1997 Minnesota Statutes

CHAPTER 256L. Minnesotacare

     256L.01 Definitions. 

    Subdivision 1.    Scope.  For purposes of sections 
 256L.01 to 256L.10, the following terms shall have the meanings 
 given them.  

    Subd. 2.    Commissioner.  "Commissioner" means the 
 commissioner of human services. 

    Subd. 3.    Eligible providers.  "Eligible providers" 
 means those health care providers who provide covered health 
 services to medical assistance recipients under rules 
 established by the commissioner for that program.  

    Subd. 4.    Gross family income.  "Gross family income" 
 for farm and nonfarm self-employed means income calculated using 
 as the baseline the adjusted gross income reported on the 
 applicant's federal income tax form for the previous year and 
 adding back in reported depreciation, carryover loss, and net 
 operating loss amounts that apply to the business in which the 
 family is currently engaged.  Applicants shall report the most 
 recent financial situation of the family if it has changed from 
 the period of time covered by the federal income tax form.  The 
 report may be in the form of percentage increase or decrease. 

    HIST: 1986 c 444; 1987 c 403 art 2 s 63; 1988 c 689 art 2 s 
 137; 1989 c 282 art 3 s 33; 1990 c 568 art 3 s 14; 1992 c 549 
 art 4 s 2,19; 1993 c 345 art 9 s 1 

     256L.02 Program administration. 

    Subdivision 1.    Purpose.  The MinnesotaCare program is 
 established to promote access to appropriate health care 
 services to assure healthy children and adults.  

    Subd. 2.    Commissioner's duties.  The commissioner 
 shall establish an office for the state administration of this 
 plan.  The plan shall be used to provide covered health services 
 for eligible persons.  Payment for these services shall be made 
 to all eligible providers.  The commissioner shall adopt rules 
 to administer the MinnesotaCare program.  The commissioner shall 
 establish marketing efforts to encourage potentially eligible 
 persons to receive information about the program and about other 
 medical care programs administered or supervised by the 
 department of human services.  A toll-free telephone number must 
 be used to provide information about medical programs and to 
 promote access to the covered services.  

    Subd. 3.    Financial management.  (a) The commissioner 
 shall manage spending for the MinnesotaCare program in a manner 
 that maintains a minimum reserve in accordance with section 
 16A.76.  The commissioner must make a quarterly assessment of 
 the expected expenditures for the covered services for the 
 remainder of the current biennium and for the following 
 biennium.  The estimated expenditure, including the reserve 
 requirements described in section 16A.76, shall be compared to 
 an estimate of the revenues that will be deposited in the health 
 care access fund.  Based on this comparison, and after 
 consulting with the chairs of the house ways and means committee 
 and the senate finance committee, and the legislative commission 
 on health care access, the commissioner shall, as necessary, 
 make the adjustments specified in paragraph (b) to ensure that 
 expenditures remain within the limits of available revenues for 
 the remainder of the current biennium and for the following 
 biennium.  The commissioner shall not hire additional staff 
 using appropriations from the health care access fund until the 
 commissioner of finance makes a determination that the 
 adjustments implemented under paragraph (b) are sufficient to 
 allow MinnesotaCare expenditures to remain within the limits of 
 available revenues for the remainder of the current biennium and 
 for the following biennium. 

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

    HIST: 1986 c 444; 1987 c 403 art 2 s 63; 1988 c 689 art 2 s 
 137; 1989 c 282 art 3 s 34; 1992 c 549 art 4 s 3,19; 1993 c 4 s 
 28; 1993 c 247 art 4 s 11; 1993 c 345 art 9 s 2; 1994 c 625 art 
 8 s 72; art 13 s 1; 1995 c 234 art 6 s 3; 1997 c 225 art 3 s 3 

     256L.03 Covered health services. 

    Subdivision 1.    Covered health services.  "Covered 
 health services" means the health services reimbursed under 
 chapter 256B, with the exception of inpatient hospital services, 
 special education services, private duty nursing services, adult 
 dental care services other than preventive services, orthodontic 
 services, nonemergency medical transportation services, personal 
 care assistant and case management services, nursing home or 
 intermediate care facilities services, inpatient mental health 
 services, and chemical dependency services.  Effective July 1, 
 1998, adult dental care for nonpreventive services with the 
 exception of orthodontic services is available to persons who 
 qualify under section 256L.04, subdivisions 1 to 7, or 256L.13, 
 with family gross income equal to or less than 175 percent of 
 the federal poverty guidelines.  Outpatient mental health 
 services covered under the MinnesotaCare program are limited to 
 diagnostic assessments, psychological testing, explanation of 
 findings, medication management by a physician, day treatment, 
 partial hospitalization, and individual, family, and group 
 psychotherapy. 

    No public funds shall be used for coverage of abortion 
 under MinnesotaCare except where the life of the female would be 
 endangered or substantial and irreversible impairment of a major 
 bodily function would result if the fetus were carried to term; 
 or where the pregnancy is the result of rape or incest. 

    Covered health services shall be expanded as provided in 
 this section. 

    Subd. 2.    Alcohol and drug dependency.  Beginning July 
 1, 1993, covered health services shall include individual 
 outpatient treatment of alcohol or drug dependency by a 
 qualified health professional or outpatient program.  

    Persons who may need chemical dependency services under the 
 provisions of this chapter shall be assessed by a local agency 
 as defined under section 254B.01, and under the assessment 
 provisions of section 254A.03, subdivision 3.  A local agency or 
 managed care plan under contract with the department of human 
 services must place a person in need of chemical dependency 
 services as provided in Minnesota Rules, parts 9530.6600 to 
 9530.6660.  Persons who are recipients of medical benefits under 
 the provisions of this chapter and who are financially eligible 
 for consolidated chemical dependency treatment fund services 
 provided under the provisions of chapter 254B shall receive 
 chemical dependency treatment services under the provisions of 
 chapter 254B only if: 

    (1) they have exhausted the chemical dependency benefits 
 offered under this chapter; or 

    (2) an assessment indicates that they need a level of care 
 not provided under the provisions of this chapter. 

    Recipients of covered health services under the children's 
 health plan, as provided in Minnesota Statutes 1990, section 
 256.936, and as amended by Laws 1991, chapter 292, article 4, 
 section 17, and recipients of covered health services enrolled 
 in the children's health plan or the MinnesotaCare program after 
 October 1, 1992, pursuant to Laws 1992, chapter 549, article 4, 
 sections 5 and 17, are eligible to receive alcohol and drug 
 dependency benefits under this subdivision. 

    Subd. 3.    Inpatient hospital services.  (a) Beginning 
 July 1, 1993, covered health services shall include inpatient 
 hospital services, including inpatient hospital mental health 
 services and inpatient hospital and residential chemical 
 dependency treatment, subject to those limitations necessary to 
 coordinate the provision of these services with eligibility 
 under the medical assistance spenddown.  Prior to July 1, 1997, 
 the inpatient hospital benefit for adult enrollees is subject to 
 an annual benefit limit of $10,000.  Effective July 1, 1997, the 
 inpatient hospital benefit for adult enrollees who qualify under 
 section 256L.04, subdivision 7, or who qualify under section 
 256L.04, subdivisions 1 to 6, or 256L.13 with family gross 
 income that exceeds 175 percent of the federal poverty 
 guidelines and who are not pregnant, is subject to an annual 
 limit of $10,000.  

