Legal authority

Minn. Stat. §256B.0911

Transition to initial assessment review (IAR)

Lead agencies can complete eligibility updates for assessments with activity dates before July 1, 2025.

Lead agencies cannot complete eligibility updates for assessments that occur on or after July 1, 2025. They must move to using the initial assessment review (IAR). For more information, refer to CBSM – IAR for HCBS, the April 1, 2025, eList announcement and the May 27, 2025, eList announcement.

Exceptions

DHS will grant exceptions to lead agencies to use eligibility updates for a limited time after June 30, 2025, for people receiving services that require waiver funding and whose eligibility for a program is still pending. This is most often people who are receiving customized living services and have requested Elderly Waiver (EW) funding to help pay for those services.

Effective July 1, 2025, lead agencies must use MnCHOICES Help Desk Contact Form, DHS-6979 to request DHS assistance to use an eligibility update for initial assessments completed from May 2, 2025, to June 30, 2025.

Definitions

Eligibility update: An activity that follows an initial assessment and is used to extend the time in which the lead agency can determine a person’s program eligibility without another in-person assessment.

Initial assessment: An assessment that happens when a person either:

Initial assessments are completed by the county of location/tribal nation or by the managed care organization (MCO) for people enrolled in Minnesota Senior Health Options (MSHO) or Minnesota Senior Care Plus (MSC+) seeking the Elderly Waiver EW).

Overview

The 2013 Minnesota Legislature authorized a way for lead agencies to update and reestablish a person’s program eligibility when they experience a delay in accessing programs because their administrative eligibility determination(s) are pending.

Waivers and Alternative Care (AC)

If the lead agency has not fully determined the person’s eligibility within 60 days of an in-person assessment, the lead agency can use an eligibility update to establish eligibility for the following programs:

The lead agency can use and subsequently enter eligibility updates into MMIS in both the DD and long-term care (LTC) screening documents.

Personal care assistance (PCA) and Community First Services and Supports (CFSS)

The lead agency can use an eligibility update for a person who is accessing or will access PCA/CFSS if the person does not need changes in the functional needs section of the assessment.

If the person does need changes to the functional needs section, the lead agency cannot use an eligibility update. In this circumstance, the lead agency must complete a new in-person assessment. For instructions, refer to CFSS Manual – Assessment for PCA/CFSS services.

When a person is waiting on external criteria to access waiver services, the lead agency can use an eligibility update for the person to access waiver services while the person is receiving PCA/CFSS.

Purpose

An eligibility update allows assessors to extend the period of time to act on an initial assessment in certain situations. These situations include, but are not limited to, when the person:

Who completes it

The certified assessor who completed the person’s initial assessment also completes the eligibility update. This action supports the initial lead agency’s role to help the person navigate the public program system and access services.

Exception

There may be circumstances when the certified assessor who completed the initial assessment cannot complete the eligibility update, including when the assessor is:

The new certified assessor must complete a thorough review of the initial assessment with the person to ensure the eligibility update accurately reflects the person’s needs.

Change in COR or MCO before final eligibility determination

When a person experiences a change in county or tribal nation of residence (COR) or a change in MCO, the lead agency that completed the person’s initial assessment is responsible to complete the eligibility update.

Timelines

Completing an eligibility update

When the lead agency has not determined the person’s program eligibility within 60 days of an initial in-person assessment, the lead agency may complete an eligibility update.

The lead agency must complete the eligibility update between the 60th and 90th day from the initial assessment. Completing and documenting the eligibility update allows the lead agency an additional 60 days from the date of the eligibility update to establish program eligibility.

The lead agency does not need to perform an eligibility update when the person meets all eligibility criteria for an HCBS program within the valid 60-day period following the in-person assessment.

If the person’s eligibility is not determined after an additional 60 days from the activity/action date of the eligibility update, the person must have a new in-person assessment to access programs and services.

Effective date

When the lead agency completes an eligibility update within 90 days of the in-person assessment and the person meets all other eligibility criteria, the effective date used to open a person to a program must be:

Annual assessment date

The timeline for completing required annual assessments is based on the date the last in-person assessment was completed, not the eligibility update activity date.

How to complete it

The lead agency must complete the eligibility update in direct communication with the person applying for services and/or the person’s representative. The lead agency may complete an eligibility update in-person or via telephone.

The certified assessor:

1. Completes the person’s initial assessment in MnCHOICES with an approved status in MMIS.

2. Creates a new MnCHOICES assessment with eligibility update assessment type.

3. Reviews the outstanding eligibility items with the person.

4. Completes the assessment in MnCHOICES.

5. Enters the new screening document and the result of the eligibility update into MMIS using the eligibility update activity type.

6. Completes any additional requirements of the assessment process.

7. Creates a new assessment summary.

8. Sends the assessment summary to the person after the final eligibility determination.

The case manager/care coordinator is responsible to complete the person’s support plan, unless the person is accessing PCA/CFSS without a waiver. In this situation, the certified assessor completes the person’s support plan. For more information, refer to CBSM – Support planning for LTSS.

Changes in needs

When the person indicates they had a change in their needs, the assessor may capture those changes as part of the eligibility update process. If the person reports significant changes, the assessor should use their professional judgement to determine if they need to complete a new in-person assessment.

Note

The lead agency does not need to gather new signatures for the assessment and program acknowledgement document part of the eligibility update.

A notice of action helps explain the person’s eligibility for programs. This notice is built into the MnCHOICES assessment summary. MCOs continue to follow their own processes to collect required signatures and inform the person of their rights and responsibilities.

Limitations

Eligibility updates cannot: