underinsurance.

EXAMPLE:

Mary resides with her husband Bob, their two minor children, and Mary's niece Rebecca. Mary may apply for MinnesotaCare on behalf of her niece Rebecca without applying for herself or the rest of her family. If Mary applies separately for Rebecca, consider Rebecca as a household of 1 and count only Rebecca's income when determining her eligibility and premium amount. See §0911 (Income) for information on what types of income to include.

Mary and her family may also apply for MinnesotaCare with Rebecca. Use a household size of 5 and count all non-excluded household income. See §0911 (Income) and §0908.11 (All or Nothing Rule).

Mary may also choose to apply for herself, her spouse and her two minor children without including Rebecca. Use a household size of 4 and exclude Rebecca's income in determining eligibility and premium amount.

Require legal guardians and relative caretakers to cooperate with medical support requirements as a condition of the guardian or caretaker's eligibility. See §0906.13 (Assigning Rights to Medical Support). Legal guardians and relative caretakers who refuse to cooperate with medical support for wards or relative children for whom they apply may not reapply separately for themselves.

EXAMPLE:

Mary applies for MinnesotaCare for her niece, Rebecca. She refuses to cooperate with medical support for Rebecca. Mary's request for coverage is denied. If the rest of the family reapplies without Rebecca, Mary remains ineligible.

Do not require foster parents to cooperate with medical support requirements.

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

DETERMINING MA/GAMC HOUSEHOLD SIZE 0908.05

MinnesotaCare:

No provisions.

MA/GAMC:

Include any of these people who live with an adult in that adult's household size:

• The person's spouse. Do not consider spouses in the same long term care facility to be living together even if they are in the same room. • Biological or adoptive children under age 21 who live with the person or are considered temporarily absent from the parental home, such as students included on the parent’s case. • Biological or adoptive children under age 21 of the person’s spouse who live in the household with the MA applicant and spouse or are considered temporarily absent.

EXCEPTION:

Do not include children under 21 who live with parents in the parents’ household if the child is or has been married, is on active duty with the armed services, or has been declared emancipated by a court.

• An unborn child or children (if a multiple pregnancy is verified), if the person is a pregnant woman or the spouse of a pregnant woman.

EXAMPLE:

Kelly, age 30, lives with her husband Jason, her daughter from a previous marriage, and Jason's son from a previous marriage. Kelly is pregnant and expecting a medically-verified single birth. Kelly and Jason each have a household size of 5: Kelly, spouse, child, stepchild (because the stepchild is the financial responsibility of the spouse), and unborn child.

Do not include children other than biological or adoptive children of the person or person’s spouse (such as grandchildren, nieces, nephews) in an adult’s household size.

Include any of these people who live with a child in that child's household size:

• The child's biological or adoptive parents. • Other children who are included in the parent’s household size.

EXCEPTION:

Do not include parents or their other children in the child’s household size if the child is or has been married, is on active duty in the armed services, or has been declared emancipated by a court.

• A stepparent if a biological or adoptive parent also lives in the home. • Children of a stepparent who live in the home or are temporarily absent. • An unborn sibling or half-sibling with whom the child shares a legally established common parent. Count multiple siblings if a multiple pregnancy is verified. • The child's spouse. • The child's minor children and unborn children if the child is pregnant.

EXAMPLE:

Allie lives with her mother, Kelly, her stepfather, Jason, and Jason's son Garrett. Kelly is pregnant and expecting a medically verified single birth. Both Allie and Garrett have a household size of 5: self, parent, stepparent, stepsibling, and unborn half-sibling.

EXAMPLE:

Megan, age 18, lives with her parents, her sister, and Megan's 2-year-old son. Megan has a household size of 5: Megan, parents, sibling, and Megan's minor child. Megan's parents each have a household size of 4: parent, spouse, and children. Megan's sister has a household size of 4: sister, parents, and sibling. Megan's son has a household size of 2: son and Megan.

Use a household size of 1 for MA if:

• A person’s eligibility is based solely on the his/her own income and assets without regard to responsible relatives with whom he/she lives, except for MA-EPD. This includes a child with TEFRA eligibility and a blind or disabled child ages 18 to 21 whose eligibility is based only on the child's income and assets.

