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Minnesota Legislature

Office of the Revisor of Statutes

HF 1935

1st Engrossment - 86th Legislature (2009 - 2010) Posted on 02/09/2010 01:56am

KEY: stricken = removed, old language.
underscored = added, new language.

Bill Text Versions

Engrossments
Introduction Posted on 03/19/2009
1st Engrossment Posted on 03/30/2009

Current Version - 1st Engrossment

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A bill for an act
relating to health care; consolidating MinnesotaCare and medical assistance;
streamlining enrollment and eligibility procedures; amending Minnesota Statutes
2008, sections 256B.056, subdivisions 1a, 4, 5c, 10; 256L.01, subdivision 3a,
by adding a subdivision; 256L.02, subdivisions 2, 3, by adding a subdivision;
256L.03, subdivision 5, by adding a subdivision; 256L.04, subdivisions 1,
8, 13; 256L.05; 256L.07, subdivisions 1, 2, 3; 256L.15, subdivisions 1, 2;
256L.17, subdivisions 1, 2, 3, 5; proposing coding for new law in Minnesota
Statutes, chapter 256L; repealing Minnesota Statutes 2008, sections 256B.055,
subdivisions 3, 3a, 5, 6, 9, 10, 10b; 256B.056, subdivisions 1c, 3c; 256B.057,
subdivisions 1, 1c, 2, 2c, 7, 8; 256L.07, subdivision 7; 256L.15, subdivision 3;
256L.17, subdivision 6.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2008, section 256B.056, subdivision 1a, is amended to
read:


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. Increases in benefits under title II of
the Social Security Act shall not be counted as income for purposes of this subdivision
until July 1 of each year. Effective upon federal approval, for children eligible under
section 256B.055, subdivision 12, or for home and community-based waiver services
whose eligibility for medical assistance is determined without regard to parental income,
child support payments, including any payments made by an obligor in satisfaction of or
in addition to a temporary or permanent order for child support, and Social Security
payments are not counted as income. deleted text beginFor 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 104-193, shall be used, except that effective October
1, 2003, the earned income disregards and deductions are limited to those in subdivision
1c.
deleted text end For these purposes, a "methodology" does not include an asset or income standard, or
accounting method, or method of determining effective dates.

Sec. 2.

Minnesota Statutes 2008, section 256B.056, subdivision 4, is amended to read:


Subd. 4.

Income.

(a) To be eligible for medical assistance, a person eligible under
section 256B.055, subdivisions 7, 7a, and 12, may have income up to 100 percent of
the federal poverty guidelines. 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.

deleted text begin (b) To be eligible for medical assistance, 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.
deleted text end

deleted text begin (c) Effective July 1, 2002, to be eligible for medical assistance, families and children
may have an income up to 100 percent of the federal poverty guidelines for the family size.
deleted text end

deleted text begin (d)deleted text endnew text begin (b)new text end In computing income to determine eligibility of persons under deleted text beginparagraphsdeleted text endnew text begin
paragraph
new text end (a) deleted text beginto (c)deleted text end 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.

Sec. 3.

Minnesota Statutes 2008, section 256B.056, subdivision 5c, is amended to read:


Subd. 5c.

Excess income standard.

deleted text begin (a) The excess income standard for families
with children is the standard specified in subdivision 4.
deleted text end

deleted text begin (b)deleted text end The excess income standard for a person whose eligibility is based on blindness,
disability, or age of 65 or more years is 70 percent of the federal poverty guidelines for the
family size. Effective July 1, 2002, the excess income standard for this paragraph shall
equal 75 percent of the federal poverty guidelines.

Sec. 4.

Minnesota Statutes 2008, section 256B.056, subdivision 10, is amended to read:


Subd. 10.

Eligibility verification.

deleted text begin (a) The commissioner shall require women who
are applying for the continuation of medical assistance coverage following the end of the
60-day postpartum period to update their income and asset information and to submit
any required income or asset verification.
deleted text end

deleted text begin (b) The commissioner shall determine the eligibility of private-sector health care
coverage for infants less than one year of age eligible under section 256B.055, subdivision
10
, or 256B.057, subdivision 1, paragraph (d), and shall pay for private-sector coverage
if this is determined to be cost-effective.
deleted text end

deleted text begin (c)deleted text end The commissioner shall verify assets and income for all applicants, and for all
recipients upon renewal.

Sec. 5.

Minnesota Statutes 2008, section 256L.01, subdivision 3a, is amended to read:


Subd. 3a.

Family with children.

(a) "Family with children" means:

(1) parents and their children residing in the same household; or

(2) grandparents, foster parents, relative caretakers as defined in deleted text beginthe medical
assistance program,
deleted text endnew text begin 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 104-193,
new text end or legal guardians; and their wards who are children residing in
the same household.

(b) The term includes children who are temporarily absent from the household in
settings such as schools, camps, or parenting time with noncustodial parents.

Sec. 6.

Minnesota Statutes 2008, section 256L.01, is amended by adding a subdivision
to read:


new text begin Subd. 6. new text end

new text begin Excess income. new text end

new text begin (a) A family who has excess income is eligible for
MinnesotaCare if the family has expenses for medical care that are more than the amount
of the family's excess income, computed by deducting incurred medical expenses from the
excess income to reduce the excess to the income standard specified in paragraph (b). The
family 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 enrollees 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 enrollee does not pay the spenddown amount on or before the last business day of
the month, the enrollee is ineligible for this option for the following month. The local
agency shall code the Medicaid Management Information System (MMIS) to indicate that
the enrollee has elected this option. The state agency shall convey enrollee eligibility
information relative to the collection of the spenddown to providers through the Electronic
Verification System (EVS). An enrollee electing advance payment must pay the state
agency the monthly spenddown amount on or before noon on the last business day of the
month in order to be eligible for this option in the following month.
new text end

new text begin (b) The excess income standard for families with children is 100 percent of the
federal poverty guidelines.
new text end

Sec. 7.

