Minnesota Legislature
SF 1175
as introduced - 94th Legislature (2025 - 2026) Posted on 02/14/2025 02:01pm
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A bill for an act
relating to human services; establishing a presumptive disability determination
process for medical assistance eligibility; amending Minnesota Statutes 2024,
sections 245D.02, subdivision 23; 256.01, subdivisions 18f, 29; 256B.055,
subdivision 7, by adding a subdivision; 256B.056, subdivisions 1b, 3, 4, 10, by
adding a subdivision; 256B.057, subdivision 12, by adding a subdivision;
256B.0761, subdivision 2; 256B.77, subdivision 7a.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
ARTICLE 1
PRESUMPTIVE DISABILITY DETERMINATIONS
Section 1.
Minnesota Statutes 2024, section 256B.055, subdivision 7, is amended to read:
Subd. 7.
deleted text begin Aged or blind persons or persons with disabilitiesdeleted text end new text begin Persons age 65 or
oldernew text end .
deleted text begin (a)deleted text end Medical assistance may be paid for a person who new text begin (1) is age 65 or older, (2) new text end meets
the deleted text begin categoricaldeleted text end eligibility requirements of the Supplemental Security Income program ordeleted text begin ,
whodeleted text end would meet those requirements except for excess income or assets, and deleted text begin whodeleted text end new text begin (3)new text end meets
the other eligibility requirements of this section.
deleted text begin
(b) Following a determination that the applicant is not aged or blind and does not meet
any other category of eligibility for medical assistance and has not been determined disabled
by the Social Security Administration, applicants under this subdivision shall be referred
to the commissioner's state medical review team for a determination of disability.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2025.
new text end
Sec. 2.
Minnesota Statutes 2024, section 256B.055, is amended by adding a subdivision
to read:
new text begin Subd. 7b. new text end
new text begin Persons who are blind or determined disabled. new text end
new text begin
(a) Medical assistance may
be paid for a person age 64 or younger who meets:
new text end
new text begin
(1) the categorical eligibility requirements of the Supplemental Security Income program;
new text end
new text begin
(2) the other eligibility requirements of the Supplemental Security Income program or
would meet those requirements except for excess income or assets; and
new text end
new text begin
(3) the other eligibility requirements of this section.
new text end
new text begin
(b) Following a determination that the applicant is not blind and does not meet any other
category of eligibility for medical assistance and has not been determined disabled by the
Social Security Administration, an applicant under this subdivision must be referred to the
commissioner's state medical review team for a determination of disability.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2025.
new text end
Sec. 3.
Minnesota Statutes 2024, section 256B.056, subdivision 3, is amended to read:
Subd. 3.
Asset limitations for certain individuals.
(a) 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, spouses, or parent and child, the household must
not own more than $6,000 in assets, plus $200 for each additional legal dependent. new text begin For the
purposes of this subdivision, a child eligible under section 256B.055, subdivision 12, is an
individual with a household size of one and the child's assets must be determined without
consideration of the parents' resources as provided by United States Code, title 42, section
1396a(e)(3). new text end 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 Supplemental
Security Income program for aged, blind, and disabled persons, with the following
exceptions:
(1) household goods and personal effects are not considered;
(2) 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;
(3) motor vehicles are excluded to the same extent excluded by the Supplemental Security
Income program;
(4) assets designated as burial expenses are excluded to the same extent excluded by the
Supplemental Security Income program. Burial expenses funded by annuity contracts or
life insurance policies must irrevocably designate the individual's estate as contingent
beneficiary to the extent proceeds are not used for payment of selected burial expenses;
(5) for a person who no longer qualifies as an employed person with a disability due to
loss of earnings, assets allowed while eligible for medical assistance under section 256B.057,
subdivision 9, are not considered for 12 months, beginning with the first month of ineligibility
as an employed person with a disability;
(6) a designated employment incentives asset account is disregarded when determining
eligibility for medical assistance for a person age 65 years or older under section 256B.055,
subdivision 7. An employment incentives asset account must only be designated by a person
who has been enrolled in medical assistance under section 256B.057, subdivision 9, for a
24-consecutive-month period. A designated employment incentives asset account contains
qualified assets owned by the person in the last month of enrollment in medical assistance
under section 256B.057, subdivision 9. Qualified assets include retirement and pension
accounts, medical expense accounts, and up to $17,000 of the person's other nonexcluded
liquid assets. An employment incentives asset account is no longer designated when a person
loses medical assistance eligibility for a calendar month or more before turning age 65. A
person who loses medical assistance eligibility before age 65 can establish a new designated
employment incentives asset account by establishing a new 24-consecutive-month period
of enrollment under section 256B.057, subdivision 9. Persons eligible under this clause are
not subject to the provisions in section 256B.059; and
(7) effective July 1, 2009, certain assets owned by American Indians are excluded as
required by section 5006 of the American Recovery and Reinvestment Act of 2009, Public
Law 111-5. For purposes of this clause, an American Indian is any person who meets the
definition of Indian according to Code of Federal Regulations, title 42, section 447.50.
