Minnesota Administrative Rules

9505.5310 DEMONSTRATION PROJECT ELIGIBILITY, APPLICATION, ENROLLMENT, AND DOCUMENTATION.

Subpart 1.

General eligibility.

The eligibility and coverage requirements in this subpart apply to applicants and enrollees.

A.

Except as provided in subpart 2, an applicant or enrollee must meet the following requirements to be eligible for the demonstration project:

(1)

be a citizen of the United States or a qualified noncitizen eligible for medical assistance with federal financial participation;

(2)

be a Minnesota resident;

(3)

be 15 years of age or older and under age 50;

(4)

have countable income at or below 200 percent of the federal poverty guidelines for the family size. Countable income is determined according to the income rules applied in eligibility determinations for families and children in the medical assistance program according to Minnesota Statutes, section 256B.056, and United States Code, title 42, chapter 7, subchapter XIX, section 1396u-1, as follows:

(a)

income includes all categories of earned and unearned income used in eligibility determinations for families and children under the medical assistance program;

(b)

income does not include any categories of income that are excluded for purposes of determining eligibility for families and children in the medical assistance program;

(c)

income methodologies, such as earned income deductions and disregards, used to determine eligibility for families and children in the medical assistance program according to Minnesota Statutes, section 256B.056, subdivisions 1a and 1c, do not apply to the determination of countable income; and

(d)

income deeming requirements used to determine eligibility for families and children in the medical assistance program apply, except that for a person under age 21, no income from a parent, spouse, or sponsor is deemed to the person;

(5)

not be pregnant;

(6)

not be enrolled in the Minnesota health care program or other health service program administered by the department; and

(7)

not be an institutionalized individual as described under Code of Federal Regulations, title 42, sections 435.1008 and 435.1009.

B.

Participation in the demonstration project does not require the consent of anyone other than the applicant.

C.

Asset requirements do not apply to applicants and enrollees.

D.

Applicants and enrollees must report available third-party coverage and cooperate with the department in obtaining third-party payments. The department shall waive this requirement if the applicant or enrollee states that reporting third-party coverage could violate the applicant's or enrollee's privacy.

Subp. 2.

Presumptive eligibility.

Services covered under the demonstration project may be provided during a presumptive eligibility period.

A.

A certified family planning services provider will screen a person for demonstration project eligibility using preliminary information provided by the person. A person who, based on the preliminary information, appears to meet the eligibility requirements in part 9505.5310, subpart 1, item A, subitems (2) to (6), is presumptively eligible for the demonstration project.

B.

The presumptive eligibility period begins the first day of the month that a certified family planning services provider determines that a person is presumptively eligible. The presumptive eligibility period ends the last day of the month following the month that the certified family planning services provider determines that a person was presumptively eligible.

C.

A person determined presumptively eligible must comply with part 9505.5310, subpart 1, item D.

D.

A person may receive presumptive eligibility once during a 12-month period.

Subp. 3.

Enrollment.

An applicant must apply for the demonstration project using forms provided by the department.

A.

The department or county agency must determine an applicant's eligibility for the demonstration project within 45 days of receipt of a completed application.

B.

Except as provided in item C, eligibility begins the first day of the month of application. If a completed application form is submitted within 30 days of the request, the month of application includes the month the department or county agency receives a written request for the demonstration project consisting of at least the name of the applicant, a means to locate the applicant, and the signature of the applicant.

C.

A person who is eligible under subparts 1 and 2 and files a demonstration project application during the presumptive eligibility period is eligible for ongoing coverage on the first day of the month following the month that presumptive eligibility ends.

Subp. 4.

Application and documentation.

The application and documentation requirements in this subpart apply to all applicants and enrollees.

A.

An enrollee is eligible for the demonstration project for one year regardless of changes in income or family size. Eligibility will end prior to the annual renewal if the enrollee:

(1)

dies;

(2)

is no longer a Minnesota resident;

(3)

voluntarily terminates eligibility;

(4)

enrolls in the Minnesota health care program or other health service program administered by the department;

(5)

reaches 50 years of age;

(6)

becomes pregnant;

(7)

becomes an institutionalized individual under Code of Federal Regulations, title 42, sections 435.1008 and 435.1009; or

(8)

is no longer a citizen of the United States or a qualified noncitizen eligible for medical assistance with federal financial participation.

B.

Applicants and enrollees must document their income at application.

C.

Enrollees must complete an annual application on forms provided by the department.

D.

Applicants and enrollees must provide documentation of immigration status at application. The department or county agency will verify applicant and enrollee immigration status according to Minnesota Statutes, section 256.01, subdivision 18.

E.

Applicants and enrollees must report a change in an eligibility factor to the department or county agency within ten days of learning about the change. Applicants and enrollees who fail to report a change that would have resulted in ineligibility for the demonstration project will be disenrolled from the demonstration project and will be ineligible for the demonstration project for a period of 12 months following the date of disenrollment. If the only unreported change is a pregnancy, applicants and enrollees will not be subject to the 12 months ineligibility period, but pregnant applicants and enrollees will be disenrolled from the demonstration project and may reapply for the demonstration project following the end of the pregnancy.

F.

Applicants and enrollees must provide information, documents, and any releases requested by the department or county agency that are necessary to verify eligibility information. An applicant or enrollee who refuses to authorize verification of an eligibility factor, including a Social Security number, is not eligible for the demonstration project, except as provided in Code of Federal Regulations, title 42, section 435.910(h)(2).

G.

Applicants must document citizenship as required by the federal Deficit Reduction Act of 2005, Public Law 109-71. Persons screened for presumptive eligibility under subpart 2 are not required to document citizenship.

H.

An applicant may withdraw an application according to the provisions of part 9505.0090, subpart 4.

Subp. 5.

Enrollment.

To be considered for Minnesota health care program eligibility, an enrollee must complete the department's health care application. Applicants and enrollees shall not use a demonstration project application form to apply for the Minnesota health care program. People who complete the department's health care application and are determined ineligible for the Minnesota health care program, either at application or during enrollment, may authorize a demonstration project eligibility determination using the information provided in the department's health care application and updated at required intervals.

Subp. 6.

Confidentiality.

Private data about persons screened for eligibility, applicants, and enrollees must be disclosed according to the provisions of the following statutes and rules:

A.

part 1205.0500 and Minnesota Statutes, chapter 13;

B.

Minnesota Statutes, sections 144.291 to 144.298;

C.

Minnesota Statutes, section 144.343;

D.

Code of Federal Regulations, title 45, parts 160, 162, and 164; and

E.

other applicable state and federal laws, statutes, rules, and regulations affecting the collection, storage, use, and dissemination of protected, private, and confidential health and other information.

Subp. 7.

Notices.

Applicants and enrollees may arrange to receive notices in a manner other than having notices mailed to the applicant's or enrollee's home address.

Statutory Authority:

MS s 256B.04

History:

31 SR 771; L 2007 c 147 art 10 s 15

NOTE:

This part is repealed contingent upon federal approval of the state Medicaid plan amendment under Laws 2014, chapter 291, article 10, section 12. Laws 2014, chapter 291, article 10, section 14.

Published Electronically:

June 24, 2016