1999 Minnesota Statutes

     256B.056 Eligibility; residency; resources; income. 

    Subdivision 1.    Residency.  To be eligible for medical 
 assistance, a person must reside in Minnesota, or, if absent 
 from the state, be deemed to be a resident of Minnesota in 
 accordance with the rules of the state agency. 

    Subd. 1a.    Income and assets generally.  Unless 
 specifically required by state law or rule or federal law or 
 regulation, the methodologies used in counting income and assets 
 to determine eligibility for medical assistance for persons 
 whose eligibility category is based on blindness, disability, or 
 age of 65 or more years, the methodologies for the supplemental 
 security income program shall be used.  For families and 
 children, which includes all other eligibility categories, the 
 methodologies under the state's AFDC plan in effect as of July 
 16, 1996, as required by the Personal Responsibility and Work 
 Opportunity Reconciliation Act of 1996 (PRWORA), Public Law 
 Number 104-193, shall be used.  Effective upon federal approval, 
 in-kind contributions to, and payments made on behalf of, a 
 recipient, by an obligor, in satisfaction of or in addition to a 
 temporary or permanent order for child support or maintenance, 
 shall be considered income to the recipient.  For these 
 purposes, a "methodology" does not include an asset or income 
 standard, or accounting method, or method of determining 
 effective dates. 

    Subd. 2.    Homestead; exclusion for institutionalized 
 persons.  The homestead shall be excluded for the first six 
 calendar months of a person's stay in a long-term care facility 
 and shall continue to be excluded for as long as the recipient 
 can be reasonably expected to return to the homestead.  For 
 purposes of this subdivision, "reasonably expected to return to 
 the homestead" means the recipient's attending physician has 
 certified that the expectation is reasonable, and the recipient 
 can show that the cost of care upon returning home will be met 
 through medical assistance or other sources.  The homestead 
 shall continue to be excluded for persons residing in a 
 long-term care facility if it is used as a primary residence by 
 one of the following individuals:  

    (a) the spouse; 

    (b) a child under age 21; 

    (c) a child of any age who is blind or permanently and 
 totally disabled as defined in the supplemental security income 
 program; 

    (d) a sibling who has equity interest in the home and who 
 resided in the home for at least one year immediately before the 
 date of the person's admission to the facility; or 

    (e) a child of any age, or, subject to federal approval, a 
 grandchild of any age, who resided in the home for at least two 
 years immediately before the date of the person's admission to 
 the facility, and who provided care to the person that permitted 
 the person to reside at home rather than in an institution.  

    Subd. 3.    Asset limitations.  To be eligible for 
 medical assistance, a person must not individually own more than 
 $3,000 in assets, or if a member of a household with two family 
 members,husband and wife, or parent and child, the household 
 must not own more than $6,000 in assets, plus $200 for each 
 additional legal dependent.  In addition to these maximum 
 amounts, an eligible individual or family may accrue interest on 
 these amounts, but they must be reduced to the maximum at the 
 time of an eligibility redetermination.  The accumulation of the 
 clothing and personal needs allowance according to section 
 256B.35 must also be reduced to the maximum at the time of the 
 eligibility redetermination.  The value of assets that are not 
 considered in determining eligibility for medical assistance is 
 the value of those assets excluded under the AFDC state plan as 
 of July 16, 1996, as required by the Personal Responsibility and 
 Work Opportunity Reconciliation Act of 1996 (PRWORA), Public Law 
 Number 104-193, for families and children, and the supplemental 
 security income program for aged, blind, and disabled persons, 
 with the following exceptions: 

    (a) Household goods and personal effects are not considered.

    (b) Capital and operating assets of a trade or business 
 that the local agency determines are necessary to the person's 
 ability to earn an income are not considered. 

    (c) Motor vehicles are excluded to the same extent excluded 
 by the supplemental security income program. 

    (d) Assets designated as burial expenses are excluded to 
 the same extent excluded by the supplemental security income 
 program. 

    Subd. 3a. Repealed, 1992 c 513 art 7 s 135 

    Subd. 3b.    Treatment of trusts.  (a) A "medical 
 assistance qualifying trust" is a revocable or irrevocable 
 trust, or similar legal device, established on or before August 
 10, 1993, by a person or the person's spouse under the terms of 
 which the person receives or could receive payments from the 
 trust principal or income and the trustee has discretion in 
 making payments to the person from the trust principal or income.
 Notwithstanding that definition, a medical assistance qualifying 
 trust does not include:  (1) a trust set up by will; (2) a trust 
 set up before April 7, 1986, solely to benefit a person with 
 mental retardation living in an intermediate care facility for 
 persons with mental retardation; or (3) a trust set up by a 
 person with payments made by the Social Security Administration 
 pursuant to the United States Supreme Court decision in Sullivan 
 v. Zebley, 110 S. Ct. 885 (1990).  The maximum amount of 
 payments that a trustee of a medical assistance qualifying trust 
 may make to a person under the terms of the trust is considered 
 to be available assets to the person, without regard to whether 
 the trustee actually makes the maximum payments to the person 
 and without regard to the purpose for which the medical 
 assistance qualifying trust was established. 

