1998 Minnesota Statutes

CHAPTER 256L. Minnesotacare

     256L.01 Definitions. 

    Subdivision 1.    Scope.  For purposes of sections 
 256L.01 to 256L.18, the following terms shall have the meanings 
 given them. 

    Subd. 1a.    Child.  "Child" means an individual under 
 21 years of age, including the unborn child of a pregnant woman, 
 an emancipated minor, and an emancipated minor's spouse. 

    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. 3a.    Family with children.  (a) "Family with 
 children" means: 

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

    (2) grandparents, foster parents, relative caretakers as 
 defined in the medical assistance program, or legal guardians; 
 their wards who are children; and dependent siblings residing in 
 the same household.  

    (b) 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.  

    (c) For purposes of this subdivision, 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, 
 grandparent, foster parent, relative caretaker, or legal 
 guardian.  Proof of school enrollment is required. 

    Subd. 4.    Gross individual or gross family income.  
 "Gross individual or 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. 

    Subd. 5.    Income.  "Income" has the meaning given for 
 earned and unearned income for families and children in the 
 medical assistance program, according to the state's aid to 
 families with dependent children plan in effect as of July 16, 
 1996.  The definition does not include medical assistance income 
 methodologies and deeming requirements.  The earned income of 
 full-time and part-time students under age 19 is not counted as 
 income.  Public assistance payments and supplemental security 
 income are not excluded income. 

    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; 1998 c 407 art 5 s 7 

     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.  As part of each state revenue and expenditure forecast, 
 the commissioner must make an assessment of the expected 
 expenditures for the covered services for the remainder of the 
 current biennium and for the following biennium.  The estimated 
 expenditure, including the reserve requirements described in 
 section 16A.76, shall be compared to an estimate of the revenues 
 that will be available in the health care access fund.  Based on 
 this comparison, and after consulting with the chairs of the 
 house 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. 

    Subd. 4.    Funding for pregnant women and children under 
 age two.  For fiscal years beginning on or after July 1, 1999, 
 the state cost of health care services provided to MinnesotaCare 
 enrollees who are pregnant women or children under age two shall 
 be paid out of the general fund rather than the health care 
 access fund.  If the commissioner of finance decides to pay for 
 these costs using a source other than the general fund, the 
 commissioner shall include the change as a budget initiative in 
 the biennial or supplemental budget, and shall not change the 
 funding source through a forecast modification. 

    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; 
 1998 c 407 art 5 s 8,9 

     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, 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. 1a.    Covered services for pregnant women and 
 children under MinnesotaCare health care reform waiver.  
 Beginning January 1, 1999, 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, except that abortion services under MinnesotaCare 
 shall be limited as provided under subdivision 1.  Pregnant 
 women and children are exempt from the provisions of subdivision 
 5, regarding copayments.  Pregnant women and children who are 
 lawfully residing in the United States but who are not 
 "qualified noncitizens" under title IV of the Personal 
 Responsibility and Work Opportunity Reconciliation Act of 1996, 
 Public Law Number 104-193, Statutes at Large, volume 110, page 
 2105, are eligible for coverage of all services provided under 
 the medical assistance program according to chapter 256B. 

    Subd. 1b.    Pregnant women; eligibility for full medical 
 assistance services.  Beginning January 1, 1999, a woman who 
 is enrolled in MinnesotaCare when her pregnancy is diagnosed is 
 eligible for coverage of all services provided under the medical 
 assistance program according to chapter 256B retroactive to the 
 date the pregnancy is medically diagnosed.  Copayments totaling 
 $30 or more, paid after the date the pregnancy is diagnosed, 
 shall be refunded. 

    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) 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.  The inpatient hospital benefit 
 for adult enrollees who qualify under section 256L.04, 
 subdivision 7, or who qualify under section 256L.04, 
 subdivisions 1 and 2, 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) 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. 

    Subd. 3a.    Interpreter services.  Covered services 
 include sign and spoken language interpreter services that 
 assist an enrollee in obtaining covered health care services. 

    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. 

    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, 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, with income equal to or less than 
 175 percent of the federal poverty guidelines. 

    Effective July 1, 1997, adult enrollees with family gross 
 income that exceeds 175 percent of the federal poverty 
 guidelines and who are not pregnant 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; 1998 c 407 art 5 s 
 10-16 

     256L.04 Eligible persons. 

    Subdivision 1.    Families with children.  (a) Families 
 with children with family income equal to or less than 275 
 percent of the federal poverty guidelines for the applicable 
 family size shall be eligible for MinnesotaCare according to 
 this section.  All other provisions of sections 256L.01 to 
 256L.18, including the insurance-related barriers to enrollment 
 under section 256L.07, shall apply unless otherwise specified. 