Minnesota Statutes 2008, section 256L.02, is amended by adding a subdivision
to read:


new text begin Subd. 1a. new text end

new text begin Authorized coverage. new text end

new text begin The MinnesotaCare program covers all families
with children, to the extent allowed under the federal and state Medicaid law and the
Prepaid Medical Assistance Project Plus and State Children Health Insurance Program
Waivers.
new text end

Sec. 8.

Minnesota Statutes 2008, section 256L.02, subdivision 2, is amended to read:


Subd. 2.

Commissioner's dutiesnew text begin; county agency dutiesnew text end.

The commissionernew text begin and
county agencies
new text end shall deleted text beginestablish an office for the state administration of this plandeleted text endnew text begin develop a
plan to administer the MinnesotaCare program. The plan must require county agencies to
administer MinnesotaCare in their respective counties under the supervision of the state
agency and the commissioner of human services, and to prepare reports and statistics, and
keep records and accounts, for MinnesotaCare as required by the commissioner
new text end. The plan
shall be used to provide covered health services for eligible persons. Payment for these
services shall be made to all eligible providers. The commissioner shall adopt rules to
administer the MinnesotaCare program. The commissioner shall establish marketing
efforts to encourage potentially eligible persons to receive information about the program
and about other medical care programs administered or supervised by the Department of
Human Services. A toll-free telephone number must be used to provide information about
medical programs and to promote access to the covered services.

Sec. 9.

Minnesota Statutes 2008, section 256L.02, subdivision 3, is amended to read:


Subd. 3.

Financial management.

(a) The commissioner shall manage spending
for the MinnesotaCare program in a manner that maintains a minimum reserve.new text begin The
commissioner shall use medical assistance funding under chapter 256B to pay for covered
services for adults in families with children with incomes at or below 100 percent of the
federal poverty guidelines and children with incomes at or below 150 percent of the
federal poverty guidelines.
new text end As part of each state revenue and expenditure forecast, the
commissioner must make an assessment of the expected expenditures for the covered
services for the remainder of the current biennium and for the following biennium. The
estimated expenditure, including the reserve, shall be compared to an estimate of the
revenues that will be available in the health care access fund. Based on this comparison,
and after consulting with the chairs of the house of representatives Ways and Means
Committee and the senate Finance Committee, and the Legislative Commission on Health
Care Access, the commissioner shall, as necessary, make the adjustments specified in
paragraph (b) to ensure that expenditures remain within the limits of available revenues for
the remainder of the current biennium and for the following biennium. The commissioner
shall not hire additional staff using appropriations from the health care access fund until
the commissioner of finance makes a determination that the adjustments implemented
under paragraph (b) are sufficient to allow MinnesotaCare expenditures to remain within
the limits of available revenues for the remainder of the current biennium and for the
following biennium.

(b) The adjustments the commissioner shall use must be implemented in this order:
first, stop enrollment of single adults and households without children; second, upon 45
days' notice, stop coverage of single adults and households without children already
enrolled in the MinnesotaCare program; third, upon 90 days' notice, decrease the premium
subsidy amounts by ten percent for families with gross annual income above 200 percent
of the federal poverty guidelines; fourth, upon 90 days' notice, decrease the premium
subsidy amounts by ten percent for families with gross annual income at or below 200
percent; and fifth, require applicants to be uninsured for at least six months prior to
eligibility in the MinnesotaCare program. If these measures are insufficient to limit the
expenditures to the estimated amount of revenue, the commissioner shall further limit
enrollment or decrease premium subsidies.

Sec. 10.

Minnesota Statutes 2008, section 256L.03, subdivision 5, is amended to read:


Subd. 5.

Co-payments and coinsurance.

(a) Except as provided in paragraphs (b)
deleted text begin and (c)deleted text endnew text begin to (h)new text end, the MinnesotaCare benefit plan shall include the following co-payments and
coinsurance requirements for deleted text beginalldeleted text end enrollees:

(1) ten percent of the paid charges for inpatient hospital services for adult enrollees,
subject to an annual inpatient out-of-pocket maximum of $1,000 per individual and
$3,000 per family;

(2) $3 per prescription for adult enrollees;

(3) $25 for eyeglasses for adult enrollees;

(4) $3 per nonpreventive visit. For purposes of this subdivision, a "visit" means an
episode of service which is required because of a recipient's symptoms, diagnosis, or
established illness, and which is delivered in an ambulatory setting by a physician or
physician ancillary, chiropractor, podiatrist, nurse midwife, advanced practice nurse,
audiologist, optician, or optometrist; and

(5) $6 for nonemergency visits to a hospital-based emergency room.