    (b) Enrollees who qualify under section 256L.04, 
 subdivision 7, or who qualify under section 256L.04, 
 subdivisions 1 to 6, or 256L.13 with family gross income that 
 exceeds 175 percent of the federal poverty guidelines and who 
 are not pregnant, and are determined by the commissioner to have 
 a basis of eligibility for medical assistance shall apply for 
 and cooperate with the requirements of medical assistance by the 
 last day of the third month following admission to an inpatient 
 hospital.  If an enrollee fails to apply for medical assistance 
 within this time period, the enrollee and the enrollee's family 
 shall be disenrolled from the plan and they may not reenroll 
 until 12 calendar months have elapsed.  Enrollees and enrollees' 
 families disenrolled for not applying for or not cooperating 
 with medical assistance may not reenroll. 

    (c) Admissions for inpatient hospital services paid for 
 under section 256L.11, subdivision 3, must be certified as 
 medically necessary in accordance with Minnesota Rules, parts 
 9505.0500 to 9505.0540, except as provided in clauses (1) and 
 (2): 

    (1) all admissions must be certified, except those 
 authorized under rules established under section 254A.03, 
 subdivision 3, or approved under Medicare; and 

    (2) payment under section 256L.11, subdivision 3, shall be 
 reduced by five percent for admissions for which certification 
 is requested more than 30 days after the day of admission.  The 
 hospital may not seek payment from the enrollee for the amount 
 of the payment reduction under this clause. 

    (d) Any enrollee or family member of an enrollee who has 
 previously been permanently disenrolled from MinnesotaCare for 
 not applying for and cooperating with medical assistance shall 
 be eligible to reenroll if 12 calendar months have elapsed since 
 the date of disenrollment. 

    Subd. 4.    Coordination with medical assistance.  The 
 commissioner shall coordinate the provision of hospital 
 inpatient services under the MinnesotaCare program with enrollee 
 eligibility under the medical assistance spenddown, and shall 
 apply to the secretary of health and human services for any 
 necessary federal waivers or approvals. 

    Subd. 5.    Copayments and coinsurance.  The 
 MinnesotaCare benefit plan shall include the following 
 copayments and coinsurance requirements:  

    (1) ten percent of the paid charges for inpatient hospital 
 services for adult enrollees not eligible for medical 
 assistance, subject to an annual inpatient out-of-pocket maximum 
 of $1,000 per individual and $3,000 per family; 

    (2) $3 per prescription for adult enrollees; 

    (3) $25 for eyeglasses for adult enrollees; and 

    (4) effective July 1, 1998, 50 percent of the 
 fee-for-service rate for adult dental care services other than 
 preventive care services for persons eligible under section 
 256L.04, subdivisions 1 to 7, or 256L.13, with income equal to 
 or less than 175 percent of the federal poverty guidelines. 

    Prior to July 1, 1997, enrollees who are not eligible for 
 medical assistance with or without a spenddown shall be 
 financially responsible for the coinsurance amount and amounts 
 which exceed the $10,000 benefit limit.  Effective July 1, 1997, 
 adult enrollees who qualify under section 256L.04, subdivision 
 7, or who qualify under section 256L.04, subdivisions 1 to 6, or 
 256L.13 with family gross income that exceeds 175 percent of the 
 federal poverty guidelines and who are not pregnant, and who are 
 not eligible for medical assistance with or without a spenddown, 
 shall be financially responsible for the coinsurance amount and 
 amounts which exceed the $10,000 inpatient hospital benefit 
 limit. 

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

    Subd. 6.    Lien.  When the state agency provides, pays 
 for, or becomes liable for covered health services, the agency 
 shall have a lien for the cost of the covered health services 
 upon any and all causes of action accruing to the enrollee, or 
 to the enrollee's legal representatives, as a result of the 
 occurrence that necessitated the payment for the covered health 
 services.  All liens under this section shall be subject to the 
 provisions of section 256.015.  For purposes of this 
 subdivision, "state agency" includes authorized agents of the 
 state agency. 

    HIST: 1986 c 444; 1992 c 549 art 4 s 4,19; 1992 c 603 s 31; 
 1993 c 247 art 4 s 2-4,11; 1993 c 345 art 9 s 3; 1993 c 366 s 
 26; 1994 c 625 art 8 s 50,51,72; 1995 c 207 art 6 s 12; 1995 c 
 234 art 6 s 4,5; 1997 c 225 art 1 s 1-3 

*   NOTE:  The amendment to subdivision 7, clause (1), now 
*renumbered as subdivision 5, clause (1), by Laws 1997, chapter 
*225, article 1, section 3, is effective July 1, 1998.  Laws 
*1997, chapter 225, article 1, section 22.

     256L.04 Eligible persons. 

    Subdivision 1.    Children; expansion and continuation of 
 eligibility.  (a)    Children.  Prior to October 1, 1992, 
 "eligible persons" means children who are one year of age or 
 older but less than 18 years of age who have gross family 
 incomes that are equal to or less than 185 percent of the 
 federal poverty guidelines and who are not eligible for medical 
 assistance without a spenddown under chapter 256B and who are 
 not otherwise insured for the covered services.  The period of 
 eligibility extends from the first day of the month in which the 
 child's first birthday occurs to the last day of the month in 
 which the child becomes 18 years old. 

    (b)    Expansion of eligibility.  Eligibility for 
 MinnesotaCare shall be expanded as provided in subdivisions 3 to 
 7, except children who meet the criteria in this subdivision 
 shall continue to be enrolled pursuant to this subdivision.  The 
 enrollment requirements in this paragraph apply to enrollment 
 under subdivisions 1 to 7.  Parents who enroll in the 
 MinnesotaCare program must also enroll their children and 
 dependent siblings, if the children and their dependent siblings 
 are eligible.  Children and dependent siblings may be enrolled 
 separately without enrollment by parents.  However, if one 
 parent in the household enrolls, both parents must enroll, 
 unless other insurance is available.  If one child from a family 
 is enrolled, all children must be enrolled, unless other 
 insurance is available.  If one spouse in a household enrolls, 
 the other spouse in the household must also enroll, unless other 
 insurance is available.  Families cannot choose to enroll only 
 certain uninsured members.  For purposes of this section, a 
 "dependent sibling" means an unmarried child who is a full-time 
 student under the age of 25 years who is financially dependent 
 upon a parent.  Proof of school enrollment will be required.  

    (c)    Continuation of eligibility.  Individuals who 
 initially enroll in the MinnesotaCare program under the 
 eligibility criteria in subdivisions 3 to 7 remain eligible for 
 the MinnesotaCare program, regardless of age, place of 
 residence, or the presence or absence of children in the same 
 household, as long as all other eligibility criteria are met and 
 residence in Minnesota and continuous enrollment in the 
 MinnesotaCare program or medical assistance are maintained.  In 
 order for either parent or either spouse in a household to 
 remain enrolled, both must remain enrolled, unless other 
 insurance is available. 

