1.1                          A bill for an act 
  1.2             relating to human services; modifying eligibility 
  1.3             provisions for medical assistance and general 
  1.4             assistance medical care; modifying MinnesotaCare; 
  1.5             amending Minnesota Statutes 1996, section 256B.057, by 
  1.6             adding a subdivision; Minnesota Statutes 1997 
  1.7             Supplement, sections 256B.04, subdivision 18; 256D.03, 
  1.8             subdivision 3; 256L.01; 256L.02, subdivision 3; 
  1.9             256L.03, subdivisions 1, 3, 4, 5, and by adding 
  1.10            subdivisions; 256L.04, subdivisions 1, 2, 7, 8, 9, 10, 
  1.11            and by adding subdivisions; 256L.05, subdivisions 2, 
  1.12            3, 4, and by adding subdivisions; 256L.06, subdivision 
  1.13            3; 256L.07; 256L.09, subdivisions 2, 4, and 6; 
  1.14            256L.11, subdivision 6; 256L.12, subdivision 5; 
  1.15            256L.15; and 256L.17, by adding a subdivision; 
  1.16            repealing Minnesota Statutes 1997 Supplement, sections 
  1.17            256B.057, subdivision 1a; 256L.04, subdivisions 3, 4, 
  1.18            5, and 6; 256L.06, subdivisions 1 and 2; 256L.08; 
  1.19            256L.09, subdivision 3; 256L.13; 256L.14; and 256L.15, 
  1.20            subdivision 3. 
  1.21  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.22     Section 1.  Minnesota Statutes 1997 Supplement, section 
  1.23  256B.04, subdivision 18, is amended to read: 
  1.24     Subd. 18.  [APPLICATIONS FOR MEDICAL ASSISTANCE.] The state 
  1.25  agency may take applications for medical assistance and conduct 
  1.26  eligibility determinations for MinnesotaCare enrollees who are 
  1.27  required to apply for medical assistance according to section 
  1.28  256L.03, subdivision 3, paragraph (b). 
  1.29     Sec. 2.  Minnesota Statutes 1996, section 256B.057, is 
  1.30  amended by adding a subdivision to read: 
  1.31     Subd. 7.  [WAIVER OF MAINTENANCE OF EFFORT 
  1.32  REQUIREMENT.] Unless a federal waiver of the maintenance of 
  1.33  effort requirement of section 2105(d) of title XXI of the 
  2.1   Balanced Budget Act of 1997, Public Law Number 105-33, Statutes 
  2.2   at Large, volume 111, page 251, is granted by the federal 
  2.3   Department of Health and Human Services by September 30, 1998, 
  2.4   eligibility for children under age 21 must be determined without 
  2.5   regard to asset standards established in section 256B.056, 
  2.6   subdivision 3.  The commissioner of human services shall publish 
  2.7   a notice in the State Register upon receipt of a federal waiver. 
  2.8      Sec. 3.  Minnesota Statutes 1997 Supplement, section 
  2.9   256D.03, subdivision 3, is amended to read: 
  2.10     Subd. 3.  [GENERAL ASSISTANCE MEDICAL CARE; ELIGIBILITY.] 
  2.11  (a) General assistance medical care may be paid for any person 
  2.12  who is not eligible for medical assistance under chapter 256B, 
  2.13  including eligibility for medical assistance based on a 
  2.14  spenddown of excess income according to section 256B.056, 
  2.15  subdivision 5, or MinnesotaCare as defined in clause (4), except 
  2.16  as provided in paragraph (b); and: 
  2.17     (1) who is receiving assistance under section 256D.05, 
  2.18  except for families with children who are eligible under 
  2.19  Minnesota family investment program-statewide (MFIP-S), who is 
  2.20  having a payment made on the person's behalf under sections 
  2.21  256I.01 to 256I.06, or who resides in group residential housing 
  2.22  as defined in chapter 256I and can meet a spenddown using the 
  2.23  cost of remedial services received through group residential 
  2.24  housing; or 
  2.25     (2)(i) who is a resident of Minnesota; and whose equity in 
  2.26  assets is not in excess of $1,000 per assistance unit.  Exempt 
  2.27  assets, the reduction of excess assets, and the waiver of excess 
  2.28  assets must conform to the medical assistance program in chapter 
  2.29  256B, with the following exception:  the maximum amount of 
  2.30  undistributed funds in a trust that could be distributed to or 
  2.31  on behalf of the beneficiary by the trustee, assuming the full 
  2.32  exercise of the trustee's discretion under the terms of the 
  2.33  trust, must be applied toward the asset maximum; and 
  2.34     (ii) who has countable income not in excess of the 
  2.35  assistance standards established in section 256B.056, 
  2.36  subdivision 4, or whose excess income is spent down according to 
  3.1   section 256B.056, subdivision 5, using a six-month budget 
  3.2   period.  The method for calculating earned income disregards and 
  3.3   deductions for a person who resides with a dependent child under 
  3.4   age 21 shall follow section 256B.056, subdivision 1a.  However, 
  3.5   if a disregard of $30 and one-third of the remainder has been 
  3.6   applied to the wage earner's income, the disregard shall not be 
  3.7   applied again until the wage earner's income has not been 
  3.8   considered in an eligibility determination for general 
  3.9   assistance, general assistance medical care, medical assistance, 
  3.10  or MFIP-S for 12 consecutive months.  The earned income and work 
  3.11  expense deductions for a person who does not reside with a 
  3.12  dependent child under age 21 shall be the same as the method 
  3.13  used to determine eligibility for a person under section 
  3.14  256D.06, subdivision 1, except the disregard of the first $50 of 
  3.15  earned income is not allowed; or 
  3.16     (3) who would be eligible for medical assistance except 
  3.17  that the person resides in a facility that is determined by the 
  3.18  commissioner or the federal Health Care Financing Administration 
  3.19  to be an institution for mental diseases.; or 
  3.20     (4) beginning July 1, 1998 January 1, 2000, applicants or 
  3.21  recipients who meet all eligibility requirements of 
  3.22  MinnesotaCare as defined in sections 256L.01 to 256L.16, and are:
  3.23     (i) adults with dependent children under 21 whose gross 
  3.24  family income is equal to or less than 275 percent of the 
  3.25  federal poverty guidelines; or 
  3.26     (ii) adults without children with earned income and whose 
  3.27  family gross income is between 75 percent of the federal poverty 
  3.28  guidelines and the amount set by section 256L.04, subdivision 7, 
  3.29  shall be terminated from general assistance medical care upon 
  3.30  enrollment in MinnesotaCare. 
  3.31     (b) For services rendered on or after July 1, 1997, 
  3.32  eligibility is limited to one month prior to application if the 
  3.33  person is determined eligible in the prior month.  A 
  3.34  redetermination of eligibility must occur every 12 months.  
  3.35  Beginning July 1, 1998 January 1, 2000, Minnesota health care 
  3.36  program applications completed by recipients and applicants who 
  4.1   are persons described in paragraph (a), clause (4), may be 
  4.2   returned to the county agency to be forwarded to the department 
  4.3   of human services or sent directly to the department of human 
  4.4   services for enrollment in MinnesotaCare.  If all other 
  4.5   eligibility requirements of this subdivision are met, 
  4.6   eligibility for general assistance medical care shall be 
  4.7   available in any month during which a MinnesotaCare eligibility 
  4.8   determination and enrollment are pending.  Upon notification of 
  4.9   eligibility for MinnesotaCare, notice of termination for 
  4.10  eligibility for general assistance medical care shall be sent to 
  4.11  an applicant or recipient.  If all other eligibility 
  4.12  requirements of this subdivision are met, eligibility for 
  4.13  general assistance medical care shall be available until 
  4.14  enrollment in MinnesotaCare subject to the provisions of 
  4.15  paragraph (d). 
  4.16     (c) The date of an initial Minnesota health care program 
  4.17  application necessary to begin a determination of eligibility 
  4.18  shall be the date the applicant has provided a name, address, 
  4.19  and social security number, signed and dated, to the county 
  4.20  agency or the department of human services.  If the applicant is 
  4.21  unable to provide an initial application when health care is 
  4.22  delivered due to a medical condition or disability, a health 
  4.23  care provider may act on the person's behalf to complete the 
  4.24  initial application.  The applicant must complete the remainder 
  4.25  of the application and provide necessary verification before 
  4.26  eligibility can be determined.  The county agency must assist 
  4.27  the applicant in obtaining verification if necessary. 
  4.28     (d) County agencies are authorized to use all automated 
  4.29  databases containing information regarding recipients' or 
  4.30  applicants' income in order to determine eligibility for general 
  4.31  assistance medical care or MinnesotaCare.  Such use shall be 
  4.32  considered sufficient in order to determine eligibility and 
  4.33  premium payments by the county agency. 