(b) Paragraph (a), clause (1), does not apply to parents and relative caretakers of
children under the age of 21.

new text begin (c) For adults in families with incomes at or below 100 percent of the federal
poverty guidelines:
new text end

new text begin (1) paragraph (a), clauses (3) and (4), do not apply;
new text end

new text begin (2) the co-payment is $3 per brand-name drug prescription and $1 per generic drug
prescription, subject to a $7 per month maximum for prescription drug co-payments. No
co-payments shall apply to antipsychotic drugs when used for the treatment of mental
illness; and
new text end

new text begin (3) total monthly co-payments under this subdivision must not exceed five percent
of family income. For purposes of this paragraph, family income is the total earned and
unearned income of the individual, and the individual's spouse if the spouse is enrolled in
MinnesotaCare and also subject to the five percent limit on co-payments.
new text end

new text begin (d) Co-payment charges shall not exceed one per day per provider for nonpreventive
visits, eyeglasses, and nonemergency visits to a hospital-based emergency room.
new text end

deleted text begin (c)deleted text endnew text begin (e)new text end Paragraph (a) does not apply tonew text begin:
new text end

new text begin (1)new text end pregnant women and children under the age of 21new text begin;
new text endnew text beginnew text end

new text begin (2) 100 percent federally funded services provided by an Indian health service; and
new text end

new text begin (3) emergency servicesnew text end.

deleted text begin (d)deleted text endnew text begin (f)new text end Paragraph (a), clause (4), does not apply to mental health services.

deleted text begin (e)deleted text endnew text begin (g)new text end Adult enrollees with family gross income that exceeds 200 percent of the
federal poverty guidelines or 215 percent of the federal poverty guidelines on or after July
1, 2009, and who are not pregnant shall be financially responsible for the coinsurance
amount, if applicable, and amounts which exceed the $10,000 inpatient hospital benefit
limit.

deleted text begin (f)deleted text endnew text begin (h)new text end When a MinnesotaCare enrollee becomes a member of a prepaid health plan,
or changes from one prepaid health plan to another during a calendar year, any charges
submitted towards the $10,000 annual inpatient benefit limit, and any out-of-pocket
expenses incurred by the enrollee for inpatient services, that were submitted or incurred
prior to enrollment, or prior to the change in health plans, shall be disregarded.

Sec. 11.

Minnesota Statutes 2008, section 256L.03, is amended by adding a subdivision
to read:


new text begin Subd. 5b. new text end

new text begin Collection of co-payments. new text end

new text begin (a) The MinnesotaCare reimbursement to the
provider shall be reduced by the amount of the co-payment, except that reimbursements
shall not be reduced:
new text end

new text begin (1) once an enrollee has reached the $12 per month maximum or the $7 per month
maximum for prescription drug co-payments; or
new text end

new text begin (2) for an enrollee identified by the commissioner under 100 percent of the federal
poverty guidelines who has met their monthly five percent co-payment limit.
new text end

new text begin (b) The provider collects the co-payment from the enrollee. Providers shall not deny
services to enrollees who are unable to pay the co-payment.
new text end

Sec. 12.

Minnesota Statutes 2008, section 256L.04, subdivision 1, is amended to read:


Subdivision 1.

Families with children.

(a) Families with children with family
income equal to or less than 275 percent of the federal poverty guidelines for the
applicable family size shall be eligible for MinnesotaCare according to this section. All
other provisions of sections 256L.01 to 256L.18, including the insurance-related barriers
to enrollment under section 256L.07, shall apply unless otherwise specified.

(b) Parents who enroll in the MinnesotaCare program must also enroll their children,
if the children are eligible. Children may be enrolled separately without enrollment by
parents. However, if one parent in the household enrolls, both parents must enroll, unless
other insurance is available. If one child from a family is enrolled, all children must
be enrolled, unless other insurance is available. If one spouse in a household enrolls,
the other spouse in the household must also enroll, unless other insurance is available.
Families cannot choose to enroll only certain uninsured members.

(c) Beginning October 1, 2003, the dependent sibling definition no longer applies
to the MinnesotaCare program. These persons are no longer counted in the parental
household and may apply as a separate household.

(d) Beginning July 1, 2003, or upon federal approval, whichever is later, parents are
not eligible for MinnesotaCare if their gross income exceeds $57,500.

deleted text begin (e) Children formerly enrolled in medical assistance and automatically deemed
eligible for MinnesotaCare according to section 256B.057, subdivision 2c, are exempt
from the requirements of this section until renewal.
deleted text end

Sec. 13.

Minnesota Statutes 2008, section 256L.04, subdivision 8, is amended to read:


Subd. 8.

Applicants potentially eligible for medical assistance.

(a) Individuals
who receive supplemental security income or retirement, survivors, or disability benefits
due to a disability, or other disability-based pension, who qualify under subdivision 7, but
who are potentially eligible for medical assistance without a spenddown shall be allowed
to enroll in MinnesotaCare for a period of 60 days, so long as the applicant meets all other
conditions of eligibility. The commissioner shall identify and refer the applications of
such individuals to their county social service agency. The county and the commissioner
shall cooperate to ensure that the individuals obtain medical assistance coverage for any
months for which they are eligible.

(b) The enrollee must cooperate with the county social service agency in determining
medical assistance eligibility within the 60-day enrollment period. Enrollees who do not
cooperate with medical assistance within the 60-day enrollment period shall be disenrolled
from the plan within one calendar month. Persons disenrolled for nonapplication for
medical assistance may not reenroll until they have obtained a medical assistance
eligibility determination. Persons disenrolled for noncooperation with medical assistance
may not reenroll until they have cooperated with the county agency and have obtained a
medical assistance eligibility determination.

deleted text begin (c) Beginning January 1, 2000, counties that choose to become MinnesotaCare
enrollment sites shall consider MinnesotaCare applications to also be applications for
medical assistance. Applicants who are potentially eligible for medical assistance, except
for those described in paragraph (a), may choose to enroll in either MinnesotaCare or
medical assistance.
deleted text end

deleted text begin (d)deleted text endnew text begin (c)new text end The commissioner shall redetermine provider payments made under
MinnesotaCare to the appropriate medical assistance payments for those enrollees who
subsequently become eligible for medical assistance.

Sec. 14.