    Subd. 2.    Cooperation.  To be eligible for 
 MinnesotaCare, individuals must cooperate with the state agency 
 to identify potentially liable third party payers and assist the 
 state in obtaining third party payments.  "Cooperation" 
 includes, but is not limited to, identifying any third party who 
 may be liable for care and services provided under MinnesotaCare 
 to the enrollee, providing relevant information to assist the 
 state in pursuing a potentially liable third party, and 
 completing forms necessary to recover third party payments. 

    Subd. 3.    Families with children.  Beginning October 
 1, 1992, "eligible persons" means children eligible under 
 subdivision 1, and parents and dependent siblings residing in 
 the same household as a child eligible under subdivision 1.  

    Subd. 4.    Continuation of eligibility.  Beginning 
 October 1, 1992, individuals who initially enrolled in the 
 MinnesotaCare program under the eligibility criteria in 
 subdivision 1 or 3 remain eligible even if their gross income 
 after enrollment exceeds 185 percent of the federal poverty 
 guidelines, subject to any premium required under section 
 256L.07, as long as all other eligibility requirements are met 
 and continuous enrollment in the MinnesotaCare program or 
 medical assistance is maintained. 

    Subd. 5.    Families with children; eligibility based on 
 percentage of income paid for health coverage.  Beginning 
 January 1, 1993, "eligible persons" means children, parents, and 
 dependent siblings residing in the same household.  Children who 
 meet the criteria in subdivision 1 or 6 shall continue to be 
 enrolled pursuant to those subdivisions.  Persons who are 
 eligible under this subdivision or subdivision 3, 4, or 7 must 
 pay a premium as determined under sections 256L.07 and 256L.08, 
 and children eligible under subdivision 1 must pay the premium 
 required under section 256L.06, subdivision 1.  Individuals and 
 families whose income is greater than the limits established 
 under section 256L.08 may not enroll in MinnesotaCare.  

    Subd. 6.    Children with lower incomes.  Beginning July 
 1, 1993, the definition of "eligible persons" is expanded to 
 include children who are one year of age or older but less than 
 18 years of age who have gross family incomes that are equal to 
 or less than 150 percent of the federal poverty guidelines and 
 who are not eligible for medical assistance without a spenddown 
 under chapter 256B and who are not otherwise insured for the 
 covered services.  The period of eligibility extends from the 
 first day of the month in which the child's first birthday 
 occurs to the last day of the month in which the child becomes 
 18 years old.  The commissioner shall exclude all earned income 
 of dependent children who: 

    (1) are full-time or part-time students; 

    (2) are employed for less than 37.5 hours per week; and 

    (3) earn less than $10,000 a year in total from all sources 
 of employment, when calculating gross family incomes for 
 applicants who would otherwise be eligible under this 
 subdivision.  

    Subd. 7.    Addition of single adults and households with 
 no children.  (a) Beginning October 1, 1994, the definition of 
 "eligible persons" is expanded to include all individuals and 
 households with no children who have gross family incomes that 
 are equal to or less than 125 percent of the federal poverty 
 guidelines and who are not eligible for medical assistance 
 without a spenddown under chapter 256B.  

    (b) Beginning July 1, 1997, the definition of eligible 
 persons is expanded to include all individuals and households 
 with no children who have gross family incomes that are equal to 
 or less than 175 percent of the federal poverty guidelines and 
 who are not eligible for medical assistance without a spenddown 
 under chapter 256B. 

    (c) All eligible persons under paragraphs (a) and (b) are 
 eligible for coverage through the MinnesotaCare program but must 
 pay a premium as determined under sections 256L.07 and 256L.08.  
 Individuals and families whose income is greater than the limits 
 established under section 256L.08 may not enroll in the 
 MinnesotaCare program. 

    Subd. 8.    Applicants potentially eligible for medical 
 assistance.  Individuals who apply for MinnesotaCare who 
 qualify under section 256L.04, subdivision 7, but who are 
 potentially eligible for medical assistance without a spenddown 
 shall be allowed to enroll in MinnesotaCare for a period of 60 
 days, so long as the applicant meets all other conditions of 
 eligibility.  The commissioner shall identify and refer such 
 individuals to their county social service agency.  The enrollee 
 must cooperate with the county social service agency in 
 determining medical assistance eligibility within the 60-day 
 enrollment period.  Enrollees who do not apply for and cooperate 
 with medical assistance within the 60-day enrollment period, and 
 their other family members, shall be disenrolled from the plan 
 within one calendar month.  Persons disenrolled for 
 nonapplication for medical assistance may not reenroll until 
 they have obtained a medical assistance eligibility 
 determination for the family member or members who were referred 
 to the county agency.  Persons disenrolled for noncooperation 
 with medical assistance may not reenroll until they have 
 cooperated with the county agency and have obtained a medical 
 assistance eligibility determination.  The commissioner shall 
 redetermine provider payments made under MinnesotaCare to the 
 appropriate medical assistance payments for those enrollees who 
 subsequently become eligible for medical assistance. 

    Subd. 9.    General assistance medical care.  A person 
 cannot have coverage under both MinnesotaCare and general 
 assistance medical care in the same month. 

    Subd. 10.    Sponsor's income and resources deemed 
 available.  When determining eligibility for any federal or 
 state benefits under sections 256L.01 to 256L.16, the income and 
 resources of all noncitizens whose sponsor signed an affidavit 
 of support as defined under United States Code, title 8, section 
 1183a, shall be deemed to include their sponsors' income and 
 resources as defined in the Personal Responsibility and Work 
 Opportunity Reconciliation Act of 1996, title IV, Public Law 
 Number 104-193, sections 421 and 422, and subsequently set out 
 in federal rules. 

    Subd. 11.    MinnesotaCare outreach.  (a) The 
 commissioner shall award grants to public or private 
 organizations to provide information on the importance of 
 maintaining insurance coverage and on how to obtain coverage 
 through the MinnesotaCare program in areas of the state with 
 high uninsured populations.  

    (b) In awarding the grants, the commissioner shall consider 
 the following: 

    (1) geographic areas and populations with high uninsured 
 rates; 

    (2) the ability to raise matching funds; and 

    (3) the ability to contact or serve eligible populations. 

    The commissioner shall monitor the grants and may terminate 
 a grant if the outreach effort does not increase the 
 MinnesotaCare program enrollment. 

    HIST: 1986 c 444; 1992 c 549 art 4 s 5,19; 1993 c 247 art 4 s 
 5; 1993 c 345 art 9 s 4-6; 1994 c 625 art 8 s 52-55,72; art 13 s 
 2; 1995 c 234 art 6 s 6-9; 1997 c 85 art 3 s 9; 1997 c 203 art 
 12 s 1; 1997 c 225 art 1 s 4-8 

     256L.05 Application procedures. 

    Subdivision 1.    Application and information 
 availability.  Applications and other information must be made 
 available to provider offices, local human services agencies, 
 school districts, public and private elementary schools in which 
 25 percent or more of the students receive free or reduced price 
 lunches, community health offices, and Women, Infants and 
 Children (WIC) program sites.  These sites may accept 
 applications and forward the forms to the commissioner.  
 Otherwise, applicants may apply directly to the commissioner.  
 Beginning January 1, 2000, MinnesotaCare enrollment sites will 
 be expanded to include local county human services agencies 
 which choose to participate.  