  4.34     (e) General assistance medical care is not available for a 
  4.35  person in a correctional facility unless the person is detained 
  4.36  by law for less than one year in a county correctional or 
  5.1   detention facility as a person accused or convicted of a crime, 
  5.2   or admitted as an inpatient to a hospital on a criminal hold 
  5.3   order, and the person is a recipient of general assistance 
  5.4   medical care at the time the person is detained by law or 
  5.5   admitted on a criminal hold order and as long as the person 
  5.6   continues to meet other eligibility requirements of this 
  5.7   subdivision.  
  5.8      (f) General assistance medical care is not available for 
  5.9   applicants or recipients who do not cooperate with the county 
  5.10  agency to meet the requirements of medical assistance.  General 
  5.11  assistance medical care is limited to payment of emergency 
  5.12  services only for applicants or recipients as described in 
  5.13  paragraph (a), clause (4), whose MinnesotaCare coverage is 
  5.14  denied or terminated for nonpayment of premiums as required by 
  5.15  sections 256L.06 to 256L.08 and 256L.07.  
  5.16     (g) In determining the amount of assets of an individual, 
  5.17  there shall be included any asset or interest in an asset, 
  5.18  including an asset excluded under paragraph (a), that was given 
  5.19  away, sold, or disposed of for less than fair market value 
  5.20  within the 60 months preceding application for general 
  5.21  assistance medical care or during the period of eligibility.  
  5.22  Any transfer described in this paragraph shall be presumed to 
  5.23  have been for the purpose of establishing eligibility for 
  5.24  general assistance medical care, unless the individual furnishes 
  5.25  convincing evidence to establish that the transaction was 
  5.26  exclusively for another purpose.  For purposes of this 
  5.27  paragraph, the value of the asset or interest shall be the fair 
  5.28  market value at the time it was given away, sold, or disposed 
  5.29  of, less the amount of compensation received.  For any 
  5.30  uncompensated transfer, the number of months of ineligibility, 
  5.31  including partial months, shall be calculated by dividing the 
  5.32  uncompensated transfer amount by the average monthly per person 
  5.33  payment made by the medical assistance program to skilled 
  5.34  nursing facilities for the previous calendar year.  The 
  5.35  individual shall remain ineligible until this fixed period has 
  5.36  expired.  The period of ineligibility may exceed 30 months, and 
  6.1   a reapplication for benefits after 30 months from the date of 
  6.2   the transfer shall not result in eligibility unless and until 
  6.3   the period of ineligibility has expired.  The period of 
  6.4   ineligibility begins in the month the transfer was reported to 
  6.5   the county agency, or if the transfer was not reported, the 
  6.6   month in which the county agency discovered the transfer, 
  6.7   whichever comes first.  For applicants, the period of 
  6.8   ineligibility begins on the date of the first approved 
  6.9   application. 
  6.10     (h) When determining eligibility for any state benefits 
  6.11  under this subdivision, the income and resources of all 
  6.12  noncitizens shall be deemed to include their sponsor's income 
  6.13  and resources as defined in the Personal Responsibility and Work 
  6.14  Opportunity Reconciliation Act of 1996, title IV, Public Law 
  6.15  Number 104-193, sections 421 and 422, and subsequently set out 
  6.16  in federal rules. 
  6.17     (i) An undocumented noncitizen or a nonimmigrant is 
  6.18  ineligible for general assistance medical care other than 
  6.19  emergency services.  For purposes of this subdivision, a 
  6.20  nonimmigrant is an individual in one or more of the classes 
  6.21  listed in United States Code, title 8, section 1101(a)(15), and 
  6.22  an undocumented noncitizen is an individual who resides in the 
  6.23  United States without the approval or acquiescence of the 
  6.24  Immigration and Naturalization Service. 
  6.25     (j) This paragraph does not apply to a child under age 18, 
  6.26  to a Cuban or Haitian entrant as defined in Public Law Number 
  6.27  96-422, section 501(e)(1) or (2)(a), or to a noncitizen who is 
  6.28  aged, blind, or disabled as defined in Code of Federal 
  6.29  Regulations, title 42, sections 435.520, 435.530, 435.531, 
  6.30  435.540, and 435.541, who cooperates with the Immigration and 
  6.31  Naturalization Service to pursue any applicable immigration 
  6.32  status, including citizenship, that would qualify the individual 
  6.33  for medical assistance with federal financial participation. 
  6.34     (k) For purposes of paragraphs (f) and (i), "emergency 
  6.35  services" has the meaning given in Code of Federal Regulations, 
  6.36  title 42, section 440.255(b)(1), except that it also means 
  7.1   services rendered because of suspected or actual pesticide 
  7.2   poisoning. 
  7.3      (l) Notwithstanding any other provision of law, a 
  7.4   noncitizen who is ineligible for medical assistance due to the 
  7.5   deeming of a sponsor's income and resources, is ineligible for 
  7.6   general assistance medical care. 
  7.7      Sec. 4.  Minnesota Statutes 1997 Supplement, section 
  7.8   256L.01, is amended to read: 
  7.9      256L.01 [DEFINITIONS.] 
  7.10     Subdivision 1.  [SCOPE.] For purposes of sections 256L.01 
  7.11  to 256L.10 256L.18, the following terms shall have the meanings 
  7.12  given them. 
  7.13     Subd. 1a.  [CHILD.] "Child" means an individual under 21 
  7.14  years of age, including the unborn child of a pregnant woman, an 
  7.15  emancipated minor, and an emancipated minor's spouse. 
  7.16     Subd. 2.  [COMMISSIONER.] "Commissioner" means the 
  7.17  commissioner of human services. 
  7.18     Subd. 3.  [ELIGIBLE PROVIDERS.] "Eligible providers" means 
  7.19  those health care providers who provide covered health services 
  7.20  to medical assistance recipients under rules established by the 
  7.21  commissioner for that program.  
  7.22     Subd. 3a.  [FAMILY WITH CHILDREN.] (a) "Family with 
  7.23  children" means: 
  7.24     (1) parents, their children, and dependent siblings 
  7.25  residing in the same household; or 
  7.26     (2) grandparents, foster parents, relative caretakers as 
  7.27  defined in the medical assistance program, or legal guardians; 
  7.28  their wards who are children; and dependent siblings residing in 
  7.29  the same household.  
  7.30     (b) The term includes children and dependent siblings who 
  7.31  are temporarily absent from the household in settings such as 
  7.32  schools, camps, or visitation with noncustodial parents.  
  7.33     (c) For purposes of this subdivision, a dependent sibling 
  7.34  means an unmarried child who is a full-time student under the 
  7.35  age of 25 years who is financially dependent upon a parent, 
  7.36  grandparent, foster parent, relative caretaker, or legal 
  8.1   guardian.  Proof of school enrollment is required. 
  8.2      Subd. 4.  [GROSS INDIVIDUAL OR GROSS FAMILY INCOME.] "Gross 
  8.3   individual or gross family income" for farm and nonfarm 
  8.4   self-employed means income calculated using as the baseline the 
  8.5   adjusted gross income reported on the applicant's federal income 
  8.6   tax form for the previous year and adding back in reported 
  8.7   depreciation, carryover loss, and net operating loss amounts 
  8.8   that apply to the business in which the family is currently 
  8.9   engaged.  Applicants shall report the most recent financial 
  8.10  situation of the family if it has changed from the period of 
  8.11  time covered by the federal income tax form.  The report may be 
  8.12  in the form of percentage increase or decrease. 
  8.13     Subd. 5.  [INCOME.] "Income" has the meaning given for 
  8.14  earned and unearned income for families and children in the 
  8.15  medical assistance program, according to the state's aid to 
  8.16  families with dependent children plan in effect as of July 16, 
  8.17  1996.  The definition does not include medical assistance income 
  8.18  methodologies and deeming requirements.  The earned income of 
  8.19  full-time and part-time students under age 19 is not counted as 
  8.20  income.  Public assistance payments and supplemental security 
  8.21  income are not excluded income. 