NOTE:

Count the income of the spouse of a disabled person ages 18 to 21, regardless of whether the person lives with his/her parents. Use a household size of 2.

See §0913.01.03 (MA-EPD Premiums) for MA-EPD household composition.

Use the regular MA household size and income to determine eligibility for the Medicare Savings Programs for people who receive MA-EPD, TEFRA, CAC, CADI, MR/RC and TBI. Use a household size for 1 to determine eligibility for the Medicare Savings Programs for people who receive EW and for the non-EW spouse.

EXAMPLE:

Ralph lives with his wife Shirley. He receives MA through the CADI waiver using only his income and assets and a household size of 1. To determine whether he is eligible for QMB or SLMB, use a household size of 2 and deem Shirley’s income and assets. If Shirley requests MA for herself, use a household size of 2 and deem Ralph’s income and assets. See §0907.23.03 (MA Waiver Programs: CADI).

EXAMPLE:

Beulah lives with her husband Henry and receives EW using only her income and assets and a household size of 1. If Henry requests MA for himself (with or without EW), use a household size of 1 and only his income and assets. Determine eligibility for the Medicare Savings Programs separately for each spouse as a household of 1. See §0907.23.11 (MA Waiver Programs: EW).

• A child does not live with a natural or adoptive parent. This is true even if the child lives with siblings. Do not count non-parental relative caretakers in the child’s household size, including stepparents if there is no biological or adoptive parent in the home.

EXAMPLE:

Betsy and Sarah are minor siblings who live with their aunt. Both children have a household size of 1. The aunt is also a household size of 1 if she requests MA for herself.

EXAMPLE:

Greg lives with his stepfather. His mother does not live in the home. Greg and his stepfather each have a household size of 1.

Use a household size of 1 in determining asset limits for LTCF residents beginning:

• The first full month after admission to the LTCF for a client with no community spouse. • The month of institutionalization for the client with a community spouse.

Use a household size of 1 for an LTC spouse when determining asset limits beginning the month the LTC spouse begins receiving home care services through elderly waiver.

See §0913.13 (Long Term Care Spenddown Calculation) for LTC income limits.

If children alternate living with separated or divorced parents, consider them to be in the household in which they spend the most time. If the time is equally divided, consider them to be in the household in which they live on the date of application. Do not consider them to be members of both households in the same month. Also see §0908.13.03 (Temporary Absence--MA/GAMC).

Consider people under house arrest to be household members.

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

HOUSEHOLD COMPOSITION: DEEMING 0908.07

Deeming means counting the income, and assets if applicable, of one person as available in determining the eligibility of another person.

MinnesotaCare:

No provisions. Consider the countable income of all household members. See §0911.05 (Excluded Income) for information on what types of income to exclude.

MA:

Deeming requirements are not the same as household composition rules. People may be included in another person's household without having their income and assets counted toward the other person's eligibility. Determine household size and countable income and assets separately for each person.

The information about counting income and assets in this section may not apply to people on an MA waiver program. See §0907.23 (MA Waiver Programs).

When the following people live with an MA applicant or enrollee, consider their income and assets available:

• The person's spouse unless it is the month the client has entered a long term care facility or begins receiving home care services covered through elderly waiver (EW). When a client is NOT divorced but is legally separated from his/her spouse and continues to live in the same household, consider the spouse's income and assets available to the client. • The client's natural or adoptive parent, if the client is under 21 and not emancipated. When the father or alleged father of a child is not married to the child's mother, deem the father's income to the child only if paternity has been established AND the father lives with the child. Paternity has been established when adjudicated by a court or when the father has signed a Declaration of Parentage or Recognition of Parentage form (DHS 3159). See DECLARATION OF PARENTAGE (DOP) in §0902.07 (Glossary: Client...) and RECOGNITION OF PARENTAGE (ROP) in §0902.33 (Glossary: Quality...).

NOTE:

Although parents' assets are considered available to children, there is no asset limit for children under 21. See §0909.03 (Exemptions from Asset Limits).