    Subd. 2.    Commissioner's duties.  The commissioner 
 shall use individuals' social security numbers as identifiers 
 for purposes of administering the plan and conduct data matches 
 to verify income.  Applicants shall submit evidence of family 
 income, earned and unearned, including the most recent income 
 tax return, wage slips, or other documentation that is necessary 
 to verify income eligibility.  The commissioner shall perform 
 random audits to verify reported income and eligibility.  The 
 commissioner may execute data sharing arrangements with the 
 department of revenue and any other governmental agency in order 
 to perform income verification related to eligibility and 
 premium payment under the MinnesotaCare program. 

    Subd. 3.    Effective date of coverage.  The effective 
 date of coverage is the first day of the month following the 
 month in which eligibility is approved and the first premium 
 payment has been received.  The effective date of coverage for 
 eligible newborns or eligible newly adoptive children added to a 
 family receiving covered health services is the date of entry 
 into the family.  The effective date of coverage for other new 
 recipients added to the family receiving covered health services 
 is the first day of the month following the month in which 
 eligibility is approved and the first premium payment has been 
 received.  The premium must be received eight working days prior 
 to the end of the month for coverage to begin the following 
 month.  Benefits are not available until the day following 
 discharge if an enrollee is hospitalized on the first day of 
 coverage.  Notwithstanding any other law to the contrary, 
 benefits under sections 256L.01 to 256L.10 are secondary to a 
 plan of insurance or benefit program under which an eligible 
 person may have coverage and the commissioner shall use cost 
 avoidance techniques to ensure coordination of any other health 
 coverage for eligible persons.  The commissioner shall identify 
 eligible persons who may have coverage or benefits under other 
 plans of insurance or who become eligible for medical assistance.

    Subd. 4.    Application processing.  The commissioner of 
 human services shall determine an applicant's eligibility for 
 MinnesotaCare no more than 30 days from the date that the 
 application is received by the department of human services.  
 Beginning January 1, 2000, this requirement also applies to 
 local county human services agencies that determine eligibility 
 for MinnesotaCare.  

    Subd. 5.    Availability of private insurance.  The 
 commissioner, in consultation with the commissioners of health 
 and commerce, shall provide information regarding the 
 availability of private health insurance coverage to all 
 families and individuals enrolled in the MinnesotaCare program 
 whose gross family income is equal to or more than 200 percent 
 of the federal poverty guidelines.  This information must be 
 provided upon initial enrollment and annually thereafter. 

    HIST: 1986 c 444; 1987 c 403 art 2 s 63; 1988 c 689 art 2 s 
 137; 1992 c 549 art 4 s 6,19; 1993 c 247 art 4 s 6; 1994 c 625 
 art 8 s 72; art 13 s 3; 1995 c 234 art 6 s 10; 1996 c 451 art 5 
 s 10; 1997 c 225 art 1 s 9-11; 1997 c 251 s 26 

     256L.06 Premium fees and payments. 

    Subdivision 1.    Premium fees.  An annual premium fee 
 of $48 is required from all MinnesotaCare enrollees eligible 
 under section 256L.04, subdivision 1. 

    Subd. 2.    Premium payments.  The commissioner shall 
 require MinnesotaCare enrollees eligible under section 256L.04, 
 subdivisions 3 to 7, to pay a premium based on a sliding scale, 
 as established under section 256L.08.  The following applicants 
 are exempt from this requirement until July 1, 1993: 

    (1) applicants who are eligible under Minnesota Statutes 
 1992, section 256.9354, subdivision 1, if the application is 
 received by MinnesotaCare staff on or before September 30, 1992; 
 and 

    (2) children who enroll in the MinnesotaCare program after 
 September 30, 1992, pursuant to Laws 1992, chapter 549, article 
 4, section 17.  

    Subd. 3.    Administration and commissioner's duties.  
 Premiums are dedicated to the commissioner for MinnesotaCare.  
 The commissioner shall make an annual redetermination of 
 continued eligibility and identify people who may become 
 eligible for medical assistance.  The commissioner shall develop 
 and implement procedures to:  (1) require enrollees to report 
 changes in income; (2) adjust sliding scale premium payments, 
 based upon changes in enrollee income; and (3) disenroll 
 enrollees from MinnesotaCare for failure to pay required 
 premiums.  Premiums are calculated on a calendar month basis and 
 may be paid on a monthly, quarterly, or annual basis, with the 
 first payment due upon notice from the commissioner of the 
 premium amount required.  Premium payment is required before 
 enrollment is complete and to maintain eligibility in 
 MinnesotaCare.  Nonpayment of the premium will result in 
 disenrollment from the plan within one calendar month after the 
 due date.  Persons disenrolled for nonpayment may not reenroll 
 until four calendar months have elapsed.  Persons disenrolled 
 for nonpayment may not reenroll for four calendar months unless 
 the person demonstrates good cause for nonpayment.  Good cause 
 does not exist if a person chooses to pay other family expenses 
 instead of the premium.  The commissioner shall define good 
 cause in rule. 

    HIST: 1986 c 444; 1987 c 403 art 2 s 63; 1988 c 689 art 2 s 
 137; 1989 c 282 art 3 s 35; 1992 c 549 art 4 s 7,19; 1993 c 247 
 art 4 s 7; 1993 c 345 art 9 s 7; 1994 c 625 art 13 s 4; 1995 c 
 234 art 8 s 56 

     256L.07 Eligibility for subsidized premiums based on 
  sliding scale. 

    Subdivision 1.    General requirements.  Families and 
 individuals who enroll on or after October 1, 1992, are eligible 
 for subsidized premium payments based on a sliding scale under 
 section 256L.08 only if the family or individual meets the 
 requirements in subdivisions 2 and 3.  Children already enrolled 
 in the children's health plan as of September 30, 1992, eligible 
 under section 256L.04, subdivision 1, paragraph (a), children 
 who enroll in the MinnesotaCare program after September 30, 
 1992, pursuant to Laws 1992, chapter 549, article 4, section 17, 
 and children who enroll under section 256L.04, subdivision 6, 
 are eligible for subsidized premium payments without meeting 
 these requirements, as long as they maintain continuous coverage 
 in the MinnesotaCare plan or medical assistance.  

    Families and individuals who initially enrolled in 
 MinnesotaCare under section 256L.04, and whose income increases 
 above the limits established in section 256L.08, may continue 
 enrollment and pay the full cost of coverage. 

    Subd. 2.    Must not have access to employer-subsidized 
 coverage.  (a) To be eligible for subsidized premium payments 
 based on a sliding scale, a family or individual must not have 
 access to subsidized health coverage through an employer, and 
 must not have had access to subsidized health coverage through 
 an employer for the 18 months prior to application for 
 subsidized coverage under the MinnesotaCare program.  The 
 requirement that the family or individual must not have had 
 access to employer-subsidized coverage during the previous 18 
 months does not apply if:  (1) employer-subsidized coverage was 
 lost due to the death of an employee or divorce; (2) 
 employer-subsidized coverage was lost because an individual 
 became ineligible for coverage as a child or dependent; or (3) 
 employer-subsidized coverage was lost for reasons that would not 
 disqualify the individual for unemployment benefits under 
 section 268.09 and the family or individual has not had access 
 to employer-subsidized coverage since the loss of coverage.  If 
 employer-subsidized coverage was lost for reasons that 
 disqualify an individual for unemployment benefits under section 
 268.09, children of that individual are exempt from the 
 requirement of no access to employer subsidized coverage for the 
 18 months prior to application, as long as the children have not 
 had access to employer subsidized coverage since the 
 disqualifying event.  The requirement that the family or 
 individual must not have had access to employer-subsidized 
 coverage during the previous 18 months does apply if 
 employer-subsidized coverage is lost due to an employer 
 terminating health care coverage as an employee benefit.  