  8.22     Sec. 5.  Minnesota Statutes 1997 Supplement, section 
  8.23  256L.02, subdivision 3, is amended to read: 
  8.24     Subd. 3.  [FINANCIAL MANAGEMENT.] (a) The commissioner 
  8.25  shall manage spending for the MinnesotaCare program in a manner 
  8.26  that maintains a minimum reserve in accordance with section 
  8.27  16A.76.  As part of each state revenue and expenditure forecast, 
  8.28  the commissioner must make a quarterly an assessment of the 
  8.29  expected expenditures for the covered services for the remainder 
  8.30  of the current biennium and for the following biennium.  The 
  8.31  estimated expenditure, including the reserve requirements 
  8.32  described in section 16A.76, shall be compared to an estimate of 
  8.33  the revenues that will be deposited available in the health care 
  8.34  access fund.  Based on this comparison, and after consulting 
  8.35  with the chairs of the house ways and means committee and the 
  8.36  senate finance committee, and the legislative commission on 
  9.1   health care access, the commissioner shall, as necessary, make 
  9.2   the adjustments specified in paragraph (b) to ensure that 
  9.3   expenditures remain within the limits of available revenues for 
  9.4   the remainder of the current biennium and for the following 
  9.5   biennium.  The commissioner shall not hire additional staff 
  9.6   using appropriations from the health care access fund until the 
  9.7   commissioner of finance makes a determination that the 
  9.8   adjustments implemented under paragraph (b) are sufficient to 
  9.9   allow MinnesotaCare expenditures to remain within the limits of 
  9.10  available revenues for the remainder of the current biennium and 
  9.11  for the following biennium. 
  9.12     (b) The adjustments the commissioner shall use must be 
  9.13  implemented in this order:  first, stop enrollment of single 
  9.14  adults and households without children; second, upon 45 days' 
  9.15  notice, stop coverage of single adults and households without 
  9.16  children already enrolled in the MinnesotaCare program; third, 
  9.17  upon 90 days' notice, decrease the premium subsidy amounts by 
  9.18  ten percent for families with gross annual income above 200 
  9.19  percent of the federal poverty guidelines; fourth, upon 90 days' 
  9.20  notice, decrease the premium subsidy amounts by ten percent for 
  9.21  families with gross annual income at or below 200 percent; and 
  9.22  fifth, require applicants to be uninsured for at least six 
  9.23  months prior to eligibility in the MinnesotaCare program.  If 
  9.24  these measures are insufficient to limit the expenditures to the 
  9.25  estimated amount of revenue, the commissioner shall further 
  9.26  limit enrollment or decrease premium subsidies. 
  9.27     Sec. 6.  Minnesota Statutes 1997 Supplement, section 
  9.28  256L.03, subdivision 1, is amended to read: 
  9.29     Subdivision 1.  [COVERED HEALTH SERVICES.] "Covered health 
  9.30  services" means the health services reimbursed under chapter 
  9.31  256B, with the exception of inpatient hospital services, special 
  9.32  education services, private duty nursing services, adult dental 
  9.33  care services other than preventive services, orthodontic 
  9.34  services, nonemergency medical transportation services, personal 
  9.35  care assistant and case management services, nursing home or 
  9.36  intermediate care facilities services, inpatient mental health 
 10.1   services, and chemical dependency services.  Effective July 1, 
 10.2   1998, adult dental care for nonpreventive services with the 
 10.3   exception of orthodontic services is available to persons who 
 10.4   qualify under section 256L.04, subdivisions 1 to 7, or 256L.13, 
 10.5   with family gross income equal to or less than 175 percent of 
 10.6   the federal poverty guidelines.  Outpatient mental health 
 10.7   services covered under the MinnesotaCare program are limited to 
 10.8   diagnostic assessments, psychological testing, explanation of 
 10.9   findings, medication management by a physician, day treatment, 
 10.10  partial hospitalization, and individual, family, and group 
 10.11  psychotherapy. 
 10.12     No public funds shall be used for coverage of abortion 
 10.13  under MinnesotaCare except where the life of the female would be 
 10.14  endangered or substantial and irreversible impairment of a major 
 10.15  bodily function would result if the fetus were carried to term; 
 10.16  or where the pregnancy is the result of rape or incest. 
 10.17     Covered health services shall be expanded as provided in 
 10.18  this section. 
 10.19     Sec. 7.  Minnesota Statutes 1997 Supplement, section 
 10.20  256L.03, is amended by adding a subdivision to read: 
 10.21     Subd. 1a.  [COVERED SERVICES FOR PREGNANT WOMEN AND 
 10.22  CHILDREN UNDER MINNESOTACARE HEALTH CARE REFORM 
 10.23  WAIVER.] Children and pregnant women are eligible for coverage 
 10.24  of all services that are eligible for reimbursement under the 
 10.25  medical assistance program according to chapter 256B.  Pregnant 
 10.26  women and children are exempt from the provisions of subdivision 
 10.27  5, regarding copayments.  Pregnant women and children who are 
 10.28  lawfully residing in the United States but who are not 
 10.29  "qualified noncitizens" under title IV of the Personal 
 10.30  Responsibility and Work Opportunity Reconciliation Act of 1996, 
 10.31  Public Law Number 104-193, Statutes at Large, volume 110, page 
 10.32  2105, are eligible for coverage of all services provided under 
 10.33  the medical assistance program according to chapter 256B. 
 10.34     Sec. 8.  Minnesota Statutes 1997 Supplement, section 
 10.35  256L.03, is amended by adding a subdivision to read: 
 10.36     Subd. 1b.  [PREGNANT WOMEN; ELIGIBILITY FOR FULL MEDICAL 
 11.1   ASSISTANCE SERVICES.] A woman who is enrolled in MinnesotaCare 
 11.2   when her pregnancy is diagnosed is eligible for coverage of all 
 11.3   services provided under the medical assistance program according 
 11.4   to chapter 256B retroactive to the date the pregnancy is 
 11.5   medically diagnosed.  Copayments totaling $30 or more, paid 
 11.6   after the date the pregnancy is diagnosed, shall be refunded. 
 11.7      Sec. 9.  Minnesota Statutes 1997 Supplement, section 
 11.8   256L.03, subdivision 3, is amended to read: 
 11.9      Subd. 3.  [INPATIENT HOSPITAL SERVICES.] (a) Beginning July 
 11.10  1, 1993, Covered health services shall include inpatient 
 11.11  hospital services, including inpatient hospital mental health 
 11.12  services and inpatient hospital and residential chemical 
 11.13  dependency treatment, subject to those limitations necessary to 
 11.14  coordinate the provision of these services with eligibility 
 11.15  under the medical assistance spenddown.  Prior to July 1, 1997, 
 11.16  the inpatient hospital benefit for adult enrollees is subject to 
 11.17  an annual benefit limit of $10,000.  Effective July 1, 1997, The 
 11.18  inpatient hospital benefit for adult enrollees who qualify under 
 11.19  section 256L.04, subdivision 7, or who qualify under section 
 11.20  256L.04, subdivisions 1 to 6 and 2, or 256L.13 with family gross 
 11.21  income that exceeds 175 percent of the federal poverty 
 11.22  guidelines and who are not pregnant, is subject to an annual 
 11.23  limit of $10,000.  
 11.24     (b) Enrollees who qualify under section 256L.04, 
 11.25  subdivision 7, or who qualify under section 256L.04, 
 11.26  subdivisions 1 to 6, or 256L.13 with family gross income that 
 11.27  exceeds 175 percent of the federal poverty guidelines and who 
 11.28  are not pregnant, and are determined by the commissioner to have 
 11.29  a basis of eligibility for medical assistance shall apply for 
 11.30  and cooperate with the requirements of medical assistance by the 
 11.31  last day of the third month following admission to an inpatient 
 11.32  hospital.  If an enrollee fails to apply for medical assistance 
 11.33  within this time period, the enrollee and the enrollee's family 
 11.34  shall be disenrolled from the plan and they may not reenroll 
 11.35  until 12 calendar months have elapsed.  Enrollees and enrollees' 
 11.36  families disenrolled for not applying for or not cooperating 
 12.1   with medical assistance may not reenroll. 
 12.2      (c) Admissions for inpatient hospital services paid for 
 12.3   under section 256L.11, subdivision 3, must be certified as 
 12.4   medically necessary in accordance with Minnesota Rules, parts 
 12.5   9505.0500 to 9505.0540, except as provided in clauses (1) and 
 12.6   (2): 
 12.7      (1) all admissions must be certified, except those 
 12.8   authorized under rules established under section 254A.03, 
 12.9   subdivision 3, or approved under Medicare; and 
 12.10     (2) payment under section 256L.11, subdivision 3, shall be 
 12.11  reduced by five percent for admissions for which certification 
 12.12  is requested more than 30 days after the day of admission.  The 
 12.13  hospital may not seek payment from the enrollee for the amount 
 12.14  of the payment reduction under this clause. 
 12.15     (d) Any enrollee or family member of an enrollee who has 
 12.16  previously been permanently disenrolled from MinnesotaCare for 
 12.17  not applying for and cooperating with medical assistance shall 
 12.18  be eligible to reenroll if 12 calendar months have elapsed since 
 12.19  the date of disenrollment. 