Do not count:

• Parents' income as available to children from birth through the end of the month of the child's first birthday if the child qualifies as an auto newborn. See §0907.19.05.03 (MA Basis: Auto Newborn). • The income of parents of blind or disabled children ages 18 to 21. • Stepparents' income as available to a stepchild. • Parent's income as available to children of any age who receive SSI. • Parent's income as available to children eligible under TEFRA. • Children's income or assets as available to parents.

GAMC:

Count the income and assets of a person's spouse when the spouse lives with the client.

MA/GAMC HOUSEHOLD SIZE AND DEEMING EXAMPLES:

EXAMPLE:

Kelly, age 30, lives with her husband Jason, age 33, her daughter from a previous marriage, Allie, age 8,and Jason's son from a previous marriage, Garrett, age 10. Kelly is pregnant and expecting a medically verified single birth. Each household member has a household size of 5. Kelly and Jason both have employment income, and Kelly receives child support for Allie. Garrett has no income. Only Kelly and Jason have assets.

Deem income and assets as follows:

Kelly: Count her own and Jason's income.

Jason: Count his own and Kelly's income and assets.

Allie: Count Kelly's income and Allie's child support.

Garrett: Count Jason's income.

Unborn child: The child will be eligible as an auto newborn if Kelly is on MA at the time of the birth. If the family requests continued MA after the child turns 1, you would count Kelly and Jason's income.

EXAMPLE:

Megan, age 18, lives with her mother, Sue, her father, Larry, her 15-year-old sister Laura, and her 2-year-old son Trevor. Megan has a household size of 5: Megan, parents, sibling, and her own minor child. Megan's parents each have a household size of 4: Larry, Sue, Megan, and Laura. Laura has a household size of 4: Laura, Larry, Sue, and Megan. Trevor has a household size of 2: Trevor and Megan.

Deem income and assets as follows:

Megan: Count Sue, Larry, and Megan's income.

Sue: Count Sue and Larry's income and assets.

Larry: Count Larry and Sue's income and assets.

Laura: Count Sue, Larry, and Laura's income.

Trevor: Count Megan and Trevor's income.

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

WHO MUST BE EXCLUDED FROM THE HOUSEHOLD 0908.09

MinnesotaCare:

Exclude the following people from the MinnesotaCare household:

• People who do not have a parental, marital, or legal guardian relationship with another household member. • Children age 21 and over, even if living in the parental home and financially dependent. • Foster children, unless they have been placed in the home for adoption OR the foster parents apply for MinnesotaCare for themselves and choose to include the child in their household size. Consider adoptive children as household members beginning the first day of the month of placement.

EXAMPLE:

Louis has been placed in the Johnson household as a foster child. This is not an adoptive placement. Louis receives MA and the Johnsons do not wish to apply for MinnesotaCare for him. Do not count Louis in the Johnson's household size.

• Emancipated minors and their spouses and children, even if living with the minor's parents.

EXAMPLE:

Ann, age 17, her husband Steve, and their son Mark live with Ann's parents. Because Ann is married, she is an emancipated minor. Ann, Steve, and Mark are a separate household of 3.

• Relative caretakers age 18 or older who reside in households with minor children and their biological or adoptive parents, stepparents, or legal guardians but do not have primary responsibility for a minor child in the household.

EXAMPLE:

Betty and her minor child Mark live with Mary, who is Mark's aunt. Because Mark's mother also resides in the home, Mary does not have primary responsibility for her nephew and may not be considered a relative caretaker. Consider Betty and Mark as a family with children. Consider Mary a separate household.

• People incarcerated in correction/penal institutions and government controlled halfway houses. • Children in secure juvenile detention facilities, state owned and operated juvenile facilities and county owned and operated secure juvenile facilities.

People who are incarcerated and children residing in secure juvenile facilities may remain part of the household until the next renewal. See §0906.09 (Institutional Residence--MinnesotaCare).

MinnesotaCare requires certain household members to enroll if they are eligible. See §0908.11 (All or Nothing Rule).

MA/GAMC:

Exclude the following people who live with an adult from the adult's household size:

• The other parent of a child in the household if the parents are unmarried.

EXAMPLE:

Robin and Mark live with their son. They are unmarried. Paternity has been legally acknowledged. Robin and Mark each have a house-hold size of 2. Do not include them in each other's household size.