Minnesota Statutes 2008, section 256L.04, subdivision 13, is amended to read:


Subd. 13.

Families with relative caretakers, foster parents, or legal guardians.

Beginning January 1, 1999, in families that include a relative caretaker as defined in deleted text beginthe
medical assistance program
deleted text endnew text begin section 256L.01, subdivision 3a, paragraph (a), clause (2)new text end,
foster parent, or legal guardian, the relative caretaker, foster parent, or legal guardian
may apply as a family or may apply separately for the children. If the caretaker applies
separately for the children, only the children's income is counted and the provisions of
subdivision 1, paragraph (b), do not apply. If the relative caretaker, foster parent, or legal
guardian applies with the children, their income is included in the gross family income for
determining eligibility and premium amount.

Sec. 15.

new text begin [256L.041] ELIGIBILITY REQUIREMENTS FOR SPECIAL
CATEGORIES.
new text end

new text begin Subdivision 1. new text end

new text begin Infants and pregnant women. new text end

new text begin (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 MinnesotaCare if countable family
income is equal to or less than 275 percent of the federal poverty guideline for the same
family size.
new text end

new text begin (b) An infant born to a woman who was eligible for and receiving MinnesotaCare
on the date of the child's birth shall continue to be eligible for MinnesotaCare without
redetermination until the child's first birthday, as long as the child remains in the woman's
household.
new text end

new text begin Subd. 2. new text end

new text begin Children under age two. new text end

new text begin MinnesotaCare 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.
new text end

new text begin Subd. 3. new text end

new text begin Eligibility verification. new text end

new text begin (a) The commissioner shall require women who
are applying for the continuation of coverage following the end of the 60-day postpartum
period to update their income information and to submit any required income verification.
new text end

new text begin (b) The commissioner shall determine the eligibility of private-sector health care
coverage for infants less than one year of age and shall pay for private-sector coverage
if this is determined to be cost-effective.
new text end

Sec. 16.

Minnesota Statutes 2008, section 256L.05, is amended to read:


256L.05 APPLICATION PROCEDURES.

Subdivision 1.

Applicationnew text begin assistancenew text end and information availability.

new text begin(a)
new text endApplications and application assistance must be made available at provider offices, local
human services agencies, school districts, public and private elementary schools in which
25 percent or more of the students receive free or reduced price lunches, community health
offices, Women, Infants and Children (WIC) program sites, Head Start program sites,
public housing councils, crisis nurseries, child care centers, early childhood education
and preschool program sites, legal aid offices, and libraries. These sites may accept
applications and forward the forms to the commissioner or local county human services
agencies deleted text beginthat choose to participate as an enrollment sitedeleted text end. Otherwise, applicants may apply
directly to the commissioner or to participating local county human services agencies.

new text begin (b) Application assistance must be available for applicants choosing to file an
online application.
new text end

new text begin (c) The commissioner and local agencies shall assist enrollees in choosing a
managed care organization by:
new text end

new text begin (1) establishing a Web site to provide information about managed care organizations
and to allow online enrollment;
new text end

new text begin (2) making applications and information on managed care organizations available
to applicants and enrollees according to Title VI of the Civil Rights Act and federal
regulations adopted under that law, or any guidance from the United States Department of
Health and Human Services; and
new text end

new text begin (3) making benefit educators available to assist applicants in choosing a managed
care organization.
new text end

Subd. 1a.

Person authorized to apply on applicant's behalf.

Beginning January 1,
1999, a family member who is age 18 or over or who is an authorized representative, as
defined in the medical assistance program, may apply on an applicant's behalf.

Subd. 1b.

MinnesotaCare enrollment by county agencies.

Beginning September
1, 2006, county agencies shall enroll single adults and households with no children
formerly enrolled in general assistance medical care in MinnesotaCare according to
section 256D.03, subdivision 3. County agencies shall perform all duties necessary
to administer the MinnesotaCare program ongoing for these enrollees, including the
redetermination of MinnesotaCare eligibility at renewal.

new text begin Subd. 1c. new text end

new text begin Open enrollment and streamlined application and enrollment
process.
new text end

new text begin (a) The commissioner and local agencies working in partnership must develop
a streamlined and efficient application and enrollment process that meets the criteria
specified in this subdivision.
new text end

new text begin (b) The commissioners of human services and education shall provide
recommendations to the legislature by January 15, 2010, on the creation of an open
enrollment process for MinnesotaCare that is tied to the public education system, including
prekindergarten programs. The recommendations must:
new text end

new text begin (1) be developed in consultation with MinnesotaCare enrollees and representatives
from organizations that advocate on behalf of children and families, low-income persons
and minority populations, counties, school administrators and nurses, health plans, and
health care providers;
new text end

new text begin (2) be based on enrollment and renewal procedures best practices, including
express-lane eligibility as required under subdivision 1d;
new text end

new text begin (3) simplify the enrollment and renewal processes wherever possible; and
new text end

new text begin (4) establish a process to:
new text end

new text begin (i) disseminate information on the MinnesotaCare to all children in the public
education system, including prekindergarten programs; and
new text end

new text begin (ii) enroll children and other household members who are eligible.
new text end

new text begin The commissioners of human services and education shall implement an open
enrollment process by August 1, 2010, to be effective beginning with the 2010-2011
school year.
new text end

new text begin (c) The commissioner and local agencies shall develop an online application process
for MinnesotaCare.
new text end

new text begin (d) The commissioner shall develop an application that is easily understandable
and does not exceed four pages in length.
new text end

new text begin (e) The commissioner of human services shall present to the legislature, by January
15, 2010, an implementation plan for the open enrollment period and online application
process.
new text end