 12.20     Sec. 10.  Minnesota Statutes 1997 Supplement, section 
 12.21  256L.03, subdivision 4, is amended to read: 
 12.22     Subd. 4.  [COORDINATION WITH MEDICAL ASSISTANCE.] The 
 12.23  commissioner shall coordinate the provision of hospital 
 12.24  inpatient services under the MinnesotaCare program with enrollee 
 12.25  eligibility under the medical assistance spenddown, and shall 
 12.26  apply to the secretary of health and human services for any 
 12.27  necessary federal waivers or approvals. 
 12.28     Sec. 11.  Minnesota Statutes 1997 Supplement, section 
 12.29  256L.03, subdivision 5, is amended to read: 
 12.30     Subd. 5.  [COPAYMENTS AND COINSURANCE.] The MinnesotaCare 
 12.31  benefit plan shall include the following copayments and 
 12.32  coinsurance requirements:  
 12.33     (1) ten percent of the paid charges for inpatient hospital 
 12.34  services for adult enrollees not eligible for medical 
 12.35  assistance, subject to an annual inpatient out-of-pocket maximum 
 12.36  of $1,000 per individual and $3,000 per family; 
 13.1      (2) $3 per prescription for adult enrollees; 
 13.2      (3) $25 for eyeglasses for adult enrollees; and 
 13.3      (4) effective July 1, 1998, 50 percent of the 
 13.4   fee-for-service rate for adult dental care services other than 
 13.5   preventive care services for persons eligible under section 
 13.6   256L.04, subdivisions 1 to 7, or 256L.13, with income equal to 
 13.7   or less than 175 percent of the federal poverty guidelines. 
 13.8      Prior to July 1, 1997, enrollees who are not eligible for 
 13.9   medical assistance with or without a spenddown shall be 
 13.10  financially responsible for the coinsurance amount and amounts 
 13.11  which exceed the $10,000 benefit limit.  Effective July 1, 1997, 
 13.12  adult enrollees who qualify under section 256L.04, subdivision 
 13.13  7, or who qualify under section 256L.04, subdivisions 1 to 6, or 
 13.14  256L.13 with family gross income that exceeds 175 percent of the 
 13.15  federal poverty guidelines and who are not pregnant, and who are 
 13.16  not eligible for medical assistance with or without a spenddown, 
 13.17  shall be financially responsible for the coinsurance amount and 
 13.18  amounts which exceed the $10,000 inpatient hospital benefit 
 13.19  limit. 
 13.20     When a MinnesotaCare enrollee becomes a member of a prepaid 
 13.21  health plan, or changes from one prepaid health plan to another 
 13.22  during a calendar year, any charges submitted towards the 
 13.23  $10,000 annual inpatient benefit limit, and any out-of-pocket 
 13.24  expenses incurred by the enrollee for inpatient services, that 
 13.25  were submitted or incurred prior to enrollment, or prior to the 
 13.26  change in health plans, shall be disregarded. 
 13.27     Sec. 12.  Minnesota Statutes 1997 Supplement, section 
 13.28  256L.04, subdivision 1, is amended to read: 
 13.29     Subdivision 1.  [CHILDREN; EXPANSION AND CONTINUATION OF 
 13.30  ELIGIBILITY FAMILIES WITH CHILDREN.] (a) [CHILDREN.] Prior to 
 13.31  October 1, 1992, "eligible persons" means children who are one 
 13.32  year of age or older but less than 18 years of age who have 
 13.33  gross family incomes that are equal to or less than 185 percent 
 13.34  of the federal poverty guidelines and who are not eligible for 
 13.35  medical assistance without a spenddown under chapter 256B and 
 13.36  who are not otherwise insured for the covered services.  The 
 14.1   period of eligibility extends from the first day of the month in 
 14.2   which the child's first birthday occurs to the last day of the 
 14.3   month in which the child becomes 18 years old.  Families with 
 14.4   children with family income equal to or less than 275 percent of 
 14.5   the federal poverty guidelines for the applicable family size 
 14.6   shall be eligible for MinnesotaCare according to this section.  
 14.7   All other provisions of sections 256L.01 to 256L.18, including 
 14.8   the insurance-related barriers to enrollment under section 
 14.9   256L.07, shall apply unless otherwise specified. 
 14.10     (b) [EXPANSION OF ELIGIBILITY.] Eligibility for 
 14.11  MinnesotaCare shall be expanded as provided in subdivisions 3 to 
 14.12  7, except children who meet the criteria in this subdivision 
 14.13  shall continue to be enrolled pursuant to this subdivision.  The 
 14.14  enrollment requirements in this paragraph apply to enrollment 
 14.15  under subdivisions 1 to 7.  Parents who enroll in the 
 14.16  MinnesotaCare program must also enroll their children and 
 14.17  dependent siblings, if the children and their dependent siblings 
 14.18  are eligible.  Children and dependent siblings may be enrolled 
 14.19  separately without enrollment by parents.  However, if one 
 14.20  parent in the household enrolls, both parents must enroll, 
 14.21  unless other insurance is available.  If one child from a family 
 14.22  is enrolled, all children must be enrolled, unless other 
 14.23  insurance is available.  If one spouse in a household enrolls, 
 14.24  the other spouse in the household must also enroll, unless other 
 14.25  insurance is available.  Families cannot choose to enroll only 
 14.26  certain uninsured members.  For purposes of this section, a 
 14.27  "dependent sibling" means an unmarried child who is a full-time 
 14.28  student under the age of 25 years who is financially dependent 
 14.29  upon a parent.  Proof of school enrollment will be required.  
 14.30     (c)  [CONTINUATION OF ELIGIBILITY.] Individuals who 
 14.31  initially enroll in the MinnesotaCare program under the 
 14.32  eligibility criteria in subdivisions 3 to 7 remain eligible for 
 14.33  the MinnesotaCare program, regardless of age, place of 
 14.34  residence, or the presence or absence of children in the same 
 14.35  household, as long as all other eligibility criteria are met and 
 14.36  residence in Minnesota and continuous enrollment in the 
 15.1   MinnesotaCare program or medical assistance are maintained.  In 
 15.2   order for either parent or either spouse in a household to 
 15.3   remain enrolled, both must remain enrolled, unless other 
 15.4   insurance is available. 
 15.5      Sec. 13.  Minnesota Statutes 1997 Supplement, section 
 15.6   256L.04, subdivision 2, is amended to read: 
 15.7      Subd. 2.  [COOPERATION IN ESTABLISHING THIRD PARTY 
 15.8   LIABILITY, PATERNITY, AND OTHER MEDICAL SUPPORT.] (a) To be 
 15.9   eligible for MinnesotaCare, individuals and families must 
 15.10  cooperate with the state agency to identify potentially liable 
 15.11  third party payers and assist the state in obtaining third party 
 15.12  payments.  "Cooperation" includes, but is not limited to, 
 15.13  identifying any third party who may be liable for care and 
 15.14  services provided under MinnesotaCare to the enrollee, providing 
 15.15  relevant information to assist the state in pursuing a 
 15.16  potentially liable third party, and completing forms necessary 
 15.17  to recover third party payments. 
 15.18     (b) A parent, guardian, or child enrolled in the 
 15.19  MinnesotaCare program must cooperate with the department of 
 15.20  human services and the local agency in establishing the 
 15.21  paternity of an enrolled child and in obtaining medical care 
 15.22  support and payments for the child and any other person for whom 
 15.23  the person can legally assign rights, in accordance with 
 15.24  applicable laws and rules governing the medical assistance 
 15.25  program.  A child shall not be ineligible for or disenrolled 
 15.26  from the MinnesotaCare program solely because the child's parent 
 15.27  or guardian fails to cooperate in establishing paternity or 
 15.28  obtaining medical support. 
 15.29     Sec. 14.  Minnesota Statutes 1997 Supplement, section 
 15.30  256L.04, subdivision 7, is amended to read: 
 15.31     Subd. 7.  [ADDITION OF SINGLE ADULTS AND HOUSEHOLDS WITH NO 
 15.32  CHILDREN.] (a) Beginning October 1, 1994, the definition of 
 15.33  "eligible persons" is expanded to include all individuals and 
 15.34  households with no children who have gross family incomes that 
 15.35  are equal to or less than 125 percent of the federal poverty 
 15.36  guidelines and who are not eligible for medical assistance 
 16.1   without a spenddown under chapter 256B.  
 16.2      (b) Beginning July 1, 1997, The definition of eligible 
 16.3   persons is expanded to include includes all individuals and 
 16.4   households with no children who have gross family incomes that 
 16.5   are equal to or less than 175 percent of the federal poverty 
 16.6   guidelines and who are not eligible for medical assistance 
 16.7   without a spenddown under chapter 256B. 