• Children age 21 and over. • Children under age 21 who are not the financial responsibility of the adult or the adult's spouse.

EXAMPLE:

Tina and her daughter live with her friend Jeff and his son. Do not include Jeff or his son in Tina's household size.

EXAMPLE:

Jeanne lives with her 17-year-old daughter Hannah and Hannah's infant son Josh. Do not count Josh in Jeanne's household size.

Exclude the following people who live with a child from the child's household size:

• Adults who live with the child and are not the child's biological or adoptive parent, or stepparent who lives with a biological or adoptive parent.

EXAMPLE:

Becky continues to live with her stepfather, Joe, following the death of her mother, Joe's wife. Becky has a household size of 1. Exclude Joe from her household size because there is no biological or adoptive parent in the home.

• Siblings, half-siblings, and stepsiblings if no biological or adoptive parent lives in the home. • Siblings over age 21.

For both adults and children, exclude family members who do not live in the household for 1 full calendar month or more, unless the absence is considered temporary. See §0908.13.03 (Temporary Absence--MA/GAMC) and §0915.05.01 (Removing a Person From Household--MA/GAMC).

For LTCF residents, exclude the community spouse and children living with the community spouse from the household of the institutionalized spouse beginning the first day of the month in which 1 spouse enters an LTCF.

Exclude children under age 18 who are not living with a community spouse from the household of the institutionalized person effective the first full calendar month following the month a person enters an LTCF.

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

ALL OR NOTHING RULE 0908.11

MinnesotaCare:

Unlike MA and GAMC, which allow people to choose which eligible household members want coverage, MinnesotaCare requires certain eligible family members to enroll. This provision is known as the All or Nothing Rule. The All or Nothing Rule requires that:

• All eligible children in a household who do not have other health insurance enroll if one child enrolls. • All eligible spouses or parents in a household who do not have other health insurance enroll if one spouse or parent enrolls. • Parents may enroll only if the eligible children in the household who do not have other health insurance enroll. Parents may choose not to enroll. Eligible children may enroll regardless of whether the parents enroll.

NOTE: If a child who is required to provide or apply for a SSN fails to do so, they are still considered an eligible child and all children are ineligible. If an adult who is required to provide or apply for a SSN fails to do so, they are still considered an eligible adult and all adults are ineligible. Eligible children or adults refer to the bullets above. See §0906.11 (Social Security Number--MinnesotaCare)

EXAMPLE:

Bob, Mary and their two children, Sam (10) and Anna (3) apply for MinnesotaCare. They do not have any other health insurance. The HCAPP lists SSNs for everyone but Anna. Bob, Mary and Sam meet all eligibility requirements; Anna does not meet the SSN requirement. Do not approve coverage for Bob, Mary and Sam until a SSN is either applied for or obtained for Anna.

EXAMPLE:

Troy, Denesha and their two children ages 15 and 13 apply for MinnesotaCare. They do not have any other health insurance. The HCAPP lists SSNs for everyone but Denesha. Do not approve coverage for Denesha or Troy until Denesha supplies her SSN. Coverage for the children can be approved under the All or Nothing Rule because parents are not required to enroll with their children.

Do not enroll people who have other health coverage that prevents enrollment in MinnesotaCare. See §0910 (Other Health Coverage).

EXAMPLE:

Bud and Mabel, a married couple with no children in the home, apply for MinnesotaCare. They are both U.S. citizens and permanent Minnesota residents. Bud is disabled and covered by Medicare Parts A and B. Mabel has no health care coverage. Both would be required to enroll under the All or Nothing Rule. However, Bud cannot enroll because he has Medicare. Mabel can enroll separately. Base eligibility and premium amount on a household of 2 with 1 person covered.

EXAMPLE:

Judy and Greg apply for MinnesotaCare for their 2 children. Judy and Greg each have health insurance through work. Neither employer offers dependent coverage. The children have no insurance. Both children must enroll if they meet all other eligibility requirements. Base eligibility and premium amount on a household of 4 with 2 people covered.