new text begin Subd. 1d. new text end

new text begin Express lane eligibility. new text end

new text begin (a) Children who complete an application
for educational benefits and indicate an interest in enrolling in MinnesotaCare on the
application form shall have the form considered an application for MinnesotaCare.
new text end

new text begin (b) The commissioner of education shall modify the application for educational
benefits to:
new text end

new text begin (1) include a separate section for MinnesotaCare;
new text end

new text begin (2) include a check-box to allow all of the children included on the application for
educational benefits to apply for MinnesotaCare; and
new text end

new text begin (3) specify that if the MinnesotaCare application box is checked, the information on
the application will be shared with the commissioner of human services.
new text end

new text begin (c) The commissioner of human services shall match the children's Social Security
numbers with the Social Security Administration database to comply with federal
citizenship documentation requirements.
new text end

new text begin (d) The commissioner of education shall forward electronically the information for
families who apply for MinnesotaCare to the commissioner of human services within
five business days of determining an applicant's eligibility for the free and reduced price
school lunch program.
new text end

new text begin (e) The commissioner of human services shall accept the income determination
made by the commissioner of education in administering the free and reduced-price school
lunch program as proof of income for MinnesotaCare eligibility until renewal. Within 30
days of receipt of information provided by the commissioner of education under paragraph
(d), the commissioner of human services shall:
new text end

new text begin (1) enroll all eligible children in the MinnesotaCare program; and
new text end

new text begin (2) provide information about Minnesota Health Care Programs for other household
members.
new text end

new text begin The date of application for the MinnesotaCare program is the date on the signed
application for educational benefits.
new text end

Subd. 2.

deleted text beginCommissioner'sdeleted text endnew text begin Commissioner or county agencynew text end duties.

The
commissioner or county agency shall use electronic verification as the primary method of
income verification. If there is a discrepancy between reported income and electronically
verified income, an individual may be required to submit additional verification. In
addition, the commissioner shall perform random audits to verify reported income and
eligibility. The commissioner may execute data sharing arrangements with the Department
of Revenue and any other governmental agency in order to perform income verification
related to eligibility and premium payment under the MinnesotaCare program.

Subd. 3.

Effective date of coverage.

(a)new text begin If adults in a family with children with
incomes at or below 100 percent of the federal poverty guidelines, or children with
incomes at or below 150 percent of the federal poverty guidelines, have been determined
to be eligible for MinnesotaCare, it will be made available for care and services included
under the plan and furnished in or after the third month before the month in which the
family or children made application for such assistance, if the adults or children were, or
upon application would have been, eligible for MinnesotaCare at the time the care and
services were furnished. The commissioner may limit, restrict, or suspend the eligibility
of an individual for up to one year, upon that individual's conviction of a criminal offense
related to application for or receipt of MinnesotaCare benefits.
new text end

new text begin (b) For adults in families with children with incomes above 100 percent of the federal
poverty guidelines, or children with incomes above 150 percent of the federal poverty
guidelines,
new text end the effective date of coverage is the first day of the month following the month
in which eligibility is approved and the first premium payment has been received. As
provided in section 256B.057, coverage for newborns is automatic from the date of birth
and must be coordinated with other health coverage. The effective date of coverage for
eligible newly adoptive children added to a family receiving covered health services is the
month of placement. The effective date of coverage for other new members added to the
family is the first day of the month following the month in which the change is reported.
All eligibility criteria must be met by the family at the time the new family member is
added. The income of the new family member is included with the family's gross income
and the adjusted premium begins in the month the new family member is added.

deleted text begin (b)deleted text endnew text begin (c)new text end The initial premium must be received by the last working day of the month
for coverage to begin the first day of the following month.

deleted text begin (c)deleted text endnew text begin (d)new text end Benefits are not available until the day following discharge if an enrollee is
hospitalized on the first day of coverage.

deleted text begin (d)deleted text endnew text begin (e)new text end Notwithstanding any other law to the contrary, benefits under sections
256L.01 to 256L.18 are secondary to a plan of insurance or benefit program under which
an eligible person may have coverage and the commissioner shall use cost avoidance
techniques to ensure coordination of any other health coverage for eligible persons. The
commissioner shall identify eligible persons who may have coverage or benefits under
other plans of insurance or who become eligible for medical assistance.

deleted text begin (e)deleted text endnew text begin (f)new text end The effective date of coverage for single adults and households with
no children formerly enrolled in general assistance medical care and enrolled in
MinnesotaCare according to section 256D.03, subdivision 3, is the first day of the month
following the last day of general assistance medical care coverage.

Subd. 3a.

Renewal of eligibility.

(a) Beginning July 1, 2007, an enrollee's eligibility
must be renewed every 12 months. The 12-month period begins in the month after the
month the application is approved.

(b) Each new period of eligibility must take into account any changes in
circumstances that impact eligibility and premium amount. An enrollee must provide all
the information needed to redetermine eligibility by the first day of the month that ends
the eligibility period. If there is no change in circumstances, the enrollee may renew
eligibilitynew text begin online ornew text end at designated locations that include community clinics and health
care providers' offices. The designated sites shall forward the renewal forms to the
commissionernew text begin or county agencynew text end. The commissioner may establish criteria and timelines
for sites to forward applications to the commissioner or county agencies. The premium
for the new period of eligibility must be received as provided in section 256L.06 in order
for eligibility to continue.

(c) For single adults and households with no children formerly enrolled in general
assistance medical care and enrolled in MinnesotaCare according to section 256D.03,
subdivision 3
, the first period of eligibility begins the month the enrollee submitted the
application or renewal for general assistance medical care.