 16.8      (c) All eligible persons under paragraphs (a) and (b) are 
 16.9   eligible for coverage through the MinnesotaCare program but must 
 16.10  pay a premium as determined under sections 256L.07 and 256L.08.  
 16.11  Individuals and families whose income is greater than the limits 
 16.12  established under section 256L.08 may not enroll in the 
 16.13  MinnesotaCare program. 
 16.14     Sec. 15.  Minnesota Statutes 1997 Supplement, section 
 16.15  256L.04, is amended by adding a subdivision to read: 
 16.16     Subd. 7a.  [INELIGIBILITY.] Applicants whose income is 
 16.17  greater than the limits established under this section may not 
 16.18  enroll in the MinnesotaCare program. 
 16.19     Sec. 16.  Minnesota Statutes 1997 Supplement, section 
 16.20  256L.04, subdivision 8, is amended to read: 
 16.21     Subd. 8.  [APPLICANTS POTENTIALLY ELIGIBLE FOR MEDICAL 
 16.22  ASSISTANCE.] (a) Individuals who apply for MinnesotaCare receive 
 16.23  supplemental security income or retirement, survivors, or 
 16.24  disability benefits due to a disability, or other 
 16.25  disability-based pension, who qualify under section 256L.04, 
 16.26  subdivision 7, but who are potentially eligible for medical 
 16.27  assistance without a spenddown shall be allowed to enroll in 
 16.28  MinnesotaCare for a period of 60 days, so long as the applicant 
 16.29  meets all other conditions of eligibility.  The commissioner 
 16.30  shall identify and refer the applications of such individuals to 
 16.31  their county social service agency.  The county and the 
 16.32  commissioner shall cooperate to ensure that the individuals 
 16.33  obtain medical assistance coverage for any months for which they 
 16.34  are eligible. 
 16.35     (b) The enrollee must cooperate with the county social 
 16.36  service agency in determining medical assistance eligibility 
 17.1   within the 60-day enrollment period.  Enrollees who do not apply 
 17.2   for and cooperate with medical assistance within the 60-day 
 17.3   enrollment period, and their other family members, shall be 
 17.4   disenrolled from the plan within one calendar month.  Persons 
 17.5   disenrolled for nonapplication for medical assistance may not 
 17.6   reenroll until they have obtained a medical assistance 
 17.7   eligibility determination for the family member or members who 
 17.8   were referred to the county agency.  Persons disenrolled for 
 17.9   noncooperation with medical assistance may not reenroll until 
 17.10  they have cooperated with the county agency and have obtained a 
 17.11  medical assistance eligibility determination. 
 17.12     (c) Beginning January 1, 2000, counties that choose to 
 17.13  become MinnesotaCare enrollment sites shall consider 
 17.14  MinnesotaCare applications of individuals described in paragraph 
 17.15  (a) to also be applications for medical assistance and shall 
 17.16  first determine whether medical assistance eligibility exists.  
 17.17  Adults with children with family income under 175 percent of the 
 17.18  federal poverty guidelines for the applicable family size, 
 17.19  pregnant women, and children who qualify under subdivision 1 who 
 17.20  are potentially eligible for medical assistance without a 
 17.21  spenddown may choose to enroll in either MinnesotaCare or 
 17.22  medical assistance. 
 17.23     (d) The commissioner shall redetermine provider payments 
 17.24  made under MinnesotaCare to the appropriate medical assistance 
 17.25  payments for those enrollees who subsequently become eligible 
 17.26  for medical assistance. 
 17.27     Sec. 17.  Minnesota Statutes 1997 Supplement, section 
 17.28  256L.04, subdivision 9, is amended to read: 
 17.29     Subd. 9.  [GENERAL ASSISTANCE MEDICAL CARE.] A person 
 17.30  cannot have coverage under both MinnesotaCare and general 
 17.31  assistance medical care in the same month.  Eligibility for 
 17.32  MinnesotaCare cannot be replaced by eligibility for general 
 17.33  assistance medical care, and eligibility for general assistance 
 17.34  medical care cannot be replaced by eligibility for MinnesotaCare.
 17.35     Sec. 18.  Minnesota Statutes 1997 Supplement, section 
 17.36  256L.04, subdivision 10, is amended to read: 
 18.1      Subd. 10.  [SPONSOR'S INCOME AND RESOURCES DEEMED 
 18.2   AVAILABLE; DOCUMENTATION.] When determining eligibility for any 
 18.3   federal or state benefits under sections 256L.01 to 256L.16 
 18.4   256L.18, the income and resources of all noncitizens whose 
 18.5   sponsor signed an affidavit of support as defined under United 
 18.6   States Code, title 8, section 1183a, shall be deemed to include 
 18.7   their sponsors' income and resources as defined in the Personal 
 18.8   Responsibility and Work Opportunity Reconciliation Act of 1996, 
 18.9   title IV, Public Law Number 104-193, sections 421 and 422, and 
 18.10  subsequently set out in federal rules.  To be eligible for the 
 18.11  program, noncitizens must provide documentation of their 
 18.12  immigration status. 
 18.13     Sec. 19.  Minnesota Statutes 1997 Supplement, section 
 18.14  256L.04, is amended by adding a subdivision to read: 
 18.15     Subd. 12.  [PERSONS IN DETENTION.] An applicant residing in 
 18.16  a correctional or detention facility is not eligible for 
 18.17  MinnesotaCare.  An enrollee residing in a correctional or 
 18.18  detention facility is not eligible at renewal of eligibility 
 18.19  under section 256L.05, subdivision 3b. 
 18.20     Sec. 20.  Minnesota Statutes 1997 Supplement, section 
 18.21  256L.04, is amended by adding a subdivision to read: 
 18.22     Subd. 13.  [FAMILIES WITH GRANDPARENTS, RELATIVE 
 18.23  CARETAKERS, FOSTER PARENTS, OR LEGAL GUARDIANS.] In families 
 18.24  that include a grandparent, relative caretaker as defined in the 
 18.25  medical assistance program, foster parent, or legal guardian, 
 18.26  the grandparent, relative caretaker, foster parent, or legal 
 18.27  guardian may apply as a family or may apply separately for the 
 18.28  child.  If the grandparent, relative caretaker, foster parent, 
 18.29  or legal guardian applies with the family, their income is 
 18.30  included in the gross family income for determining eligibility 
 18.31  and premium amount. 
 18.32     Sec. 21.  Minnesota Statutes 1997 Supplement, section 
 18.33  256L.05, is amended by adding a subdivision to read: 
 18.34     Subd. 1a.  [PERSON AUTHORIZED TO APPLY ON APPLICANT'S 
 18.35  BEHALF.] A family member who is age 18 or over or who is an 
 18.36  authorized representative, as defined in the medical assistance 
 19.1   program, may apply on an applicant's behalf. 
 19.2      Sec. 22.  Minnesota Statutes 1997 Supplement, section 
 19.3   256L.05, subdivision 2, is amended to read: 
 19.4      Subd. 2.  [COMMISSIONER'S DUTIES.] The commissioner shall 
 19.5   use individuals' social security numbers as identifiers for 
 19.6   purposes of administering the plan and conduct data matches to 
 19.7   verify income.  Applicants shall submit evidence of individual 
 19.8   and family income, earned and unearned, including such as the 
 19.9   most recent income tax return, wage slips, or other 
 19.10  documentation that is determined by the commissioner as 
 19.11  necessary to verify income eligibility.  The commissioner shall 
 19.12  perform random audits to verify reported income and 
 19.13  eligibility.  The commissioner may execute data sharing 
 19.14  arrangements with the department of revenue and any other 
 19.15  governmental agency in order to perform income verification 
 19.16  related to eligibility and premium payment under the 
 19.17  MinnesotaCare program. 
 19.18     Sec. 23.  Minnesota Statutes 1997 Supplement, section 
 19.19  256L.05, subdivision 3, is amended to read: 
 19.20     Subd. 3.  [EFFECTIVE DATE OF COVERAGE.] The effective date 
 19.21  of coverage is the first day of the month following the month in 
 19.22  which eligibility is approved and the first premium payment has 
 19.23  been received.  As provided in section 256B.057, coverage for 
 19.24  newborns is automatic from the date of birth and must be 
 19.25  coordinated with other health coverage.  The effective date of 
 19.26  coverage for eligible newborns or eligible newly adoptive 
 19.27  children added to a family receiving covered health services is 
 19.28  the date of entry into the family.  The effective date of 
 19.29  coverage for other new recipients added to the family receiving 
 19.30  covered health services is the first day of the month following 
 19.31  the month in which eligibility is approved and the first premium 
 19.32  payment has been received or at renewal, whichever the family 
 19.33  receiving covered health services prefers.  All eligibility 
 19.34  criteria must be met by the family at the time the new family 
 19.35  member is added.  The income of the new family member is 
 19.36  included with the family's gross income and the adjusted premium 
 20.1   begins in the month the new family member is added.  The premium 
 20.2   must be received eight working days prior to the end of the 
 20.3   month for coverage to begin the following month.  Benefits are 
 20.4   not available until the day following discharge if an enrollee 
 20.5   is hospitalized on the first day of coverage.  Notwithstanding 
 20.6   any other law to the contrary, benefits under sections 256L.01 
 20.7   to 256L.10 256L.18 are secondary to a plan of insurance or 
 20.8   benefit program under which an eligible person may have coverage 
 20.9   and the commissioner shall use cost avoidance techniques to 
 20.10  ensure coordination of any other health coverage for eligible 
 20.11  persons.  The commissioner shall identify eligible persons who 
 20.12  may have coverage or benefits under other plans of insurance or 
 20.13  who become eligible for medical assistance. 