    (b) Trusts established after August 10, 1993, are treated 
 according to section 13611(b) of the Omnibus Budget 
 Reconciliation Act of 1993 (OBRA), Public Law Number 103-66. 

    Subd. 4.    Income.  To be eligible for medical 
 assistance, a person eligible under section 256B.055, 
 subdivision 7, not receiving supplemental security income 
 program payments, and families and children may have an income 
 up to 133-1/3 percent of the AFDC income standard in effect 
 under the July 16, 1996, AFDC state plan.  Effective July 1, 
 2000, the base AFDC standard in effect on July 16, 1996, shall 
 be increased by three percent. Effective January 1, 2000, and 
 each successive January, recipients of supplemental security 
 income may have an income up to the supplemental security income 
 standard in effect on that date.  In computing income to 
 determine eligibility of persons who are not residents of 
 long-term care facilities, the commissioner shall disregard 
 increases in income as required by Public Law Numbers 94-566, 
 section 503; 99-272; and 99-509.  Veterans aid and attendance 
 benefits and Veterans Administration unusual medical expense 
 payments are considered income to the recipient. 

    Subd. 4a.    Asset verification.  For purposes of 
 verification, the value of a life estate shall be considered not 
 salable unless the owner of the remainder interest intends to 
 purchase the life estate, or the owner of the life estate and 
 the owner of the remainder sell the entire property. 

    Subd. 4b.    Income verification.  The local agency 
 shall not require a monthly income verification form for a 
 recipient who is a resident of a long-term care facility and who 
 has monthly earned income of $80 or less. 

    Subd. 5.    Excess income.  A person who has excess 
 income is eligible for medical assistance if the person has 
 expenses for medical care that are more than the amount of the 
 person's excess income, computed by deducting incurred medical 
 expenses from the excess income to reduce the excess to the 
 income standard specified in subdivision 4.  The person shall 
 elect to have the medical expenses deducted at the beginning of 
 a one-month budget period or at the beginning of a six-month 
 budget period.  The commissioner shall allow persons eligible 
 for assistance on a one-month spenddown basis under this 
 subdivision to elect to pay the monthly spenddown amount in 
 advance of the month of eligibility to the state agency in order 
 to maintain eligibility on a continuous basis.  If the recipient 
 does not pay the spenddown amount on or before the 20th of the 
 month, the recipient is ineligible for this option for the 
 following month.  The local agency shall code the Medicaid 
 Management Information System (MMIS) to indicate that the 
 recipient has elected this option.  The state agency shall 
 convey recipient eligibility information relative to the 
 collection of the spenddown to providers through the Electronic 
 Verification System (EVS).  A recipient electing advance payment 
 must pay the state agency the monthly spenddown amount on or 
 before the 20th of the month in order to be eligible for this 
 option in the following month.  

    Subd. 5a.    Individuals on fixed income.  Recipients of 
 medical assistance who receive only fixed unearned income, where 
 such income is unvarying in amount and timing of receipt 
 throughout the year, shall report and verify their income 
 annually. 

    Subd. 5b.    Individuals with low income.  Recipients of 
 medical assistance not residing in a long-term care facility who 
 have slightly fluctuating income which is below the medical 
 assistance income limit shall report and verify their income on 
 a semiannual basis. 

    Subd. 6.    Assignment of benefits.  To be eligible for 
 medical assistance a person must have applied or must agree to 
 apply all proceeds received or receivable by the person or the 
 person's spouse from any third person liable for the costs of 
 medical care for the person, the spouse, and children.  The 
 state agency shall require from any applicant or recipient of 
 medical assistance the assignment of any rights to medical 
 support and third party payments.  Persons must cooperate with 
 the state in establishing paternity and obtaining third party 
 payments.  By signing an application for medical assistance, a 
 person assigns to the department of human services all rights 
 the person may have to medical support or payments for medical 
 expenses from any other person or entity on their own or their 
 dependent's behalf and agrees to cooperate with the state in 
 establishing paternity and obtaining third party payments.  Any 
 rights or amounts so assigned shall be applied against the cost 
 of medical care paid for under this chapter.  Any assignment 
 takes effect upon the determination that the applicant is 
 eligible for medical assistance and up to three months prior to 
 the date of application if the applicant is determined eligible 
 for and receives medical assistance benefits.  The application 
 must contain a statement explaining this assignment.  Any 
 assignment shall not be effective as to benefits paid or 
 provided under automobile accident coverage and private health 
 care coverage prior to notification of the assignment by the 
 person or organization providing the benefits.  