(b) No asset limit shall apply to persons eligible under sections 256B.055, subdivision
15, and 256B.057, subdivision 9.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2025.
new text end
Sec. 4.
Minnesota Statutes 2024, 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 7deleted text begin , 7a,deleted text end new text begin to 7bnew text end and 12, may have income up to 100 percent of the
federal poverty guidelines. new text begin For the purposes of this section, a child eligible under section
256B.055, subdivision 12, is an individual with a household size of one and the child's
income must be determined without consideration of the parents' income as provided by
United States Code, title 42, section 1396(e)(3). new text end 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.
(b) To be eligible for medical assistance under section 256B.055, subdivision 3a, a parent
or caretaker relative may have an income up to 133 percent of the federal poverty guidelines
for the household size.
(c) To be eligible for medical assistance under section 256B.055, subdivision 15, a
person may have an income up to 133 percent of federal poverty guidelines for the household
size.
(d) To be eligible for medical assistance under section 256B.055, subdivision 16, a child
age 19 to 20 may have an income up to 133 percent of the federal poverty guidelines for
the household size.
(e) To be eligible for medical assistance under section 256B.055, subdivision 3a, a child
under age 19 may have income up to 275 percent of the federal poverty guidelines for the
household size.
(f) In computing income to determine eligibility of persons under paragraphs (a) to (e)
who are not residents of long-term care facilities, the commissioner shall disregard increases
in income as required by Public Laws 94-566, section 503; 99-272; and 99-509. For persons
eligible under paragraph (a), veteran aid and attendance benefits and Veterans Administration
unusual medical expense payments are considered income to the recipient.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2025.
new text end
Sec. 5.
Minnesota Statutes 2024, section 256B.057, subdivision 12, is amended to read:
Subd. 12.
Presumptive eligibility determinations made by qualified hospitals.
new text begin (a)
new text end The commissioner shall establish a process to qualify hospitals that are participating providers
under the medical assistance program to determine presumptive eligibility for medical
assistance for applicants whonew text begin :
new text end
new text begin (1)new text end may have a basis of eligibility using the modified adjusted gross income methodology
as defined in section 256B.056, subdivision 1a, paragraph (b), clause (1)new text begin ; or
new text end
new text begin
(2) have a presumptive disability determination under subdivision 13 and may have a
basis of eligibility using the methodology under section 256B.056, subdivision 1a, paragraph
(a).
new text end
new text begin
(b) A qualified hospital must determine that an applicant is not presumptively eligible
under paragraph (a), clause (1), before it may determine presumptive eligibility under
paragraph (a), clause (2).
new text end
new text begin
(c) An infant younger than two years of age who has a presumptive disability
determination under subdivision 13 by reason of an initial positive newborn screening or a
compassionate care allowance and is determined not to be presumptively eligible under
paragraph (a), clause (1), is presumptively eligible for medical assistance under paragraph
(a), clause (2).
new text end
new text begin (d) The period of presumptive eligibility under paragraph (a), clause (2), begins on the
date of the applicant's presumptive disability determination and extends until either the last
day of the month following the month in which the applicant's presumptive eligibility is
approved or, if the applicant submits a regular medical assistance application, until the final
determination of disability by the commissioner's state medical review team according to
section 256.01, subdivision 29, or by the federal Social Security Administration. If a final
determination of disability is denied by the commissioner's state medical review team or
the federal Social Security Administration, a new presumptive eligibility determination
under paragraph (a), clause (2), must not be made for that person unless the person's condition
has changednew text end .
new text begin
(e) When calculating the ratio of applicants determined eligible for medical assistance
on the basis of a regular application for medical assistance to applicants determined
presumptively eligible for medical assistance by the hospital, the commissioner must exclude
those applicants whose eligibility for medical assistance is denied based on a final denial
of a determination of disability by the commissioner's state medical review team or by the
federal Social Security Administration.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2025.
new text end
Sec. 6.