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

    Subd. 3.    Period uninsured.  To be eligible for 
 subsidized premium payments based on a sliding scale, families 
 and individuals initially enrolled in the MinnesotaCare program 
 under section 256L.04, subdivisions 5 and 7, must have had no 
 health coverage for at least four months prior to application.  
 The commissioner may change this eligibility criterion for 
 sliding scale premiums in order to remain within the limits of 
 available appropriations.  The requirement of at least four 
 months of no health coverage prior to application for the 
 MinnesotaCare program does not apply to: 

    (1) families, children, and individuals who apply for the 
 MinnesotaCare program upon termination from or as required by 
 the medical assistance program, general assistance medical care 
 program, or coverage under a regional demonstration project for 
 the uninsured funded under section 256B.73, the Hennepin county 
 assured care program, or the Group Health, Inc., community 
 health plan; 

    (2) families and individuals initially enrolled under 
 section 256L.04, subdivisions 1, paragraph (a), and 3; 

    (3) children enrolled pursuant to Laws 1992, chapter 549, 
 article 4, section 17; or 

    (4) individuals currently serving or who have served in the 
 military reserves, and dependents of these individuals, if these 
 individuals:  (i) reapply for MinnesotaCare coverage after a 
 period of active military service during which they had been 
 covered by the Civilian Health and Medical Program of the 
 Uniformed Services (CHAMPUS); (ii) were covered under 
 MinnesotaCare immediately prior to obtaining coverage under 
 CHAMPUS; and (iii) have maintained continuous coverage. 

    HIST: 1986 c 444; 1992 c 549 art 4 s 8,19; 1993 c 345 art 9 s 
 8; 1994 c 625 art 8 s 56,72; 1995 c 234 art 6 s 11-13; 1997 c 
 187 art 1 s 18; 1997 c 225 art 1 s 12 

     256L.08 Premiums. 

    Subdivision 1.    Premium determination.  Each 
 individual or family enrolled in the MinnesotaCare program shall 
 pay a premium determined according to a sliding fee based on the 
 cost of coverage as a percentage of the individual's or family's 
 gross family income. 

    Subd. 2.    Sliding scales to determine percentage of 
 gross family income.  The commissioner shall establish sliding 
 scales to determine the percentage of gross family income that 
 households at different income levels must pay to obtain 
 coverage through the MinnesotaCare program.  The sliding scale 
 must be based on the enrollee's gross family income, as defined 
 in section 256L.01, subdivision 4, during the previous four 
 months.  The sliding scale must provide separate sliding scales 
 for individuals, two-person households, and households of three 
 or more. 

    Subd. 3.    Sliding scales after June 30, 1993.  
 Beginning July 1, 1993, the sliding scales begin with a premium 
 of 1.5 percent of gross family income for individuals with 
 incomes below the limits for the medical assistance program set 
 at 133-1/3 percent of the AFDC payment standard and proceed 
 through the following evenly spaced steps:  1.8, 2.3, 3.1, 3.8, 
 4.8, 5.9, 7.4, and 8.8.  These percentages are matched to evenly 
 spaced income steps ranging from the medical assistance income 
 limit to a gross monthly income of $1,600 for an individual, 
 $2,160 for a household of two, $2,720 for a household of three, 
 $3,280 for a household of four, and $3,840 for a household of 
 five or more persons.  

    Subd. 4.    Ineligibility.  Families with children whose 
 gross monthly income is above the amount specified in 
 subdivision 3 are not eligible for the plan.  An individual or 
 households with no children whose gross family income is greater 
 than the amount specified in section 256L.04, subdivision 7, are 
 ineligible for the plan. 

    Subd. 5.    Premium collection through wage withholding. 
  The premium for coverage under the MinnesotaCare program may 
 be collected through wage withholding with the consent of the 
 employer and the employee. 

    Subd. 6.    Exclusion from chapter 14.  The sliding fee 
 scale and percentages are not subject to the provisions of 
 chapter 14. 

    Subd. 7.    Minimum premium payment.  Beginning with 
 premium payments due on or after July 1, 1995, the commissioner 
 shall require all MinnesotaCare enrollees to pay a minimum 
 premium of $4 per month. 

    HIST: 1986 c 444; 1992 c 549 art 4 s 9,19; 1993 c 247 art 4 s 
 11; 1994 c 625 art 8 s 72; art 13 s 5; 1995 c 234 art 6 s 14-16; 
 1997 c 225 art 1 s 13 

     256L.09 Residency. 

    Subdivision 1.    Findings and purpose.  The legislature 
 finds that the enactment of a comprehensive health plan for 
 uninsured Minnesotans creates a risk that persons needing 
 medical care will migrate to the state for the primary purpose 
 of obtaining medical care subsidized by the state.  The risk of 
 migration undermines the state's ability to provide to 
 legitimate state residents a valuable and necessary health care 
 program which is an important component of the state's 
 comprehensive cost containment and health care system reform 
 plan.  Intent-based residency requirements, which are expressly 
 authorized under decisions of the United States Supreme Court, 
 are an unenforceable and ineffective method of denying benefits 
 to those persons the Supreme Court has stated may legitimately 
 be denied eligibility for state programs.  If the state is 
 unable to limit eligibility to legitimate permanent residents of 
 the state, the state faces a significant risk that it will be 
 forced to reduce the eligibility and benefits it would otherwise 
 provide to Minnesotans.  The legislature finds that a durational 
 residence requirement is a legitimate, objective, enforceable 
 standard for determining whether a person is a permanent 
 resident of the state.  The legislature also finds low-income 
 persons who have not lived in the state for the required time 
 period will have access to necessary health care services 
 through the general assistance medical care program, the medical 
 assistance program, and public and private charity care programs.

    Subd. 2.    Residency requirement.  (a) Prior to July 1, 
 1997, to be eligible for health coverage under the MinnesotaCare 
 program, families and individuals must be permanent residents of 
 Minnesota.  

    (b) Effective July 1, 1997, to be eligible for health 
 coverage under the MinnesotaCare program, adults without 
 children must be permanent residents of Minnesota. 

    (c) Effective July 1, 1997, to be eligible for health 
 coverage under the MinnesotaCare program, pregnant women, 
 families, and children must meet the residency requirements as 
 provided by Code of Federal Regulations, title 42, section 
 435.403, except that the provisions of section 256B.056, 
 subdivision 1, shall apply upon receipt of federal approval. 

    Subd. 3.    Permanent Minnesota resident.  For purposes 
 of this section, a permanent Minnesota resident is a person who 
 has demonstrated, through persuasive and objective evidence, 
 that the person is domiciled in the state and intends to live in 
 the state permanently.  

