2000 Minnesota Statutes

     256B.057 Eligibility; income and asset limitations for 
  special categories. 

    Subdivision 1.    Pregnant women and infants.  (a) An 
 infant less than one year of age or a pregnant woman who has 
 written verification of a positive pregnancy test from a 
 physician or licensed registered nurse, is eligible for medical 
 assistance if countable family income is equal to or less than 
 275 percent of the federal poverty guideline for the same family 
 size.  For purposes of this subdivision, "countable family 
 income" means the amount of income considered available using 
 the methodology of the AFDC program under the state's AFDC 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, except for the earned income disregard and 
 employment deductions.  An amount equal to the amount of earned 
 income exceeding 275 percent of the federal poverty guideline, 
 up to a maximum of the amount by which the combined total of 185 
 percent of the federal poverty guideline plus the earned income 
 disregards and deductions of the AFDC program under the state's 
 AFDC 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, exceeds 275 percent of the 
 federal poverty guideline will be deducted for pregnant women 
 and infants less than one year of age.  

    (b) An infant born on or after January 1, 1991, to a woman 
 who was eligible for and receiving medical assistance on the 
 date of the child's birth shall continue to be eligible for 
 medical assistance without redetermination until the child's 
 first birthday, as long as the child remains in the woman's 
 household. 

    Subd. 1a. Repealed, 1998 c 407 art 5 s 48 

    Subd. 1b.    Pregnant women and infants; expansion.  (a) 
 This subdivision supersedes subdivision 1 as long as the 
 Minnesota health care reform waiver remains in effect.  When the 
 waiver expires, the commissioner of human services shall publish 
 a notice in the State Register and notify the revisor of 
 statutes.  An infant less than two years of age or a pregnant 
 woman who has written verification of a positive pregnancy test 
 from a physician or licensed registered nurse, is eligible for 
 medical assistance if countable family income is equal to or 
 less than 275 percent of the federal poverty guideline for the 
 same family size.  For purposes of this subdivision, "countable 
 family income" means the amount of income considered available 
 using the methodology of the AFDC program under the state's AFDC 
 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, except for the earned 
 income disregard and employment deductions.  An amount equal to 
 the amount of earned income exceeding 275 percent of the federal 
 poverty guideline, up to a maximum of the amount by which the 
 combined total of 185 percent of the federal poverty guideline 
 plus the earned income disregards and deductions of the AFDC 
 program under the state's AFDC 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, 
 exceeds 275 percent of the federal poverty guideline will be 
 deducted for pregnant women and infants less than two years of 
 age.  

    (b) An infant born on or after January 1, 1991, to a woman 
 who was eligible for and receiving medical assistance on the 
 date of the child's birth shall continue to be eligible for 
 medical assistance without redetermination until the child's 
 second birthday, as long as the child remains in the woman's 
 household. 

    Subd. 1c.    No asset test for pregnant women.  
 Beginning September 30, 1998, eligibility for medical assistance 
 for a pregnant woman must be determined without regard to asset 
 standards established in section 256B.056, subdivision 3.  

    Subd. 2.    Children.  A child one through five years of 
 age in a family whose countable income is less than 133 percent 
 of the federal poverty guidelines for the same family size, is 
 eligible for medical assistance.  A child six through 18 years 
 of age, who was born after September 30, 1983, in a family whose 
 countable income is less than 100 percent of the federal poverty 
 guidelines for the same family size is eligible for medical 
 assistance.  

    Subd. 2a. Repealed, 1997 c 203 art 4 s 73 

    Subd. 2b. Repealed, 1997 c 203 art 4 s 73 

    Subd. 3.    Qualified medicare beneficiaries.  A person 
 who is entitled to Part A Medicare benefits, whose income is 
 equal to or less than 100 percent of the federal poverty 
 guidelines, and whose assets are no more than $10,000 for a 
 single individual and $18,000 for a married couple or family of 
 two or more, is eligible for medical assistance reimbursement of 
 Part A and Part B premiums, Part A and Part B coinsurance and 
 deductibles, and cost-effective premiums for enrollment with a 
 health maintenance organization or a competitive medical plan 
 under section 1876 of the Social Security Act.  Reimbursement of 
 the Medicare coinsurance and deductibles, when added to the 
 amount paid by Medicare, must not exceed the total rate the 
 provider would have received for the same service or services if 
 the person were a medical assistance recipient with Medicare 
 coverage.  Increases in benefits under Title II of the Social 
 Security Act shall not be counted as income for purposes of this 
 subdivision until the first day of the second full month 
 following publication of the change in the federal poverty 
 guidelines.  

    Subd. 3a.    Eligibility for payment of Medicare Part B 
 premiums.  A person who would otherwise be eligible as a 
 qualified Medicare beneficiary under subdivision 3, except the 
 person's income is in excess of the limit, is eligible for 
 medical assistance reimbursement of Medicare Part B premiums if 
 the person's income is less than 120 percent of the official 
 federal poverty guidelines for the applicable family size.  

    Subd. 3b.    Qualifying individuals.  Beginning July 1, 
 1998, to the extent of the federal allocation to Minnesota, a 
 person who would otherwise be eligible as a qualified Medicare 
 beneficiary under subdivision 3, except that the person's income 
 is in excess of the limit, is eligible as a qualifying 
 individual according to the following criteria: 

    (1) if the person's income is greater than 120 percent, but 
 less than 135 percent of the official federal poverty guidelines 
 for the applicable family size, the person is eligible for 
 medical assistance reimbursement of Medicare Part B premiums; or 

    (2) if the person's income is equal to or greater than 135 
 percent but less than 175 percent of the official federal 
 poverty guidelines for the applicable family size, the person is 
 eligible for medical assistance reimbursement of that portion of 
 the Medicare Part B premium attributable to an increase in Part 
 B expenditures which resulted from the shift of home care 
 services from Medicare Part A to Medicare Part B under Public 
 Law Number 105-33, section 4732, the Balanced Budget Act of 1997.