Minnesota Statutes 2024, section 256B.057, is amended by adding a subdivision
to read:
new text begin Subd. 13. new text end
new text begin Presumptive disability determinations made by qualified hospitals. new text end
new text begin
(a)
The commissioner shall establish a process to qualify hospitals that are participating providers
under the medical assistance program to determine presumptive disability for medical
assistance for applicants who may have a categorical basis of eligibility under section
256B.055, subdivision 7b or 12, as provided by United States Code, title 42, section
1396a(a)(47)(B).
new text end
new text begin
(b) Qualifying hospitals must make a presumptive determination of disability if the
applicant is a patient of the hospital and the applicant's attending physician attests in writing
that:
new text end
new text begin
(1) the applicant has a positive initial newborn screening for either congenital heart
disease or a heritable or congenital disorder included on the commissioner of health's list
of tests to be administered for determining the presence of a heritable or congenital disorder
and the applicant urgently requires diagnostic testing or treatment;
new text end
new text begin
(2) the applicant has been diagnosed with a condition included on the federal Social
Security Administration's list of compassionate allowances conditions and urgently requires
treatment; or
new text end
new text begin
(3) the applicant is receiving inpatient care in the hospital, the applicant needs long-term
services and supports in order to be safely discharged from the hospital, or either a long-term
care facility will not admit the applicant until medical assistance benefits are in effect or
the applicant is unable to return home or to a community-based setting without home and
community-based waiver services; and
new text end
new text begin
(i) for applicants 17 years of age or younger, has one or more medically determinable
physical or mental impairments that result in marked and severe functional limitations and
the impairments have lasted or are expected to last for a continuous period of at least 12
months or are expected to result in death; or
new text end
new text begin
(ii) for applicants 18 years of age or older, has one or more medically determinable
physical or mental impairments that cause severe functional limitations or inability to work
and the impairments have lasted or are expected to last for a continuous period of at least
12 months or are expected to result in death.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2025.
new text end
ARTICLE 2
CONFORMING CHANGES
Section 1.
Minnesota Statutes 2024, section 245D.02, subdivision 23, is amended to read:
Subd. 23.
Person with a disability.
"Person with a disability" means a person determined
to have a disability by the commissioner's state medical review team as identified in section
256B.055, subdivision deleted text begin 7deleted text end new text begin 7bnew text end , the Social Security Administration, or the person is determined
to have a developmental disability or a related condition as defined in Minnesota Rules,
part 9525.0016, subpart 2, items A to E.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2025.
new text end
Sec. 2.
Minnesota Statutes 2024, section 256.01, subdivision 18f, is amended to read:
Subd. 18f.
Asset verification system.
The commissioner shall implement the Asset
Verification System (AVS) according to Public Law 110-252, title VII, section 7001(d), to
verify assets for an individual applying for or renewing health care benefits under section
256B.055, deleted text begin subdivision 7deleted text end new text begin subdivisions 7 and 7bnew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2025.
new text end
Sec. 3.
Minnesota Statutes 2024, section 256.01, subdivision 29, is amended to read:
Subd. 29.
State medical review team.
(a) To ensure the timely processing of
determinations of disability by the commissioner's state medical review team under sections
256B.055, subdivisions deleted text begin 7, paragraph (b),deleted text end new text begin 7bnew text end and 12, and 256B.057, subdivision 9, the
commissioner shall review all medical evidence and seek information from providers,
applicants, and enrollees to support the determination of disability where necessary. Disability
shall be determined according to the rules of title XVI and title XIX of the Social Security
Act and pertinent rules and policies of the Social Security Administration.
(b) Prior to a denial or withdrawal of a requested determination of disability due to
insufficient evidence, the commissioner shall (1) ensure that the missing evidence is necessary
and appropriate to a determination of disability, and (2) assist applicants and enrollees to
obtain the evidence, including, but not limited to, medical examinations and electronic
medical records.
(c) Any appeal made under section 256.045, subdivision 3, of a disability determination
made by the state medical review team must be decided according to the timelines under
section 256.0451, subdivision 22, paragraph (a). If a written decision is not issued within
the timelines under section 256.0451, subdivision 22, paragraph (a), the appeal must be
immediately reviewed by the chief human services judge.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2025.
new text end
Sec. 4.
Minnesota Statutes 2024, section 256B.056, subdivision 1b, is amended to read:
Subd. 1b.
deleted text begin Aged, blind, and disableddeleted text end Income methodologynew text begin for persons who are age
65 or oldernew text end .