    Subd. 4.    Eligibility as Minnesota resident.  To be 
 eligible, all applicants must demonstrate the requisite intent 
 to live in the state permanently by: 

    (1) showing that the applicant maintains a residence at a 
 verified address other than a place of public accommodation, 
 through the use of evidence of residence described in section 
 256D.02, subdivision 12a, clause (1); 

    (2) demonstrating that the applicant has been continuously 
 domiciled in the state for no less than 180 days immediately 
 before the application; and 

    (3) signing an affidavit declaring that (A) the applicant 
 currently resides in the state and intends to reside in the 
 state permanently; and (B) the applicant did not come to the 
 state for the primary purpose of obtaining medical coverage or 
 treatment. 

    Subd. 5.    Persons excluded as permanent residents.  An 
 individual or family that moved to Minnesota primarily to obtain 
 medical treatment or health coverage for a preexisting condition 
 is not a permanent resident.  

    Subd. 6.    12-month preexisting exclusion.  If the 
 180-day requirement in subdivision 4, clause (2), is determined 
 by a court to be unconstitutional, the commissioner of human 
 services shall impose a 12-month preexisting condition exclusion 
 on coverage for persons who have been domiciled in the state for 
 less than 180 days.  

    Subd. 7.    Effect of a court determination.  If any 
 paragraph, sentence, clause, or phrase of this section is for 
 any reason determined by a court to be unconstitutional, the 
 decision shall not affect the validity of the remaining portions 
 of the section.  The legislature declares that it would have 
 passed each paragraph, sentence, clause, and phrase in this 
 section, irrespective of the fact that any one or more 
 paragraphs, sentences, clauses, or phrases is declared 
 unconstitutional. 

    HIST: 1986 c 444; 1992 c 549 art 4 s 10,19; 1993 c 247 art 4 s 
 11; 1994 c 625 art 8 s 72; 1997 c 225 art 1 s 14 

     256L.10 Appeals. 

    If the commissioner suspends, reduces, or terminates 
 eligibility for the MinnesotaCare program, or services provided 
 under the MinnesotaCare program, the commissioner must provide 
 notification according to the laws and rules governing the 
 medical assistance program.  A MinnesotaCare program applicant 
 or enrollee aggrieved by a determination of the commissioner has 
 the right to appeal the determination according to section 
 256.045. 

    HIST: 1986 c 444; 1991 c 292 art 4 s 17; 1992 c 549 art 4 s 
 11,19; 1993 c 247 art 4 s 11; 1994 c 625 art 8 s 72 

     256L.11 Provider payment. 

    Subdivision 1.    Medical assistance rate to be used.  
 Payment to providers under sections 256L.01 to 256L.11 shall be 
 at the same rates and conditions established for medical 
 assistance, except as provided in subdivisions 2 to 6. 

    Subd. 2.    Payment of certain providers.  Services 
 provided by federally qualified health centers, rural health 
 clinics, and facilities of the Indian health service shall be 
 paid for according to the same rates and conditions applicable 
 to the same service provided by providers that are not federally 
 qualified health centers, rural health clinics, or facilities of 
 the Indian health service. 

    Subd. 3.    Inpatient hospital services.  Inpatient 
 hospital services provided under section 256L.03, subdivision 3, 
 shall be paid for as provided in subdivisions 4 to 6. 

    Subd. 4.    Definition of medical assistance rate for 
 inpatient hospital services.  The "medical assistance rate," 
 as used in this section to apply to rates for providing 
 inpatient hospital services, means the rates established under 
 sections 256.9685 to 256.9695 for providing inpatient hospital 
 services to medical assistance recipients who receive aid to 
 families with dependent children. 

    Subd. 5.    Enrollees younger than 18.  Payment for 
 inpatient hospital services provided to MinnesotaCare enrollees 
 who are younger than 18 years old on the date of admission to 
 the inpatient hospital shall be at the medical assistance rate. 

    Subd. 6.    Enrollees 18 or older.  Payment by the 
 MinnesotaCare program for inpatient hospital services provided 
 to MinnesotaCare enrollees eligible under section 256L.04, 
 subdivision 7, or who qualify under section 256L.04, 
 subdivisions 1 to 6, or 256L.13 with family gross income that 
 exceeds 175 percent of the federal poverty guidelines and who 
 are not pregnant, who are 18 years old or older on the date of 
 admission to the inpatient hospital must be in accordance with 
 paragraphs (a) and (b).  Payment for adults who are not pregnant 
 and are eligible under section 256L.04, subdivisions 1 to 6, or 
 256L.13, and whose incomes are equal to or less than 175 percent 
 of the federal poverty guidelines, shall be as provided for 
 under paragraph (c).  

    (a) If the medical assistance rate minus any copayment 
 required under section 256L.03, subdivision 4, is less than or 
 equal to the amount remaining in the enrollee's benefit limit 
 under section 256L.03, subdivision 3, payment must be the 
 medical assistance rate minus any copayment required under 
 section 256L.03, subdivision 4.  The hospital must not seek 
 payment from the enrollee in addition to the copayment.  The 
 MinnesotaCare payment plus the copayment must be treated as 
 payment in full. 

    (b) If the medical assistance rate minus any copayment 
 required under section 256L.03, subdivision 4, is greater than 
 the amount remaining in the enrollee's benefit limit under 
 section 256L.03, subdivision 3, payment must be the lesser of: 

    (1) the amount remaining in the enrollee's benefit limit; 
 or 

    (2) charges submitted for the inpatient hospital services 
 less any copayment established under section 256L.03, 
 subdivision 4. 

    The hospital may seek payment from the enrollee for the 
 amount by which usual and customary charges exceed the payment 
 under this paragraph.  If payment is reduced under section 
 256L.03, subdivision 3, paragraph (c), the hospital may not seek 
 payment from the enrollee for the amount of the reduction. 

    (c) For admissions occurring during the period of July 1, 
 1997, through June 30, 1998, for adults who are not pregnant and 
 are eligible under section 256L.04, subdivisions 1 to 6, or 
 256L.13, and whose incomes are equal to or less than 175 percent 
 of the federal poverty guidelines, the commissioner shall pay 
 hospitals directly, up to the medical assistance payment rate, 
 for inpatient hospital benefits in excess of the $10,000 annual 
 inpatient benefit limit. 

    HIST: 1993 c 345 art 9 s 9; 1994 c 625 art 8 s 57; 1997 c 225 
 art 1 s 15 

     256L.12 Managed care. 

    Subdivision 1.    Selection of vendors.  In order to 
 contain costs, the commissioner of human services shall select 
 vendors of medical care who can provide the most economical care 
 consistent with high medical standards and shall, where 
 possible, contract with organizations on a prepaid capitation 
 basis to provide these services.  The commissioner shall 
 consider proposals by counties and vendors for managed care 
 plans which may include:  prepaid capitation programs, 
 competitive bidding programs, or other vendor payment mechanisms 
 designed to provide services in an economical manner or to 
 control utilization, with safeguards to ensure that necessary 
 services are provided.  

    Subd. 2.    Geographic area.  The commissioner shall 
 designate the geographic areas in which eligible individuals 
 must receive services through managed care plans. 