EXAMPLE:

Alice applies for MinnesotaCare for her son Troy, who requires regular care for chronic ear infections. She does not want coverage for herself and her daughter Mavis, because they have no ongoing medical needs and Alice feels she can't afford the premium for 3 people. All 3 household members meet MinnesotaCare eligibility requirements. No one in the household has other health care coverage available. Both Troy and Mavis must enroll under the all or nothing rule. Alice is not required to enroll. Base eligibility and premium amount on a household of 3 with 2 people covered.

EXAMPLE:

Abe and Mary apply for MinnesotaCare for themselves and their 2 children, Kevin and Kyle. Mary is pregnant and covered by MA. Kevin is also on MA. Abe and Kyle are not covered on MA or GAMC because of excess income. They have no other coverage available. Mary and Kevin want to stay on MA. Kevin and Kyle would be required to enroll together because of the all or nothing rule, as would Abe and Mary. However, since Mary and Kevin have other health coverage through MA, they are not required to enroll. Kyle can enroll separately from Kevin. Abe is not required to enroll but may enroll separately from Mary as long as Kyle enrolls. Base eligibility and premium amount on a household of 4 with 2 people enrolled.

Do not apply the All or Nothing Rule to non-insurance eligibility factors that apply only to individual household members. Ineligibility of household members due to technical factors does not affect the eligibility of other members who meet eligibility requirements. These factors include but are not limited to:

• Providing or applying for Social Security Numbers (SSNs). People required to provide or apply for SSNs who fail to do so are ineligible. Other household members who provide or apply for SSNs and meet all eligibility factors are eligible. See §0906.11 (Social Security Number--MinnesotaCare). • Cooperating with obtaining medical support. Caretakers who fail to cooperate without good cause are ineligible. Spouses and children may be eligible. See §0906.13 (Assigning Rights to Medical Support) and §0906.13.05 (Good Cause Exemptions--Medical Support). • Cooperating with applying for MA. Certain people with disabilities are required to apply for MA and become ineligible for MinnesotaCare if they fail to do so. Their spouses may remain eligible. See §0907.15 (MinnesotaCare Adults Without Children). • Meeting citizenship and immigration requirements. People who do not have a status that qualifies for MinnesotaCare are ineligible. Other household members with a qualifying status may be eligible. See §0906.03 (Citizenship and Immigration Status).

M.S. 256L.04 Subd. 1b

Minnesota Rules 9506.0020 Subp. 4

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.

TEMPORARY ABSENCE -- MINNESOTACARE - PART 1 0908.13

MinnesotaCare:

Consider people who are temporarily absent from the home to be members of the MinnesotaCare household if they are otherwise required to be included.

There is no time limit on temporary absences. Temporary absence provisions apply to absences within and outside of Minnesota. The health plan in which a temporarily absent individual or household is enrolled remains responsible for their care during the absence. Refer the individual to the health plan for information on how to get care outside the health plan's service area. See §0914 (Service Delivery).

If an individual or household leaves the residence in which they are enrolled in MinnesotaCare and establishes a new residence with intent to remain in the new residence permanently, do not consider the absence to be temporary. If the new residence is in another county, the individual or household may need to choose a new health plan. See §0914.03.07 (Health Plan Changes). If the new residence is in another state, terminate MinnesotaCare. Consider people to be temporarily absent from the state if they have left the state for a temporary purpose and intend to return when the purpose of the absence has been accomplished. A person is not temporarily absent from the state if another state has determined that person is a resident for any reason. In order to receive services, people who are temporarily absent from the state must follow the requirements of their health plan. See §0906.05.03 (State Residence--MinnesotaCare Families, MA) and §0906.05.05 (State Residence--MinnesotaCare Adults).

Temporary absence circumstances include:

• Vacations. • School attendance.

EXAMPLE:

Paula is included on her parents' case as a dependent sibling. She attends college out-of-state and lives in a dormitory when school is in session. She returns to her parents' home during school breaks and for occasional weekend visits. Consider her to be temporarily absent when she is at school. See §0908.03 (Determining MinnesotaCare Household Size).

• Employment.

EXAMPLE:

Joe is a construction worker. He gets a job on a project 75 miles from his home and lives on the construction site during the week. Consider him temporarily absent from his family's home.

• Job search.