    (b) Parents who enroll in the MinnesotaCare program must 
 also enroll their children 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.  

    Subd. 2.    Cooperation in establishing third-party 
 liability, paternity, and other medical support.  (a) To be 
 eligible for MinnesotaCare, individuals and families 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. 

    (b) A parent, guardian, or child enrolled in the 
 MinnesotaCare program must cooperate with the department of 
 human services and the local agency in establishing the 
 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 the child's parent 
 or guardian fails to cooperate in establishing paternity or 
 obtaining medical support. 

    Subd. 3. Repealed, 1998 c 407 art 5 s 48 

    Subd. 4. Repealed, 1998 c 407 art 5 s 48 

    Subd. 5. Repealed, 1998 c 407 art 5 s 48 

    Subd. 6. Repealed, 1998 c 407 art 5 s 48 

    Subd. 7.    Single adults and households with no children. 
  The definition of eligible persons includes 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. 

    Subd. 7a.    Ineligibility.  Applicants whose income is 
 greater than the limits established under this section may not 
 enroll in the MinnesotaCare program. 

    Subd. 8.    Applicants potentially eligible for medical 
 assistance.  (a) Individuals who receive supplemental security 
 income or retirement, survivors, or disability benefits due to a 
 disability, or other disability-based pension, who qualify under 
 subdivision 7, but who are potentially eligible for medical 
 assistance without a spenddown shall be allowed to enroll in 
 MinnesotaCare for a period of 60 days, so long as the applicant 
 meets all other conditions of eligibility.  The commissioner 
 shall identify and refer the applications of such individuals to 
 their county social service agency.  The county and the 
 commissioner shall cooperate to ensure that the individuals 
 obtain medical assistance coverage for any months for which they 
 are eligible. 

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

    (c) Beginning January 1, 2000, counties that choose to 
 become MinnesotaCare enrollment sites shall consider 
 MinnesotaCare applications of individuals described in paragraph 
 (a) to also be applications for medical assistance and shall 
 first determine whether medical assistance eligibility exists.  
 Adults with children with family income under 175 percent of the 
 federal poverty guidelines for the applicable family size, 
 pregnant women, and children who qualify under subdivision 1 who 
 are potentially eligible for medical assistance without a 
 spenddown may choose to enroll in either MinnesotaCare or 
 medical assistance. 

    (d) 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.  Eligibility for 
 MinnesotaCare cannot be replaced by eligibility for general 
 assistance medical care, and eligibility for general assistance 
 medical care cannot be replaced by eligibility for MinnesotaCare.

    Subd. 10.    Sponsor's income and resources deemed 
 available; documentation.  When determining eligibility for 
 any federal or state benefits under sections 256L.01 to 256L.18, 
 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.  To be eligible for the 
 program, noncitizens must provide documentation of their 
 immigration status. 

    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. 

    Subd. 12.    Persons in detention.  Beginning January 1, 
 1999, an applicant residing in a correctional or detention 
 facility is not eligible for MinnesotaCare.  An enrollee 
 residing in a correctional or detention facility is not eligible 
 at renewal of eligibility under section 256L.05, subdivision 3b. 

    Subd. 13.    Families with grandparents, relative 
 caretakers, foster parents, or legal guardians.  Beginning 
 January 1, 1999, in families that include a grandparent, 
 relative caretaker as defined in the medical assistance program, 
 foster parent, or legal guardian, the grandparent, relative 
 caretaker, foster parent, or legal guardian may apply as a 
 family or may apply separately for the children.  If the 
 caretaker applies separately for the children, only the 
 children's income is counted.  If the grandparent, relative 
 caretaker, foster parent, or legal guardian applies with the 
 children, their income is included in the gross family income 
 for determining eligibility and premium amount. 

    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; 1998 c 407 art 5 s 17-25 

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

    Subd. 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 
 individual and family income, earned and unearned, such as the 
 most recent income tax return, wage slips, or other 
 documentation that is determined by the commissioner as 
 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.  As provided in section 256B.057, 
 coverage for newborns is automatic from the date of birth and 
 must be coordinated with other health coverage.  The effective 
 date of coverage for eligible newly adoptive children added to a 
 family receiving covered health services is the 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 or at renewal, whichever the family 
 receiving covered health services prefers.  All eligibility 
 criteria must be met by the family at the time the new family 
 member is added.  The income of the new family member is 
 included with the family's gross income and the adjusted premium 
 begins in the month the new family member is added.  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.18 are secondary to a plan of insurance or benefit 
 program under which an eligible person may have coverage and the 
 commissioner shall use cost avoidance techniques to ensure 
 coordination of any other health coverage for eligible persons.  
 The commissioner shall identify eligible persons who may have 
 coverage or benefits under other plans of insurance or who 
 become eligible for medical assistance. 