    The commissioner shall limit enrollment of qualifying 
 individuals under this subdivision according to the requirements 
 of Public Law Number 105-33, section 4732. 

    Subd. 4.    Qualified working disabled adults.  A person 
 who is entitled to Medicare Part A benefits under section 1818A 
 of the Social Security Act; whose income does not exceed 200 
 percent of the federal poverty guidelines for the applicable 
 family size; whose nonexempt assets do not exceed twice the 
 maximum amount allowable under the supplemental security income 
 program, according to family size; and who is not otherwise 
 eligible for medical assistance, is eligible for medical 
 assistance reimbursement of the Medicare Part A premium.  

    Subd. 5.    Disabled adult children.  A person who is at 
 least 18 years old, who was eligible for supplemental security 
 income benefits on the basis of blindness or disability, who 
 became disabled or blind before reaching the age of 22, and who 
 lost eligibility as a result of becoming entitled to a child's 
 insurance benefits on or after July 1, 1987, under section 
 202(d) of the Social Security Act, or because of an increase in 
 those benefits effective on or after July 1, 1987, is eligible 
 for medical assistance as long as the person would be entitled 
 to supplemental security income in the absence of child's 
 insurance benefits or increases in those benefits. 

    Subd. 6.    Disabled widows and widowers.  A person who 
 is at least 50 years old who is entitled to disabled widow's or 
 widower's benefits under United States Code, title 42, section 
 402(e) or (f), who is not entitled to Medicare Part A, and who 
 received supplemental security income or Minnesota supplemental 
 aid in the month before the month the widow's or widower's 
 benefits began, is eligible for medical assistance as long as 
 the person would be entitled to supplemental security income or 
 Minnesota supplemental aid in the absence of the widow's or 
 widower's benefits. 

    Subd. 7.    Waiver of maintenance of effort requirement. 
  Unless a federal waiver of the maintenance of effort 
 requirement of section 2105(d) of title XXI of the Balanced 
 Budget Act of 1997, Public Law Number 105-33, Statutes at Large, 
 volume 111, page 251, is granted by the federal Department of 
 Health and Human Services by September 30, 1998, eligibility for 
 children under age 21 must be determined without regard to asset 
 standards established in section 256B.056, subdivision 3.  The 
 commissioner of human services shall publish a notice in the 
 State Register upon receipt of a federal waiver. 

    Subd. 8.    Children under age two.  Medical assistance 
 may be paid for a child under two years of age whose countable 
 family income is above 275 percent of the federal poverty 
 guidelines for the same size family but less than or equal to 
 280 percent of the federal poverty guidelines for the same size 
 family. 

    Subd. 9.    Employed persons with disabilities.  (a) 
 Medical assistance may be paid for a person who is employed and 
 who: 

    (1) meets the definition of disabled under the supplemental 
 security income program; 

    (2) is at least 16 but less than 65 years of age; 

    (3) meets the asset limits in paragraph (b); and 

    (4) pays a premium, if required, under paragraph (c).  

 Any spousal income or assets shall be disregarded for purposes 
 of eligibility and premium determinations. 

    (b) For purposes of determining eligibility under this 
 subdivision, a person's assets must not exceed $20,000, 
 excluding: 

    (1) all assets excluded under section 256B.056; 

    (2) retirement accounts, including individual accounts, 
 401(k) plans, 403(b) plans, Keogh plans, and pension plans; and 

    (3) medical expense accounts set up through the person's 
 employer. 

    (c) A person whose earned and unearned income is greater 
 than 200 percent of federal poverty guidelines for the 
 applicable family size must pay a premium to be eligible for 
 medical assistance.  The premium shall be equal to ten percent 
 of the person's gross earned and unearned income above 200 
 percent of federal poverty guidelines for the applicable family 
 size up to the cost of coverage. 

    (d) A person's eligibility and premium shall be determined 
 by the local county agency.  Premiums must be paid to the 
 commissioner.  All premiums are dedicated to the commissioner. 

    (e) Any required premium shall be determined at application 
 and redetermined annually at recertification or when a change in 
 income or family size occurs. 

    (f) Premium payment is due upon notification from the 
 commissioner of the premium amount required.  Premiums may be 
 paid in installments at the discretion of the commissioner. 

    (g) Nonpayment of the premium shall result in denial or 
 termination of medical assistance unless the person demonstrates 
 good cause for nonpayment.  Good cause exists if the 
 requirements specified in Minnesota Rules, part 9506.0040, 
 subpart 7, items B to D, are met.  Nonpayment shall include 
 payment with a returned, refused, or dishonored instrument.  The 
 commissioner may require a guaranteed form of payment as the 
 only means to replace a returned, refused, or dishonored 
 instrument. 

    HIST: 1986 c 444; 1989 c 282 art 3 s 48; 1990 c 568 art 3 s 
 33-36; 1991 c 292 art 4 s 35-39; 1992 c 513 art 7 s 39; 1992 c 
 549 art 4 s 12; 1993 c 345 art 9 s 11-13; 1Sp1993 c 6 s 9; 1995 
 c 234 art 6 s 36,37; 1997 c 85 art 3 s 16-18; 1997 c 203 art 4 s 
 22-24; 1998 c 407 art 5 s 3-5; 1998 c 407 art 4 s 17,18; 1999 c 
 245 art 4 s 33,34; 2000 c 260 s 97; 2000 c 340 s 3; 2000 c 488 
 art 9 s 15