EXAMPLE:

Janet is enrolled in MinnesotaCare with her children. She recently completed job training through a program for single parents. She is unable to find a job in her home town and plans to stay with her sister in another city in Minnesota while she looks for a job. Her children will stay with her mother. Janet plans to relocate the family once she finds employment. Both Janet and the children are temporarily absent from their home. They remain part of the same household during the temporary absence.

• Illness or hospitalization.

NOTE:

People cannot enroll in MinnesotaCare while they are hospitalized. Enrollees who enter the hospital do not lose eligibility, although their benefits may be limited depending on their status.

EXAMPLE:

Harry is enrolled in MinnesotaCare with his wife and children. He enters 30-day inpatient chemical dependency treatment. He will live in a halfway house for two months after completing treatment. Harry remains a member of the household.

• Visits with a non-custodial parent or other relatives.

EXAMPLE:

Brandon and his mother are enrolled in MinnesotaCare. Brandon visits his father in another state for 2 months every summer. He remains a member of his mother's household.

In cases where custody alternates between parents or other caretakers, a child must live with the parent or caretaker requesting MinnesotaCare for the child at least half (50%) of the time during the year to be considered a member of the parent's household.

EXAMPLE:

Jeremy lives with his father for 9 months during the school year and with his mother for 3 months during the summer. Consider Jeremy to be a member of his father's household. He cannot enroll in MinnesotaCare with his mother during the summer months because he lives in her household less than half the time during the year.

If parents share custody of a child equally, the child can be counted as a member of both households. However, the child can only be enrolled in one household. Allow the parents to choose which household will enroll the child.

EXAMPLE:

Marvin and Joan are divorced and have joint custody of their daughter, Becky. Becky alternates living with Marvin one week and with Joan the next. Time with each parent is exactly equal throughout the year. Joan and Marvin both apply for MinnesotaCare. Both will be a household of 2 (Marvin and Becky and Joan and Becky). Allow Marvin and Joan to choose which household Becky will enroll in.

Base the determination of a child's home on current circumstances. Use the custody information from a court order only in contested cases.

EXAMPLE:

John and his daughter Martha are enrolled in MinnesotaCare. Martha's mother, June, applies for MinnesotaCare and lists Martha as living in her home. June provides a court order showing that she has physical custody of Martha. Advise John that you have information showing that Martha does not live in his home at least 50% of the time. Count Martha as a member of June's household until the court order is changed or both parents agree in writing that Martha's living situation has changed. Do not require either parent to go to court as a condition of eligibility.

This list of temporary absence circumstances is continued in §0908.13.01 (Temporary Absence--MinnesotaCare - Part 2).

MA/GAMC:

See §0908.13.03 (Temporary Absence--MA/GAMC).

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

TEMPORARY ABSENCE -- MINNESOTACARE - PART 2 0908.13.01

MinnesotaCare:

See §0908.13 (Temporary Absence--MinnesotaCare - Part 1) for general information. The list below is continued from §0908.13.

Additional temporary absence circumstances include:

• Placement in foster care. A MinnesotaCare child who is placed in foster care may remain part of the MinnesotaCare household unless the placement is expected to be permanent. The family must continue to pay the child's premium, and the child will continue to be covered and must receive services through the family's managed care plan. Most foster children are eligible for MA. Terminate MinnesotaCare if the child is approved for MA.

EXAMPLE:

John is enrolled in MinnesotaCare with his mother and brother. John is placed in foster care in another county. The county social worker expects the placement to last from 6 months to 1 year. John could remain in the MinnesotaCare household since the placement is not expected to be permanent. However, the social worker decides to apply for MA for him because the MinnesotaCare health plan is not available in the county where he is placed. Coordinate with the county worker when terminating John's MinnesotaCare to avoid a lapse in coverage.

• Absence from the home due to natural disaster or catastrophic event.

EXAMPLE:

Jerry and Dora's home is damaged by a flood. Dora and the children go to stay with a relative. Jerry remains in a trailer on the property while repairing the home. They remain in the same household for MinnesotaCare.

• Personal or family emergency.

EXAMPLE:

Karen is enrolled in MinnesotaCare with her husband and children. She goes to stay with her mother in another state for two months while her mother recovers from surgery. Karen remains a member of the MinnesotaCare household.