 20.14     Sec. 24.  Minnesota Statutes 1997 Supplement, section 
 20.15  256L.05, is amended by adding a subdivision to read: 
 20.16     Subd. 3a.  [PERIOD OF ELIGIBILITY BEGIN AND END DATE.] The 
 20.17  12-month period of eligibility begins in the month after the 
 20.18  month the application is approved and pending premium payment. 
 20.19     Sec. 25.  Minnesota Statutes 1997 Supplement, section 
 20.20  256L.05, is amended by adding a subdivision to read: 
 20.21     Subd. 3b.  [RENEWAL OF ELIGIBILITY.] The eligibility of 
 20.22  enrollees must be renewed every 12 months.  Individuals who 
 20.23  initially enroll in the MinnesotaCare program under section 
 20.24  256L.04, subdivision 1 or 7, remain eligible for the 
 20.25  MinnesotaCare program regardless of age, place of residence, or 
 20.26  the presence or absence of children in the same household, as 
 20.27  long as all other eligibility criteria are met, and residence in 
 20.28  Minnesota and continuous enrollment in the MinnesotaCare program 
 20.29  or medical assistance are maintained.  Families and individuals 
 20.30  must reapply after a lapse in coverage of one calendar month or 
 20.31  more and must meet all eligibility criteria. 
 20.32     Sec. 26.  Minnesota Statutes 1997 Supplement, section 
 20.33  256L.05, subdivision 4, is amended to read: 
 20.34     Subd. 4.  [APPLICATION PROCESSING.] The commissioner of 
 20.35  human services shall determine an applicant's eligibility for 
 20.36  MinnesotaCare no more than 30 days from the date that the 
 21.1   application is received by the department of human services.  
 21.2   Beginning January 1, 2000, this requirement also applies to 
 21.3   local county human services agencies that determine eligibility 
 21.4   for MinnesotaCare.  To prevent processing delays, applicants who 
 21.5   appear to meet eligibility requirements shall be enrolled.  The 
 21.6   enrollee must provide all required verifications within 30 days 
 21.7   of enrollment or coverage from the program shall be terminated. 
 21.8      Sec. 27.  Minnesota Statutes 1997 Supplement, section 
 21.9   256L.06, subdivision 3, is amended to read: 
 21.10     Subd. 3.  [ADMINISTRATION AND COMMISSIONER'S DUTIES.] (a) 
 21.11  Premiums are dedicated to the commissioner for MinnesotaCare.  
 21.12  The commissioner shall make an annual redetermination of 
 21.13  continued eligibility and identify people who may become 
 21.14  eligible for medical assistance.  
 21.15     (b) The commissioner shall develop and implement procedures 
 21.16  to:  (1) require enrollees to report changes in income; (2) 
 21.17  adjust sliding scale premium payments, based upon changes in 
 21.18  enrollee income; and (3) disenroll enrollees from MinnesotaCare 
 21.19  for failure to pay required premiums.  Failure to pay includes 
 21.20  payment with a dishonored check.  The commissioner may demand a 
 21.21  guaranteed form of payment as the only means to replace a 
 21.22  dishonored check. 
 21.23     (c) Premiums are calculated on a calendar month basis and 
 21.24  may be paid on a monthly, quarterly, or annual basis, with the 
 21.25  first payment due upon notice from the commissioner of the 
 21.26  premium amount required.  Premium payment is required before 
 21.27  enrollment is complete and to maintain eligibility in 
 21.28  MinnesotaCare.  
 21.29     (d) Nonpayment of the premium will result in disenrollment 
 21.30  from the plan within one calendar month after the due date.  
 21.31  Persons disenrolled for nonpayment or who voluntarily terminate 
 21.32  coverage from the program may not reenroll until four calendar 
 21.33  months have elapsed.  Persons disenrolled for nonpayment or who 
 21.34  voluntarily terminate coverage from the program may not reenroll 
 21.35  for four calendar months unless the person demonstrates good 
 21.36  cause for nonpayment.  Good cause does not exist if a person 
 22.1   chooses to pay other family expenses instead of the premium.  
 22.2   The commissioner shall define good cause in rule. 
 22.3      Sec. 28.  Minnesota Statutes 1997 Supplement, section 
 22.4   256L.07, is amended to read: 
 22.5      256L.07 [ELIGIBILITY FOR SUBSIDIZED PREMIUMS BASED ON 
 22.6   SLIDING SCALE.] 
 22.7      Subdivision 1.  [GENERAL REQUIREMENTS.] Families and 
 22.8   individuals who enroll on or after October 1, 1992, are eligible 
 22.9   for subsidized premium payments based on a sliding scale under 
 22.10  section 256L.08 only if the family or individual meets the 
 22.11  requirements in subdivisions 2 and 3.  Children already enrolled 
 22.12  in the children's health plan as of September 30, 1992, eligible 
 22.13  under section 256L.04, subdivision 1, paragraph (a), children 
 22.14  who enroll in the MinnesotaCare program after September 30, 
 22.15  1992, pursuant to Laws 1992, chapter 549, article 4, section 17, 
 22.16  and children who enroll under section 256L.04, subdivision 6, 
 22.17  are eligible for subsidized premium payments without meeting 
 22.18  these requirements, as long as they maintain continuous coverage 
 22.19  in the MinnesotaCare plan or medical assistance. (a) Children 
 22.20  enrolled in the original children's health plan as of September 
 22.21  30, 1992, children who enrolled in the MinnesotaCare program 
 22.22  after September 30, 1992, pursuant to Laws 1992, chapter 549, 
 22.23  article 4, section 17, and children who have family gross 
 22.24  incomes that are equal to or less than 150 percent of the 
 22.25  federal poverty guidelines are eligible for subsidized premium 
 22.26  payments without meeting the requirements of subdivision 2 or 3. 
 22.27     (b) Families and individuals who initially enrolled in 
 22.28  MinnesotaCare under section 256L.04, and subdivision 1 or 7, 
 22.29  whose income increases above the limits established in section 
 22.30  256L.08 275 percent of the federal poverty guidelines, may 
 22.31  continue enrollment and pay the full cost of coverage.  
 22.32     Subd. 2.  [MUST NOT HAVE ACCESS TO EMPLOYER-SUBSIDIZED 
 22.33  COVERAGE.] (a) To be eligible for subsidized premium payments 
 22.34  based on a sliding scale, a family or individual must not have 
 22.35  access to subsidized health coverage through an employer, and 
 22.36  must not have had access to subsidized health coverage through 
 23.1   an employer for the 18 months prior to application for 
 23.2   subsidized coverage under the MinnesotaCare program.  The 
 23.3   requirement that the family or individual must not have had 
 23.4   access to employer-subsidized coverage during the previous 18 
 23.5   months does not apply if:  (1) employer-subsidized coverage was 
 23.6   lost due to the death of an employee or divorce; (2) 
 23.7   employer-subsidized coverage was lost because an individual 
 23.8   became ineligible for coverage as a child or dependent; or (3) 
 23.9   employer-subsidized coverage was lost for reasons that would not 
 23.10  disqualify the individual for unemployment benefits under 
 23.11  section 268.09 and the family or individual has not had access 
 23.12  to employer-subsidized coverage since the loss of coverage.  If 
 23.13  employer-subsidized coverage was lost for reasons that 
 23.14  disqualify an individual for unemployment benefits under section 
 23.15  268.09, children of that individual are exempt from the 
 23.16  requirement of no access to employer subsidized coverage for the 
 23.17  18 months prior to application, as long as the children have not 
 23.18  had access to employer subsidized coverage since the 
 23.19  disqualifying event.  The requirement that the.  A family or 
 23.20  individual must not have had access to employer-subsidized 
 23.21  coverage during the previous 18 months does apply if whose 
 23.22  employer-subsidized coverage is lost due to an employer 
 23.23  terminating health care coverage as an employee benefit during 
 23.24  the previous 18 months is not eligible.  