    Subd. 3.    Limitation of choice.  Persons enrolled in 
 the MinnesotaCare program who reside in the designated 
 geographic areas must enroll in a managed care plan to receive 
 their health care services.  Enrollees must receive their health 
 care services from health care providers who are part of the 
 managed care plan provider network, unless authorized by the 
 managed care plan, in cases of medical emergency, or when 
 otherwise required by law or by contract. 

    If only one managed care option is available in a 
 geographic area, the managed care plan may require that 
 enrollees designate a primary care provider from which to 
 receive their health care.  Enrollees will be permitted to 
 change their designated primary care provider upon request to 
 the managed care plan.  Requests to change primary care 
 providers may be limited to once annually.  If more than one 
 managed care plan is offered in a geographic area, enrollees 
 will be enrolled in a managed care plan for up to one year from 
 the date of enrollment, but shall have the right to change to 
 another managed care plan once within the first year of initial 
 enrollment.  Enrollees may also change to another managed care 
 plan during an annual 30-day open enrollment period.  Enrollees 
 shall be notified of the opportunity to change to another 
 managed care plan before the start of each annual open 
 enrollment period.  

    Enrollees may change managed care plans or primary care 
 providers at other than the above designated times for cause as 
 determined through an appeal pursuant to section 256.045. 

    Subd. 4.    Exemptions to limitations on choice.  All 
 contracts between the department of human services and prepaid 
 health plans to serve medical assistance, general assistance 
 medical care, and MinnesotaCare recipients must comply with the 
 requirements of United States Code, title 42, section 1396a 
 (a)(23)(B), notwithstanding any waivers authorized by the United 
 States Department of Health and Human Services pursuant to 
 United States Code, title 42, section 1315. 

    Subd. 5.    Eligibility for other state programs.  
 MinnesotaCare enrollees who become eligible for medical 
 assistance or general assistance medical care will remain in the 
 same managed care plan if the managed care plan has a contract 
 for that population.  Effective January 1, 1998, MinnesotaCare 
 enrollees who were formerly eligible for general assistance 
 medical care pursuant to section 256D.03, subdivision 3, within 
 six months of MinnesotaCare enrollment and were enrolled in a 
 prepaid health plan pursuant to section 256D.03, subdivision 4, 
 paragraph (d), must remain in the same managed care plan if the 
 managed care plan has a contract for that population.  Contracts 
 between the department of human services and managed care plans 
 must include MinnesotaCare, and medical assistance and may, at 
 the option of the commissioner of human services, also include 
 general assistance medical care. 

    Subd. 6.    Copayments and benefit limits.  Enrollees 
 are responsible for all copayments in section 256L.03, 
 subdivision 4, and shall pay copayments to the managed care plan 
 or to its participating providers.  The enrollee is also 
 responsible for payment of inpatient hospital charges which 
 exceed the MinnesotaCare benefit limit. 

    Subd. 7.    Managed care plan vendor requirements.  The 
 following requirements apply to all counties or vendors who 
 contract with the department of human services to serve 
 MinnesotaCare recipients.  Managed care plan contractors: 

    (1) shall authorize and arrange for the provision of the 
 full range of services listed in section 256L.03 in order to 
 ensure appropriate health care is delivered to enrollees; 

    (2) shall accept the prospective, per capita payment or 
 other contractually defined payment from the commissioner in 
 return for the provision and coordination of covered health care 
 services for eligible individuals enrolled in the program; 

    (3) may contract with other health care and social service 
 practitioners to provide services to enrollees; 

    (4) shall provide for an enrollee grievance process as 
 required by the commissioner and set forth in the contract with 
 the department; 

    (5) shall retain all revenue from enrollee copayments; 

    (6) shall accept all eligible MinnesotaCare enrollees, 
 without regard to health status or previous utilization of 
 health services; 

    (7) shall demonstrate capacity to accept financial risk 
 according to requirements specified in the contract with the 
 department.  A health maintenance organization licensed under 
 chapter 62D, or a nonprofit health plan licensed under chapter 
 62C, is not required to demonstrate financial risk capacity, 
 beyond that which is required to comply with chapters 62C and 
 62D; and 

    (8) shall submit information as required by the 
 commissioner, including data required for assessing enrollee 
 satisfaction, quality of care, cost, and utilization of services.

    Subd. 8.    Chemical dependency assessments.  The 
 managed care plan shall be responsible for assessing the need 
 and placement for chemical dependency services according to 
 criteria set forth in Minnesota Rules, parts 9530.6600 to 
 9530.6660. 

    Subd. 9.    Rate setting.  Rates will be prospective, 
 per capita, where possible.  The commissioner may allow health 
 plans to arrange for inpatient hospital services on a risk or 
 nonrisk basis.  The commissioner shall consult with an 
 independent actuary to determine appropriate rates. 

    Subd. 10.    Childhood immunization.  Each managed care 
 plan contracting with the department of human services under 
 this section shall collaborate with the local public health 
 agencies to ensure childhood immunization to all enrolled 
 families with children.  As part of this collaboration the plan 
 must provide the families with a recommended immunization 
 schedule. 

    HIST: 1993 c 345 art 9 s 10; 1994 c 625 art 8 s 58-60; 1995 c 
 234 art 6 s 17; 1997 c 225 art 1 s 16; art 2 s 56,62 

     256L.13 Eligibility for MinnesotaCare for families and 
  children under the MinnesotaCare health care reform waiver. 

    Subdivision 1.    Families with children; in general.  
 Families with children with family income equal to or less than 
 275 percent of the federal poverty guidelines for the applicable 
 family size shall be determined eligible for MinnesotaCare 
 according to this section, and section 256L.04, subdivisions 3 
 to 6, shall no longer apply.  All other provisions of sections 
 256L.01 to 256L.12, including the insurance-related barriers to 
 enrollment under section 256L.07, shall apply unless otherwise 
 specified in sections 256L.13 to 256L.16.  

    Subd. 2.    Children.  For purposes of sections 256L.13 
 to 256L.16, a "child" is an individual under 21 years of age, 
 including the unborn child of a pregnant woman, and including an 
 emancipated minor, and the emancipated minor's spouse.  

    Subd. 3.    Families with children.  For purposes of 
 sections 256L.13 to 256L.16, a "family with children" means a 
 parent or parents and their children, or legal guardians and 
 their wards who are children, and dependent siblings, residing 
 in the same household.  The term includes children and dependent 
 siblings who are temporarily absent from the household in 
 settings such as schools, camps, or visitation with noncustodial 
 parents.  For purposes of this section, a "dependent sibling" 
 means an unmarried child who is a full-time student under the 
 age of 25 years who is financially dependent upon a parent.  
 Proof of school enrollment will be required. 

    Subd. 4.    Children in families with income at or less 
 than 150 percent of federal poverty guidelines.  Children who 
 have gross family incomes that are equal to or less than 150 
 percent of the federal poverty guidelines and who are not 
 otherwise insured for the covered services, are eligible for 
 enrollment under sections 256L.13 to 256L.16.  For the purposes 
 of this section, "not otherwise insured for covered services" 
 has the meaning given in Minnesota Rules, part 9506.0020, 
 subpart 3, item B.  

    Subd. 5.    Residency.  Families and children who are 
 otherwise eligible for enrollment under this section are exempt 
 from the Minnesota residency requirements of section 256L.09, if 
 they meet the residency requirements of the medical assistance 
 program according to chapter 256B.  