The $20 general income disregard allowed under the Supplemental Security
Income program is included in the standard and shall not be allowed as a deduction from
income for a person eligible under section 256B.055, deleted text begin subdivisions 7, 7a, and 12deleted text end new text begin subdivision
7new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2025.
new text end
Sec. 5.
Minnesota Statutes 2024, section 256B.056, is amended by adding a subdivision
to read:
new text begin Subd. 1e. new text end
new text begin Income methodology for persons who are blind or determined disabled. new text end
new text begin
The
$20 general income disregard allowed under the Supplemental Security Income program
is included in the standard and shall not be allowed as a deduction from income for a person
eligible under section 256B.055, subdivisions 7a, 7b, and 12.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2025.
new text end
Sec. 6.
Minnesota Statutes 2024, section 256B.056, subdivision 10, is amended to read:
Subd. 10.
Eligibility verification.
(a) The commissioner shall require women who are
applying for the continuation of medical assistance coverage following the end of the
12-month postpartum period to update their income and asset information and to submit
any required income or asset verification.
(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 (c), and shall pay for private-sector coverage if this is
determined to be cost-effective.
(c) The commissioner shall verify assets and income for all applicants, and for all
recipients upon renewal.
(d) The commissioner shall utilize information obtained through the electronic service
established by the secretary of the United States Department of Health and Human Services
and other available electronic data sources in Code of Federal Regulations, title 42, sections
435.940 to 435.956, to verify eligibility requirements. The commissioner shall establish
standards to define when information obtained electronically is reasonably compatible with
information provided by applicants and enrollees, including use of self-attestation, to
accomplish real-time eligibility determinations and maintain program integrity.
(e) Each person applying for or receiving medical assistance under section 256B.055,
deleted text begin subdivision 7deleted text end new text begin subdivisions 7 and 7bnew text end , and any other person whose resources are required by
law to be disclosed to determine the applicant's or recipient's eligibility must authorize the
commissioner to obtain information from financial institutions to verify assets as required
in section 256.01, subdivision 18f. If a person refuses or revokes the authorization, the
commissioner may determine that the applicant or recipient is ineligible for medical
assistance. For purposes of this paragraph, an authorization to verify assets meets the
requirements of the Right to Financial Privacy Act, United States Code, title 12, chapter
35, and need not be furnished to the financial institution.
(f) County and tribal agencies shall comply with the standards established by the
commissioner for appropriate use of the asset verification system specified in section 256.01,
subdivision 18f.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2025.
new text end
Sec. 7.
Minnesota Statutes 2024, section 256B.0761, subdivision 2, is amended to read:
Subd. 2.
Eligible individuals.
Notwithstanding section 256B.055, subdivision 14,
individuals are eligible to receive services under this demonstration if they are eligible under
section 256B.055, subdivision 3a, 6, 7, 7a, new text begin 7b, new text end 9, 15, 16, or 17, as determined by the
commissioner in collaboration with correctional facilities, local governments, and Tribal
governments.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2025.
new text end
Sec. 8.
Minnesota Statutes 2024, section 256B.77, subdivision 7a, is amended to read:
Subd. 7a.
Eligible individuals.
(a) Persons are eligible for the demonstration project as
provided in this subdivision.
(b) "Eligible individuals" means those persons living in the demonstration site who are
eligible for medical assistance and are disabled based on a disability determination under
section 256B.055, subdivisions 7new text begin , 7b,new text end and 12, or who are eligible for medical assistance and
have been diagnosed as having:
(1) serious and persistent mental illness as defined in section 245.462, subdivision 20;
(2) severe emotional disturbance as defined in section 245.4871, subdivision 6; or
(3) developmental disability, or being a person with a developmental disability as defined
in section 252A.02, or a related condition as defined in section 256B.02, subdivision 11.
Other individuals may be included at the option of the county authority based on agreement
with the commissioner.
(c) Eligible individuals include individuals in excluded time status, as defined in chapter
256G. Enrollees in excluded time at the time of enrollment shall remain in excluded time
status as long as they live in the demonstration site and shall be eligible for 90 days after
placement outside the demonstration site if they move to excluded time status in a county
within Minnesota other than their county of financial responsibility.
(d) A person who is a sexual psychopathic personality as defined in section 253D.02,
subdivision 15, or a sexually dangerous person as defined in section 253D.02, subdivision
16, is excluded from enrollment in the demonstration project.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2025.
new text end