(d) An enrollee who fails to submit renewal forms and related documentation
necessary for verification of continued eligibility in a timely manner shall remain eligible
for one additional month beyond the end of the current eligibility period before being
disenrolled. The enrollee remains responsible for MinnesotaCare premiums for the
additional month.

Subd. 3b.

Reapplication.

Beginning January 1, 1999, families and individuals
must reapply after a lapse in coverage of one calendar month or more and must meet all
eligibility criteria.

Subd. 3c.

Retroactive coverage.

Notwithstanding subdivision 3, the effective
date of coverage shall be the first day of the month following termination from medical
assistance or general assistance medical care for families and individuals who are eligible
for MinnesotaCare and who submitted a written request for retroactive MinnesotaCare
coverage with a completed application within 30 days of the mailing of notification of
termination from medical assistance or general assistance medical care. The applicant
must provide all required verifications within 30 days of the written request for
verification. For retroactive coverage, premiums must be paid in full for any retroactive
month, current month, and next month within 30 days of the premium billing.

Subd. 4.

Application processing.

The commissioner of human servicesnew text begin or local
county agencies
new text end shall determine an applicant's eligibility for MinnesotaCare no more
than 30 days from the date that the application is received deleted text beginby the Department of Human
Services. Beginning January 1, 2000, this requirement also applies to local county human
services agencies that determine eligibility for MinnesotaCare
deleted text end.

Subd. 5.

Availability of private insurance.

The commissioner, in consultation with
the commissioners of health and commerce, shall provide information regarding the
availability of private health insurance coverage and the possibility of disenrollment
under section 256L.07, subdivision 1, paragraphs (b) and (c), to all: (1) families enrolled
in the MinnesotaCare program whose gross family income is equal to or more than 225
percent of the federal poverty guidelines; and (2) single adults and households without
children enrolled in the MinnesotaCare program whose gross family income is equal to
or more than 165 percent of the federal poverty guidelines. This information must be
provided upon initial enrollment and annually thereafter. The commissioner shall also
include information regarding the availability of private health insurance coverage in the
notice of ineligibility provided to persons subject to disenrollment under section 256L.07,
subdivision 1
, paragraphs (b) and (c).

Sec. 17.

Minnesota Statutes 2008, section 256L.07, subdivision 1, is amended to read:


Subdivision 1.

General requirements.

(a) Children enrolled in the original
children's health plan as of September 30, 1992, children who enrolled in the
MinnesotaCare program after September 30, 1992, pursuant to Laws 1992, chapter 549,
article 4, section 17, and children who have family gross incomes that are equal to or
less than deleted text begin150deleted text endnew text begin 200new text end percent of the federal poverty guidelines are eligible without meeting
the requirements of subdivision 2 and the four-month requirement in subdivision 3, as
long as they maintain continuous coverage in the MinnesotaCare program deleted text beginor medical
assistance. Children who apply for MinnesotaCare on or after the implementation date
of the employer-subsidized health coverage program as described in Laws 1998, chapter
407, article 5, section 45, who have family gross incomes that are equal to or less than 150
percent of the federal poverty guidelines, must meet the requirements of subdivision 2 to
be eligible for MinnesotaCare
deleted text end.

Families enrolled in MinnesotaCare under section 256L.04, subdivision 1, whose
income increases above 275 percent of the federal poverty guidelines, are no longer
eligible for the program and shall be disenrolled by the commissioner. Beginning January
1, 2008, individuals enrolled in MinnesotaCare under section 256L.04, subdivision
7
, whose income increases above 200 percent of the federal poverty guidelines or 250
percent of the federal poverty guidelines on or after July 1, 2009, are no longer eligible for
the program and shall be disenrolled by the commissioner. For persons disenrolled under
this subdivision, MinnesotaCare coverage terminates the last day of the calendar month
following the month in which the commissioner determines that the income of a family or
individual exceeds program income limits.

(b) Notwithstanding paragraph (a), children may remain enrolled in MinnesotaCare
if ten percent of their gross individual or gross family income as defined in section
256L.01, subdivision 4, is less than the annual premium for a policy with a $500
deductible available through the Minnesota Comprehensive Health Association. Children
who are no longer eligible for MinnesotaCare under this clause shall be given a 12-month
notice period from the date that ineligibility is determined before disenrollment. The
premium for children remaining eligible under this clause shall be the maximum premium
determined under section 256L.15, subdivision 2, paragraph (b).

(c) Notwithstanding paragraphs (a) and (b), parents are not eligible for
MinnesotaCare if gross household income exceeds $57,500 for the 12-month period
of eligibility.

Sec. 18.

Minnesota Statutes 2008, section 256L.07, subdivision 2, is amended to read:


Subd. 2.

Must not have access to employer-subsidized coverage.

(a) To be
eligible, a family or individual must not have access to subsidized health coverage through
an employer and must not have had access to employer-subsidized coverage through
a current employer for 18 months prior to application or reapplication. A family or
individual whose employer-subsidized coverage is lost due to an employer terminating
health care coverage as an employee benefit during the previous 18 months is not eligible.

(b) This subdivision does not apply to a family or individual who was enrolled
in MinnesotaCare within six months or less of reapplication and who no longer has
employer-subsidized coverage due to the employer terminating health care coverage
as an employee benefit.new text begin This subdivision does not apply to adults in families with
children under 21 years of age with income at or below 100 percent of the federal poverty
guidelines and to children with family gross incomes that are at or below 200 percent of
federal poverty guidelines.
new text end

(c) For purposes of this requirement, subsidized health coverage means health
coverage for which the employer pays at least 50 percent of the cost of coverage for
the employee or dependent, or a higher percentage as specified by the commissioner.
Children are eligible for employer-subsidized coverage through either parent, including
the noncustodial parent. The commissioner must treat employer contributions to Internal
Revenue Code Section 125 plans and any other employer benefits intended to pay
health care costs as qualified employer subsidies toward the cost of health coverage for
employees for purposes of this subdivision.