    Subd. 7.    Period of eligibility.  Eligibility is 
 available for the month of application and for three months 
 prior to application if the person was eligible in those prior 
 months.  A redetermination of eligibility must occur every 12 
 months. 

    Subd. 8.    Cooperation.  To be eligible for medical 
 assistance, applicants and recipients must cooperate with the 
 state and local agency to identify potentially liable 
 third-party payers and assist the state in obtaining third party 
 payments, unless good cause for noncooperation is determined 
 according to Code of Federal Regulations, title 42, part 
 433.147.  "Cooperation" includes identifying any third party who 
 may be liable for care and services provided under this chapter 
 to the applicant, recipient, or any other family member for whom 
 application is made and providing relevant information to assist 
 the state in pursuing a potentially liable third party.  
 Cooperation also includes providing information about a group 
 health plan for which the person may be eligible and if the plan 
 is determined cost-effective by the state agency and premiums 
 are paid by the local agency or there is no cost to the 
 recipient, they must enroll or remain enrolled with the group.  
 For purposes of this subdivision, coverage provided by the 
 Minnesota comprehensive health association under chapter 62E 
 shall not be considered group health plan coverage or 
 cost-effective by the state and local agency.  Cost-effective 
 insurance premiums approved for payment by the state agency and 
 paid by the local agency are eligible for reimbursement 
 according to section 256B.19. 

    HIST: Ex1967 c 16 s 6; 1969 c 841 s 1; 1973 c 717 s 18; 1974 c 
 525 s 1,2; 1975 c 247 s 10; 1976 c 236 s 3; 1977 c 448 s 6; 1978 
 c 760 s 1; 1979 c 309 s 4; 1980 c 509 s 106; 1980 c 527 s 1; 
 1981 c 360 art 2 s 28; 1Sp1981 c 2 s 14; 3Sp1981 c 2 art 1 s 32; 
 3Sp1981 c 3 s 17; 1982 c 553 s 6; 1982 c 640 s 5; 1983 c 312 art 
 5 s 15; 1984 c 422 s 1; 1984 c 534 s 22; 1984 c 654 art 5 s 58; 
 1985 c 248 s 70; 1985 c 252 s 21; 1986 c 444; 1Sp1986 c 1 art 8 
 s 5; 1987 c 403 art 2 s 79,80; 1988 c 689 art 2 s 144,145,268; 
 1989 c 282 art 3 s 45-47; 1989 c 332 s 1; 1990 c 568 art 3 s 
 28-32; 1992 c 513 art 7 s 34-38; 1993 c 339 s 13; 1Sp1993 c 1 
 art 5 s 31; art 6 s 25; 1995 c 207 art 6 s 28,29; 1995 c 248 art 
 17 s 1-4; 1996 c 451 art 2 s 8,9; 1997 c 85 art 3 s 13-15; 1997 
 c 203 art 4 s 20,21; 1997 c 225 art 6 s 4; 1998 c 407 art 4 s 
 15,16; 1999 c 245 art 4 s 32 

*   NOTE:  The amendment to subdivision 3b by Laws 1995, 
*chapter 207, article 6, section 28, is effective retroactive to 
*August 11, 1993.  Laws 1995, chapter 207, article 6, section 
*125, subdivision 3. 

*   NOTE:  Subdivision 5a, as added by Laws 1995, chapter 248, 
*article 17, section 3, ceases to be effective if a federal 
*agency determines that implementation of subdivision 5a would 
*cause a loss of federal funding.  Laws 1995, chapter 248, 
*article 17, section 8. 

*   NOTE:  The federal approval required by Laws 1996, chapter 
*451, article 2, section 62, for the amendment to subdivision 1 
*made by Laws 1996, chapter 451, article 2, section 8 was 
*denied.  In the 1998 edition of Minnesota Statutes, subdivision 
*1 is as it appeared prior to the 1996 amendment. 

*   NOTE:  The amendment to subdivision 8 by Laws 1997, chapter 
*225, article 6, section 4, expires June 30, 1999.  Laws 1997, 
*chapter 225, article 6, section 8.