 23.25     (b) For purposes of this requirement, subsidized health 
 23.26  coverage means health coverage for which the employer pays at 
 23.27  least 50 percent of the cost of coverage for the employee, 
 23.28  excluding dependent coverage or dependent, or a higher 
 23.29  percentage as specified by the commissioner.  Children are 
 23.30  eligible for employer-subsidized coverage through either parent, 
 23.31  including the noncustodial parent.  The commissioner must treat 
 23.32  employer contributions to Internal Revenue Code Section 125 
 23.33  plans and any other employer benefits intended to pay health 
 23.34  care costs as qualified employer subsidies toward the cost of 
 23.35  health coverage for employees for purposes of this subdivision. 
 23.36     Subd. 3.  [PERIOD UNINSURED OTHER HEALTH COVERAGE.] To be 
 24.1   eligible for subsidized premium payments based on a sliding 
 24.2   scale, (a) Families and individuals initially enrolled in the 
 24.3   MinnesotaCare program under section 256L.04, subdivisions 5 and 
 24.4   7, must have had no health coverage for at least four months 
 24.5   prior to application and renewal.  The commissioner may change 
 24.6   this eligibility criterion for sliding scale premiums in order 
 24.7   to remain within the limits of available appropriations.  The 
 24.8   requirement of at least four months of no health coverage prior 
 24.9   to application for the MinnesotaCare program does not apply 
 24.10  to: newborns. 
 24.11     (1) families, children, and individuals who apply for the 
 24.12  MinnesotaCare program upon termination from or as required by 
 24.13  the medical assistance program, general assistance medical care 
 24.14  program, or coverage under a regional demonstration project for 
 24.15  the uninsured funded under section 256B.73, the Hennepin county 
 24.16  assured care program, or the Group Health, Inc., community 
 24.17  health plan; 
 24.18     (2) families and individuals initially enrolled under 
 24.19  section 256L.04, subdivisions 1, paragraph (a), and 3; 
 24.20     (3) children enrolled pursuant to Laws 1992, chapter 549, 
 24.21  article 4, section 17; or 
 24.22     (4) individuals currently serving or who have served in the 
 24.23  military reserves, and dependents of these individuals, if these 
 24.24  individuals:  (i) reapply for MinnesotaCare coverage after a 
 24.25  period of active military service during which they had been 
 24.26  covered by the Civilian Health and Medical Program of the 
 24.27  Uniformed Services (CHAMPUS); (ii) were covered under 
 24.28  MinnesotaCare immediately prior to obtaining coverage under 
 24.29  CHAMPUS; and (iii) have maintained continuous coverage. 
 24.30     (b) For purposes of this section, medical assistance, 
 24.31  general assistance medical care, and civilian health and medical 
 24.32  program of the uniformed service (CHAMPUS) are not considered 
 24.33  insurance or health coverage. 
 24.34     (c) For purposes of this section, Medicare part A or B 
 24.35  coverage under title XVIII of the Social Security Act, United 
 24.36  States Code, title 42, sections 1395c to 1395w-4, is considered 
 25.1   health coverage.  An applicant or enrollee may not refuse 
 25.2   Medicare coverage to establish eligibility for MinnesotaCare. 
 25.3      Sec. 29.  Minnesota Statutes 1997 Supplement, section 
 25.4   256L.09, subdivision 2, is amended to read: 
 25.5      Subd. 2.  [RESIDENCY REQUIREMENT.] (a) Prior to July 1, 
 25.6   1997, to be eligible for health coverage under the MinnesotaCare 
 25.7   program, families and individuals must be permanent residents of 
 25.8   Minnesota.  
 25.9      (b) Effective July 1, 1997, To be eligible for health 
 25.10  coverage under the MinnesotaCare program, adults without 
 25.11  children must be permanent residents of Minnesota. 
 25.12     (c) Effective July 1, 1997, (b) To be eligible for health 
 25.13  coverage under the MinnesotaCare program, pregnant women, 
 25.14  families, and children must meet the residency requirements as 
 25.15  provided by Code of Federal Regulations, title 42, section 
 25.16  435.403, except that the provisions of section 256B.056, 
 25.17  subdivision 1, shall apply upon receipt of federal approval. 
 25.18     Sec. 30.  Minnesota Statutes 1997 Supplement, section 
 25.19  256L.09, subdivision 4, is amended to read: 
 25.20     Subd. 4.  [ELIGIBILITY AS MINNESOTA RESIDENT.] (a) For 
 25.21  purposes of this section, a permanent Minnesota resident is a 
 25.22  person who has demonstrated, through persuasive and objective 
 25.23  evidence, that the person is domiciled in the state and intends 
 25.24  to live in the state permanently. 
 25.25     (b) To be eligible as a permanent resident, all applicants 
 25.26  an applicant must demonstrate the requisite intent to live in 
 25.27  the state permanently by: 
 25.28     (1) showing that the applicant maintains a residence at a 
 25.29  verified address other than a place of public accommodation, 
 25.30  through the use of evidence of residence described in section 
 25.31  256D.02, subdivision 12a, clause (1); 
 25.32     (2) demonstrating that the applicant has been continuously 
 25.33  domiciled in the state for no less than 180 days immediately 
 25.34  before the application; and 
 25.35     (3) signing an affidavit declaring that (A) the applicant 
 25.36  currently resides in the state and intends to reside in the 
 26.1   state permanently; and (B) the applicant did not come to the 
 26.2   state for the primary purpose of obtaining medical coverage or 
 26.3   treatment. 
 26.4      (c) A person who is temporarily absent from the state for 
 26.5   three months or less does not lose eligibility for MinnesotaCare.
 26.6   "Temporarily absent from the state" means the person is out of 
 26.7   the state for a temporary purpose and intends to return when the 
 26.8   purpose of the absence has been accomplished.  A person is not 
 26.9   temporarily absent from the state if another state has 
 26.10  determined that the person is a resident for any purpose.  If 
 26.11  temporarily absent from the state, the person must follow the 
 26.12  requirements of the health plan in which he or she is enrolled 
 26.13  to receive services. 
 26.14     Sec. 31.  Minnesota Statutes 1997 Supplement, section 
 26.15  256L.09, subdivision 6, is amended to read: 
 26.16     Subd. 6.  [12-MONTH PREEXISTING EXCLUSION.] If the 180-day 
 26.17  requirement in subdivision 4, paragraph (b), clause (2), is 
 26.18  determined by a court to be unconstitutional, the commissioner 
 26.19  of human services shall impose a 12-month preexisting condition 
 26.20  exclusion on coverage for persons who have been domiciled in the 
 26.21  state for less than 180 days.  
 26.22     Sec. 32.  Minnesota Statutes 1997 Supplement, section 
 26.23  256L.11, subdivision 6, is amended to read: 
 26.24     Subd. 6.  [ENROLLEES 18 OR OLDER.] Payment by the 
 26.25  MinnesotaCare program for inpatient hospital services provided 
 26.26  to MinnesotaCare enrollees eligible under section 256L.04, 
 26.27  subdivision 7, or who qualify under section 256L.04, 
 26.28  subdivisions 1 to 6 and 2, or 256L.13 with family gross income 
 26.29  that exceeds 175 percent of the federal poverty guidelines and 
 26.30  who are not pregnant, who are 18 years old or older on the date 
 26.31  of admission to the inpatient hospital must be in accordance 
 26.32  with paragraphs (a) and (b).  Payment for adults who are not 
 26.33  pregnant and are eligible under section 256L.04, subdivisions 
 26.34  1 to 6 and 2, or 256L.13, and whose incomes are equal to or less 
 26.35  than 175 percent of the federal poverty guidelines, shall be as 
 26.36  provided for under paragraph (c).  
 27.1      (a) If the medical assistance rate minus any copayment 
 27.2   required under section 256L.03, subdivision 4, is less than or 
 27.3   equal to the amount remaining in the enrollee's benefit limit 
 27.4   under section 256L.03, subdivision 3, payment must be the 
 27.5   medical assistance rate minus any copayment required under 
 27.6   section 256L.03, subdivision 4.  The hospital must not seek 
 27.7   payment from the enrollee in addition to the copayment.  The 
 27.8   MinnesotaCare payment plus the copayment must be treated as 
 27.9   payment in full. 
 27.10     (b) If the medical assistance rate minus any copayment 
 27.11  required under section 256L.03, subdivision 4, is greater than 
 27.12  the amount remaining in the enrollee's benefit limit under 
 27.13  section 256L.03, subdivision 3, payment must be the lesser of: 
 27.14     (1) the amount remaining in the enrollee's benefit limit; 
 27.15  or 
 27.16     (2) charges submitted for the inpatient hospital services 
 27.17  less any copayment established under section 256L.03, 
 27.18  subdivision 4. 