    Subd. 6.    Cooperation with medical assistance.  
 Pregnant women and children applying for MinnesotaCare under 
 this section are not required to apply for the medical 
 assistance program as a condition of enrollment.  Other adults 
 enrolled in MinnesotaCare determined by the commissioner to have 
 a basis of eligibility for medical assistance must cooperate in 
 completing an application for medical assistance by the last day 
 of the third month following admission to an inpatient 
 hospital.  If an enrollee fails to complete an application for 
 medical assistance within this time period, the enrollee shall 
 be disenrolled and may not reenroll. 

    Subd. 7.    Cooperation in establishing paternity and 
 other medical support.  Families and children enrolled in the 
 MinnesotaCare program must cooperate with the department of 
 human services and the local agency in establishing paternity of 
 an enrolled child and in obtaining medical care support and 
 payments for the child and any other person for whom the person 
 can legally assign rights, in accordance with applicable laws 
 and rules governing the medical assistance program.  A child 
 shall not be ineligible for or disenrolled from the 
 MinnesotaCare program solely because of the child's parent or 
 caretaker's failure to cooperate in establishing paternity or 
 obtaining medical support. 

    HIST: 1995 c 234 art 6 s 18 

     256L.14 Covered services for pregnant women and children 
  under the MinnesotaCare health care reform waiver. 

    Children and pregnant women are eligible for coverage of 
 all services that are eligible for reimbursement under the 
 medical assistance program according to chapter 256B.  Pregnant 
 women and children are exempt from the provisions of section 
 256L.03, subdivision 5, regarding copayments.  

    HIST: 1995 c 234 art 6 s 19 

     256L.15 Premiums. 

    Subdivision 1.    Premium determination.  Families and 
 children enrolled according to sections 256L.13 to 256L.16 shall 
 pay a premium determined according to a sliding fee based on the 
 cost of coverage as a percentage of the family's gross family 
 income.  Pregnant women and children under age two are exempt 
 from the provisions of section 256L.06, subdivision 3, clause 
 (3), requiring disenrollment for failure to pay premiums.  For 
 pregnant women, this exemption continues until the first day of 
 the month following the 60th day postpartum.  Women who remain 
 enrolled during pregnancy or the postpartum period, despite 
 nonpayment of premiums, shall be disenrolled on the first of the 
 month following the 60th day postpartum for the penalty period 
 that otherwise applies under section 256L.06. 

    Subd. 2.    Sliding scale to determine percentage of gross 
 family income.  The commissioner shall establish a sliding fee 
 scale to determine the percentage of gross family income that 
 households at different income levels must pay to obtain 
 coverage through the MinnesotaCare program.  The sliding fee 
 scale must be based on the enrollee's gross family income during 
 the previous four months.  The sliding fee scale begins with a 
 premium of 1.5 percent of gross family income for families with 
 incomes below the limits for the medical assistance program for 
 families and children and proceeds through the following evenly 
 spaced steps:  1.8, 2.3, 3.1, 3.8, 4.8, 5.9, 7.4, and 8.8 
 percent.  These percentages are matched to evenly spaced income 
 steps ranging from the medical assistance income limit for 
 families and children to 275 percent of the federal poverty 
 guidelines for the applicable family size.  The sliding fee 
 scale and percentages are not subject to the provisions of 
 chapter 14.  If a family reports increased income after 
 enrollment, premiums shall not be adjusted until eligibility 
 renewal.  

    Subd. 3.    Exceptions to sliding scale.  An annual 
 premium of $48 is required for all children who are eligible 
 according to section 256L.13, subdivision 4.  

    HIST: 1995 c 234 art 6 s 20 

     256L.16 Payment rates; services for families and 
  children under the MinnesotaCare health care reform waiver. 

    Section 256L.11, subdivision 2, shall not apply to services 
 provided to children who are eligible to receive expanded 
 services according to section 256L.14. 

    HIST: 1995 c 234 art 6 s 21 

     256L.17 Asset requirement for MinnesotaCare. 

    Subdivision 1.    Definitions.  For purposes of this 
 section, the following definitions apply. 

    (a) "Asset" means cash and other personal property, as well 
 as any real property, that a family or individual owns which has 
 monetary value. 

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

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

    Subd. 2.    Limit on total assets.  (a) Effective April 
 1, 1997, or upon federal approval, whichever is later, in order 
 to be eligible for the MinnesotaCare program, a household of two 
 or more persons must not own more than $30,000 in total net 
 assets, and a household of one person must not own more than 
 $15,000 in total net assets. 

    (b) For purposes of this subdivision, total net assets 
 include all assets, with the following exceptions: 

    (1) a homestead is not considered; 

    (2) household goods and personal effects are not 
 considered; 

    (3) any assets owned by children; 

    (4) vehicles used for employment; 

    (5) court-ordered settlements up to $10,000; 

    (6) individual retirement accounts; and 

    (7) capital and operating assets of a trade or business up 
 to $200,000 in net assets are not considered. 

    (c) If an asset excluded under paragraph (b) has a negative 
 value, the negative value shall be subtracted from the total net 
 assets under paragraph (a). 

    Subd. 3.    Documentation.  (a) The commissioner of 
 human services shall require individuals and families, at the 
 time of application or renewal, to indicate on a checkoff form 
 developed by the commissioner whether they satisfy the 
 MinnesotaCare asset requirement.  This form must include the 
 following or similar language:  "To be eligible for 
 MinnesotaCare, individuals and families must not own net assets 
 in excess of $30,000 for a household of two or more persons or 
 $15,000 for a household of one person, not including a 
 homestead, household goods and personal effects, assets owned by 
 children, vehicles used for employment, court-ordered 
 settlements up to $10,000, individual retirement accounts, and 
 capital and operating assets of a trade or business up to 
 $200,000.  Do you and your household own net assets in excess of 
 these limits?" 

    (b) The commissioner may require individuals and families 
 to provide any information the commissioner determines necessary 
 to verify compliance with the asset requirement, if the 
 commissioner determines that there is reason to believe that an 
 individual or family has assets that exceed the program limit. 

    Subd. 4.    Penalties.  Individuals or families who are 
 found to have knowingly misreported the amount of their assets 
 as described in this section shall be subject to the penalties 
 in section 256.98.  The commissioner shall present 
 recommendations on additional penalties to the 1998 legislature. 

    Subd. 5.    Exemption.  This section does not apply to 
 pregnant women.  For purposes of this subdivision, a woman is 
 considered pregnant for 60 days postpartum. 

    HIST: 1997 c 225 art 1 s 17 

     256L.18 Penalties. 

    Whoever obtains or attempts to obtain, or aids or abets any 
 person to obtain by means of a willfully false statement or 
 representation, or by the intentional withholding or concealment 
 of a material fact, or by impersonation, or other fraudulent 
 device: 

    (1) benefits under the MinnesotaCare program to which the 
 person is not entitled; or 

    (2) benefits under the MinnesotaCare program greater than 
 that to which the person is reasonably entitled; 

 shall be considered to have violated section 256.98, and shall 
 be subject to both the criminal and civil penalties provided 
 under that section. 

    HIST: 1997 c 225 art 1 s 18