Sec. 19.

Minnesota Statutes 2008, section 256L.07, subdivision 3, is amended to read:


Subd. 3.

Other health coverage.

(a) Families and individuals enrolled in the
MinnesotaCare program must have no health coverage while enrolled deleted text beginor for at least four
months prior to application and renewal
deleted text end. new text beginChildren with family gross incomes above
200 percent of the federal poverty guidelines, and adults in families with children with
incomes above 100 percent of the federal poverty guidelines must have had no health
coverage for at least four months prior to application and renewal.
new text endChildren enrolled in the
original children's health plan and children in families with income equal to or less than
deleted text begin 150deleted text endnew text begin 200new text end percent of the federal poverty guidelines, who have other health insurance, are
eligible if the coverage:

(1) lacks two or more of the following:

(i) basic hospital insurance;

(ii) medical-surgical insurance;

(iii) prescription drug coverage;

(iv) dental coverage; or

(v) vision coverage;

(2) requires a deductible of $100 or more per person per year; or

(3) lacks coverage because the child has exceeded the maximum coverage for a
particular diagnosis or the policy excludes a particular diagnosis.

The commissioner may change this eligibility criterion for sliding scale premiums
in order to remain within the limits of available appropriations. The requirement of no
health coverage does not apply to newborns.

(b) Medical assistance, general assistance medical care, and the Civilian Health and
Medical Program of the Uniformed Service, CHAMPUS, or other coverage provided under
United States Code, title 10, subtitle A, part II, chapter 55, are not considered insurance or
health coverage for purposes of the four-month requirement described in this subdivision.

(c) For purposes of this subdivision, an applicant or enrollee who is entitled to
Medicare Part A or enrolled in Medicare Part B coverage under title XVIII of the Social
Security Act, United States Code, title 42, sections 1395c to 1395w-152, is considered to
have health coverage. An applicant or enrollee who is entitled to premium-free Medicare
Part A may not refuse to apply for or enroll in Medicare coverage to establish eligibility
for MinnesotaCare.

(d) Applicants who were recipients of deleted text beginmedical assistance ordeleted text end general assistance
medical care within one month of application must meet the provisions of this subdivision
and subdivision 2.

(e)new text begin Adults in families with children with incomes at or below 100 percent of the
federal poverty guidelines and children in families with income at or below 200 percent
may have cost-effective insurance, as determined under section 256B.056, subdivision 8.
new text end
Cost-effective health insurance deleted text beginthat was paid for by medical assistancedeleted text end is not considered
health coverage for purposes of the four-month requirement under this section, deleted text beginexcept
if
deleted text endnew text begin unlessnew text end the insurance continued after deleted text beginmedical assistancedeleted text endnew text begin it wasnew text end no longer considered deleted text beginitdeleted text end
cost-effective or after medical assistance closed.

Sec. 20.

Minnesota Statutes 2008, section 256L.15, subdivision 1, is amended to read:


Subdivision 1.

Premium determination.

(a)new text begin Adults innew text end families with childrennew text begin with
incomes above 100 percent of the federal poverty guidelines, children in families with
incomes above 200 percent of the federal poverty guidelines,
new text end and individuals shall pay a
premium determined according to subdivision 2.

(b) Pregnant women and children under age two are exempt from the provisions
of section 256L.06, subdivision 3, paragraph (b), clause (3), requiring disenrollment
for failure to pay premiums. For pregnant women, this exemption continues until the
first day of the month following the 60th day postpartum. Women who remain enrolled
during pregnancy or the postpartum period, despite nonpayment of premiums, shall be
disenrolled on the first of the month following the 60th day postpartum for the penalty
period that otherwise applies under section 256L.06, unless they begin paying premiums.

(c) Members of the military and their families who meet the eligibility criteria
for MinnesotaCare upon eligibility approval made within 24 months following the end
of the member's tour of active duty shall have their premiums paid by the commissioner.
The effective date of coverage for an individual or family who meets the criteria of this
paragraph shall be the first day of the month following the month in which eligibility is
approved. This exemption applies for 12 months. This paragraph expires June 30, 2010.

Sec. 21.

Minnesota Statutes 2008, section 256L.15, subdivision 2, is amended to read:


Subd. 2.

Sliding fee scale; monthly gross individual or family income.

(a) The
commissioner shall establish a sliding fee scale to determine the percentage of monthly
gross individual or family income that households at different income levels must pay to
obtain coverage through the MinnesotaCare program. The sliding fee scale must be based
on the enrollee's monthly gross individual or family income. The sliding fee scale must
contain separate tables based on enrollment of one, two, or three or more persons. Until
June 30, 2009, the sliding fee scale begins with a premium of 1.5 percent of monthly gross
individual or family income for individuals or families with incomes below the limits for
the medical assistance program for families and children in effect on January 1, 1999, and
proceeds through the following evenly spaced steps: 1.8, 2.3, 3.1, 3.8, 4.8, 5.9, 7.4, and
8.8 percent. These percentages are matched to evenly spaced income steps ranging from
the medical assistance income limit for families and children in effect on January 1, 1999,
to 275 percent of the federal poverty guidelines for the applicable family size, up to a
family size of five. The sliding fee scale for a family of five must be used for families of
more than five. The sliding fee scale and percentages are not subject to the provisions of
chapter 14. If a family or individual reports increased income after enrollment, premiums
shall be adjusted at the time the change in income is reported.