Minnesota Rules 9506.0010 subp. 11

MA/GAMC:

See §0908.13.03 (Temporary Absence--MA/GAMC).

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

TEMPORARY ABSENCE -- MA/GAMC 0908.13.03

MinnesotaCare:

See §0908.13 (Temporary Absence--MinnesotaCare - Part 1) and §0908.13.01 (Temporary Absence--MinnesotaCare - Part 2).

MA/GAMC:

Continue to deem and include in the household size a person who intends to return to the home and is:

• Absent less than one calendar month. If an absence is expected to continue beyond one month, consider the person to be out of the household beginning with the first full calendar month they are absent.

EXCEPTION:

Consider a spouse admitted to an LTCF to be permanently absent beginning with the month of admission to the LTCF if you expect the spouse to be absent for more than 30 consecutive days.

EXAMPLE:

Jacob is on MA with his parents. He is admitted to the hospital on May 23. He is expected to remain hospitalized until approximately June 15. Continue to include him in his parent's household.

EXAMPLE:

Ryan, age 17, moves out of his parent's home to live with a friend on May 5. Remove him from his parent's household beginning June 1.

EXAMPLE:

Gilbert receives MA with his wife, Sadie. He is admitted to a nursing home on August 10. The stay is expected to be permanent. Consider both Gilbert and Sadie to be a household of 1 and begin long term care budgeting starting in August.

• On vacation. • Absent due to employment, looking for work, or military service. • Attending training or an educational facility.

EXAMPLE:

Rita and Henry are a married couple without children receiving GAMC. Henry moves in with his parents in another county to attend a 6-month vocational training program. Continue to include him in Rita's household and deem their income and assets to each other.

• A hospitalized newborn whose mother is eligible for assistance in the month of the infant's birth, unless the mother legally relinquishes control of the child. This includes retroactive eligibility determinations resulting from applications filed after the infant's birth. Also see §0907.19.05.03 (MA Basis: Auto Newborn). • An student ages 18 to 21 whom the parents claim as a financial dependent on tax or financial aid forms.

EXAMPLE:

Paula, age 18, receives MA with her parents and younger brother. She attends college in another city and lives in a dormitory when school is in session. She returns to her parents' home during school breaks and for occasional weekend visits. Her parents claim her as a dependent on their taxes. Consider her to be temporarily absent and a member of her parents' household when she is at school.

• A child visiting a non-custodial parent. See §0908.05 (Determining MA/GAMC Household Size) if custody alternates between parents.

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

NURSING FACILITIES AND ICF-MR LEAVE DAYS 0908.15

MinnesotaCare:

No provisions.

MA:

MA enrollees who reside in Nursing Facilities or ICF-MRs may be eligible for hospital or therapeutic leave days. Leave days allow the facility to reserve and receive payment for the client's bed when the client is hospitalized or on leave.

Payment for hospital leave days is limited to 18 consecutive days for each separate and distinct episode of medically necessary hospitalization. A separate and distinct episode means one of the following:

• The occurrence of a health condition that is an emergency.

OR

• The occurrence of a health condition which requires inpatient hospital services but is not related to a condition which required previous hospitalization and was not evident at the time of discharge.

OR

• The repeat occurrence of a health condition that is not an emergency but requires inpatient hospitalization at least two calendar days after the recipient's most recent discharge from a hospital.

Payment for therapeutic leave days is limited to the number of days listed below.

• Enrollees receiving nursing facility services are entitled to 36 leave days per calendar year. • Enrollees residing in an ICF-MR are entitled to 72 leave days per calendar year. DHS may authorize an additional 48 days if:
• The client or authorized representative requests additional therapeutic leave days.
AND
• The case manager determines that the leave is consistent with the goals of the client's individual service plan.
AND
• An evaluation by the case manager demonstrates that home and community based services and other alternative services are not feasible.
AND
• The additional days meet all other state and federal requirements for therapeutic leave days.
• Enrollees residing in a long term care facility that has a license to provide services for the physically handicapped are entitled to 72 leave days per calendar year.

GAMC:

No provisions.

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