 27.19     The hospital may seek payment from the enrollee for the 
 27.20  amount by which usual and customary charges exceed the payment 
 27.21  under this paragraph.  If payment is reduced under section 
 27.22  256L.03, subdivision 3, paragraph (c) (b), the hospital may not 
 27.23  seek payment from the enrollee for the amount of the reduction. 
 27.24     (c) For admissions occurring during the period of July 1, 
 27.25  1997, through June 30, 1998, for adults who are not pregnant and 
 27.26  are eligible under section 256L.04, subdivisions 1 to 6 and 
 27.27  2, or 256L.13, and whose incomes are equal to or less than 175 
 27.28  percent of the federal poverty guidelines, the commissioner 
 27.29  shall pay hospitals directly, up to the medical assistance 
 27.30  payment rate, for inpatient hospital benefits in excess of the 
 27.31  $10,000 annual inpatient benefit limit. 
 27.32     Sec. 33.  Minnesota Statutes 1997 Supplement, section 
 27.33  256L.12, subdivision 5, is amended to read: 
 27.34     Subd. 5.  [ELIGIBILITY FOR OTHER STATE PROGRAMS.] 
 27.35  MinnesotaCare enrollees who become eligible for medical 
 27.36  assistance or general assistance medical care will remain in the 
 28.1   same managed care plan if the managed care plan has a contract 
 28.2   for that population.  Effective January 1, 1998, MinnesotaCare 
 28.3   enrollees who were formerly eligible for general assistance 
 28.4   medical care pursuant to section 256D.03, subdivision 3, within 
 28.5   six months of MinnesotaCare enrollment and were enrolled in a 
 28.6   prepaid health plan pursuant to section 256D.03, subdivision 4, 
 28.7   paragraph (d), must remain in the same managed care plan if the 
 28.8   managed care plan has a contract for that population.  Contracts 
 28.9   between the department of human services and managed care plans 
 28.10  must include MinnesotaCare, and medical assistance and may, at 
 28.11  the option of the commissioner of human services, also include 
 28.12  general assistance medical care.  Managed care plans must 
 28.13  participate in the MinnesotaCare and general assistance medical 
 28.14  care programs under a contract with the department of human 
 28.15  services in service areas where they participate in the medical 
 28.16  assistance program. 
 28.17     Sec. 34.  Minnesota Statutes 1997 Supplement, section 
 28.18  256L.15, is amended to read: 
 28.19     256L.15 [PREMIUMS.] 
 28.20     Subdivision 1.  [PREMIUM DETERMINATION.] Families and with 
 28.21  children enrolled according to sections 256L.13 to 256L.16 and 
 28.22  individuals shall pay an enrollment fee or a premium determined 
 28.23  according to a sliding fee based on the cost of coverage as a 
 28.24  percentage of the family's gross family income.  Pregnant women 
 28.25  and children under age two are exempt from the provisions of 
 28.26  section 256L.06, subdivision 3, paragraph (b), clause (3), 
 28.27  requiring disenrollment for failure to pay premiums.  For 
 28.28  pregnant women, this exemption continues until the first day of 
 28.29  the month following the 60th day postpartum.  Women who remain 
 28.30  enrolled during pregnancy or the postpartum period, despite 
 28.31  nonpayment of premiums, shall be disenrolled on the first of the 
 28.32  month following the 60th day postpartum for the penalty period 
 28.33  that otherwise applies under section 256L.06, unless they begin 
 28.34  paying premiums. 
 28.35     Subd. 1a.  [PAYMENT OPTIONS.] The commissioner may offer 
 28.36  the following payment options to an enrollee: 
 29.1      (1) payment by check; 
 29.2      (2) payment by credit card; 
 29.3      (3) payment by recurring automatic checking withdrawal; 
 29.4      (4) payment by one-time electronic transfer of funds; or 
 29.5      (5) payment by wage withholding with the consent of the 
 29.6   employer and the employee. 
 29.7      Subd. 1b.  [PAYMENTS NONREFUNDABLE.] MinnesotaCare premiums 
 29.8   and enrollment fees are not refundable. 
 29.9      Subd. 2.  [SLIDING SCALE TO DETERMINE PERCENTAGE OF GROSS 
 29.10  INDIVIDUAL OR FAMILY INCOME.] The commissioner shall establish a 
 29.11  sliding fee scale to determine the percentage of 
 29.12  gross individual or family income that households at different 
 29.13  income levels must pay to obtain coverage through the 
 29.14  MinnesotaCare program.  The sliding fee scale must be based on 
 29.15  the enrollee's gross individual or family income during the 
 29.16  previous four months.  The sliding fee scale begins with a 
 29.17  premium of 1.5 percent of gross individual or family income for 
 29.18  individuals or families with incomes below the limits for the 
 29.19  medical assistance program for families and children and 
 29.20  proceeds through the following evenly spaced steps:  1.8, 2.3, 
 29.21  3.1, 3.8, 4.8, 5.9, 7.4, and 8.8 percent.  These percentages are 
 29.22  matched to evenly spaced income steps ranging from the medical 
 29.23  assistance income limit for families and children to 275 percent 
 29.24  of the federal poverty guidelines for the applicable family 
 29.25  size.  An adult without children whose income is equal to or 
 29.26  less than 175 percent of the federal poverty guidelines shall 
 29.27  pay premiums according to the sliding fee scale.  When an 
 29.28  enrollee's income exceeds eligibility limits, the enrollee must 
 29.29  pay the full cost of coverage as required under section 256L.07, 
 29.30  subdivision 1.  The sliding fee scale and percentages are not 
 29.31  subject to the provisions of chapter 14.  If a family or 
 29.32  individual reports increased income after enrollment, premiums 
 29.33  shall not be adjusted until eligibility renewal.  
 29.34     Subd. 3.  [EXCEPTIONS TO SLIDING SCALE.] An annual premium 
 29.35  of $48 is required for all children who are eligible according 
 29.36  to section 256L.13, subdivision 4.  
 30.1      Subd. 4.  [CHILDREN IN FAMILIES WITH INCOME AT OR LESS THAN 
 30.2   150 PERCENT OF FEDERAL POVERTY GUIDELINES.] Children in families 
 30.3   with income at or below 150 percent of the federal poverty 
 30.4   guidelines, when only the children are enrolled, may pay an 
 30.5   annual enrollment fee of $24 per child.  Payment of the $24 
 30.6   annual enrollment fee in families with only the children 
 30.7   enrolled guarantees eligibility for 12 months regardless of 
 30.8   changes in circumstances.  If the entire family is enrolled, the 
 30.9   children are required to pay a monthly premium of $2. 
 30.10     Sec. 35.  Minnesota Statutes 1997 Supplement, section 
 30.11  256L.17, is amended by adding a subdivision to read: 
 30.12     Subd. 6.  [WAIVER OF MAINTENANCE OF EFFORT 
 30.13  REQUIREMENT.] Unless a federal waiver of the maintenance of 
 30.14  effort requirements of section 2105(d) of title XXI of the 
 30.15  Balanced Budget Act of 1997, Public Law Number 105-33, Statutes 
 30.16  at Large, volume 111, page 251, is granted by the federal 
 30.17  Department of Health and Human Services by September 30, 1998, 
 30.18  this section does not apply to children.  The commissioner shall 
 30.19  publish a notice in the State Register upon receipt of a federal 
 30.20  waiver. 
 30.21     Sec. 36.  [REVISOR'S INSTRUCTION.] 
 30.22     In each section of Minnesota Statutes referred to in column 
 30.23  A, the revisor of statutes shall delete the reference in column 
 30.24  B and insert the reference in column C. 
 30.25     Column A            Column B            Column C
 30.26     256B.057, subd. 1a  256L.08             256L.15
 30.27     256B.0645           256L.14             256L.03, subd. 1a
 30.28     256L.16             256L.14             256L.03, subd. 1a
 30.29     Sec. 37.  [REPEALER.] 
 30.30     Minnesota Statutes 1997 Supplement, sections 256B.057, 
 30.31  subdivision 1a; 256L.04, subdivisions 3, 4, 5, and 6; 256L.06, 
 30.32  subdivisions 1 and 2; 256L.08; 256L.09, subdivision 3; 256L.13; 
 30.33  256L.14; and 256L.15, subdivision 3, are repealed. 
 30.34     Sec. 38.  [EFFECTIVE DATE.] 
 30.35     Sections 1 to 33; 34, subdivisions 1, 1b, 2, and 4; 36; and 
 30.36  37 are effective January 1, 1999.  Sections 34, subdivision 1a; 
 31.1   and 35 are effective September 30, 1998.