(b) Children in families whose gross income is above 275 percent of the federal
poverty guidelines shall pay the maximum premium. The maximum premium is defined
as a base charge for one, two, or three or more enrollees so that if all MinnesotaCare
cases paid the maximum premium, the total revenue would equal the total cost of
MinnesotaCare medical coverage and administration. In this calculation, administrative
costs shall be assumed to equal ten percent of the total. The costs of medical coverage
for pregnant women and children under age two and the enrollees in these groups shall
be excluded from the total. The maximum premium for two enrollees shall be twice the
maximum premium for one, and the maximum premium for three or more enrollees shall
be three times the maximum premium for one.

(c) Beginning July 1, 2009, MinnesotaCare enrollees shall pay premiums according
to the premium scale specified in paragraph (d) with the exception thatnew text begin adults in families
with
new text end children deleted text beginin familiesdeleted text end with income at or below deleted text begin150deleted text endnew text begin 100new text end percent of the federal poverty
guidelinesnew text begin and children in families with incomes at or below 200 percent of the federal
poverty guidelines
new text end shall pay deleted text begina monthly premium of $4deleted text endnew text begin no premiumsnew text end. For purposes of
paragraph (d), "minimum" means a monthly premium of $4.

(d) The following premium scale is established for individuals and families with
gross family incomes of 300 percent of the federal poverty guidelines or less:

Federal Poverty Guideline Range
Percent of Average Gross Monthly
Income
0-45%
minimum
46-54%
1.1%
55-81%
1.6%
82-109%
2.2%
110-136%
2.9%
137-164%
3.6%
165-191%
4.6%
192-219%
5.6%
220-248%
6.5%
249-274%
7.2%
275-300%
8.0%

Sec. 22.

Minnesota Statutes 2008, section 256L.17, subdivision 1, is amended to read:


Subdivision 1.

Definitions.

For purposes of this section, the following definitions
apply.

(a) "Asset" means cash and other personal property, as well as any real property, that
deleted text begin a family ordeleted text endnew text begin annew text end individual owns which has monetary value.

(b) "Homestead" means the home that is owned by, and is the usual residence of,
deleted text begin the family ordeleted text endnew text begin annew text end individual, together with the surrounding property which is not separated
from the home by intervening property owned by others. Public rights-of-way, such as
roads that run through the surrounding property and separate it from the home, will not
affect the exemption of the property. "Usual residence" includes the home from which the
family or individual is temporarily absent due to illness, employment, or education, or
because the home is temporarily not habitable due to casualty or natural disaster.

(c) "Net asset" means the asset's fair market value minus any encumbrances
including, but not limited to, liens and mortgages.

Sec. 23.

Minnesota Statutes 2008, section 256L.17, subdivision 2, is amended to read:


Subd. 2.

Limit on total assets.

(a) deleted text beginEffective July 1, 2002, or upon federal approval,
whichever is later,
deleted text end In order to be eligible for the MinnesotaCare program, a household of
two or more persons must not own more than $20,000 in total net assets, and a household
of one person must not own more than $10,000 in total net assets.

(b) For purposes of this subdivision, assets are determined according to section
256B.056, subdivision 3c, except that workers' compensation settlements received due to
a work-related injury shall not be considered.

(c) State-funded MinnesotaCare is not available for applicants or enrollees who are
otherwise eligible for medical assistance but fail to verify assets. Enrollees who become
eligible for federally funded medical assistance shall be terminated from state-funded
MinnesotaCare and transferred to medical assistance.

Sec. 24.

Minnesota Statutes 2008, section 256L.17, subdivision 3, is amended to read:


Subd. 3.

Documentation.

(a) The commissioner of human services shall require
individuals deleted text beginand familiesdeleted text end, at the time of application or renewal, to indicate on a checkoff
form developed by the commissioner whether they satisfy the MinnesotaCare asset
requirement.

(b) The commissioner may require individuals deleted text beginand familiesdeleted text end to provide any
information the commissioner determines necessary to verify compliance with the asset
requirement, if the commissioner determines that there is reason to believe that an
individual deleted text beginor familydeleted text end has assets that exceed the program limit.

Sec. 25.

Minnesota Statutes 2008, section 256L.17, subdivision 5, is amended to read:


Subd. 5.

Exemption.

This section does not apply to pregnant womennew text begin and families
with children under 21 years of age
new text end. For purposes of this subdivision, a woman is
considered pregnant for 60 days postpartum.

Sec. 26.

new text begin [256L.19] FEDERAL APPROVAL.
new text end

new text begin The commissioner shall seek all federal waivers and approvals necessary to
implement sections 256L.01 to 256L.17.
new text end

Sec. 27. new text begin REPEALER.
new text end

new text begin (a) Minnesota Statutes 2008, sections 256B.055, subdivisions 3, 3a, 5, 6, 9, 10,
and 10b; 256B.056, subdivisions 1c and 3c; and 256B.057, subdivisions 1, 1c, 2, 2c, 7,
and 8,
new text end new text begin are repealed effective July 1, 2010.
new text end

new text begin (b) Minnesota Statutes 2008, sections 256L.07, subdivision 7; 256L.15, subdivision
3; and 256L.17, subdivision 6,
new text end new text begin are repealed effective July 1, 2010.
new text end

Sec. 28. new text beginEFFECTIVE DATE.
new text end

new text begin Sections 1 to 27 are effective July 1, 2010, or upon federal approval, whichever is
later.
new text end