    Subd. 3a.    Renewal of eligibility.  Beginning January 
 1, 1999, an enrollee's eligibility must be renewed every 12 
 months.  The 12-month period begins in the month after the month 
 the application is approved.  

    Subd. 3b.    Reapplication.  Beginning January 1, 1999, 
 families and individuals must reapply after a lapse in coverage 
 of one calendar month or more and must meet all eligibility 
 criteria. 

    Subd. 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.  To prevent processing delays, applicants 
 who, from the information provided on the application, appear to 
 meet eligibility requirements shall be enrolled.  The enrollee 
 must provide all required verifications within 30 days of 
 enrollment or coverage from the program shall be terminated.  
 Enrollees who are determined to be ineligible when verifications 
 are provided shall be disenrolled from the program. 

    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; 1998 c 407 art 5 
 s 26-31 

     256L.06 Premium fees and payments. 

    Subdivision 1. Repealed, 1998 c 407 art 5 s 48 

    Subd. 2. Repealed, 1998 c 407 art 5 s 48 

    Subd. 3.    Administration and commissioner's duties.  
 (a) Premiums are dedicated to the commissioner for MinnesotaCare.

    (b) 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.  Beginning July 1, 1998, 
 failure to pay includes payment with a dishonored check and the 
 commissioner may demand a guaranteed form of payment as the only 
 means to replace a dishonored check. 

    (c) 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.  The commissioner shall inform 
 applicants and enrollees of these premium payment options. 
 Premium payment is required before enrollment is complete and to 
 maintain eligibility in MinnesotaCare.  

    (d) Nonpayment of the premium will result in disenrollment 
 from the plan within one calendar month after the due date.  
 Persons disenrolled for nonpayment or who voluntarily terminate 
 coverage from the program may not reenroll until four calendar 
 months have elapsed.  Persons disenrolled for nonpayment or who 
 voluntarily terminate coverage from the program 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; 1998 c 407 art 5 s 32 

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

    Subdivision 1.    General requirements.  (a) Children 
 enrolled in the original children's health plan as of September 
 30, 1992, children who enrolled in the MinnesotaCare program 
 after September 30, 1992, pursuant to Laws 1992, chapter 549, 
 article 4, section 17, and children who have family gross 
 incomes that are equal to or less than 150 percent of the 
 federal poverty guidelines are eligible for subsidized premium 
 payments without meeting the requirements of subdivision 2, as 
 long as they maintain continuous coverage in the MinnesotaCare 
 program or medical assistance.  Children who apply for 
 MinnesotaCare on or after the implementation date of the 
 employer-subsidized health coverage program as described in Laws 
 1998, chapter 407, article 5, section 45, who have family gross 
 incomes that are equal to or less than 150 percent of the 
 federal poverty guidelines, must meet the requirements of 
 subdivision 2 to be eligible for MinnesotaCare. 

    (b) Families enrolled in MinnesotaCare under section 
 256L.04, subdivision 1, whose income increases above 275 percent 
 of the federal poverty guidelines, are no longer eligible for 
 the program and shall be disenrolled by the commissioner.  
 Individuals enrolled in MinnesotaCare under section 256L.04, 
 subdivision 7, whose income increases above 175 percent of the 
 federal poverty guidelines are no longer eligible for the 
 program and shall be disenrolled by the commissioner.  For 
 persons disenrolled under this subdivision, MinnesotaCare 
 coverage terminates the last day of the calendar month following 
 the month in which the commissioner determines that the income 
 of a family or individual, determined over a four-month period 
 as required by section 256L.15, subdivision 2, exceeds program 
 income limits.  

    (c) Notwithstanding paragraph (b), individuals and families 
 may remain enrolled in MinnesotaCare if ten percent of their 
 annual income is less than the annual premium for a policy with 
 a $500 deductible available through the Minnesota comprehensive 
 health association.  Individuals and families who are no longer 
 eligible for MinnesotaCare under this subdivision shall be given 
 an 18-month notice period from the date that ineligibility is 
 determined before disenrollment.  

    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.  A 
 family or individual whose employer-subsidized coverage is lost 
 due to an employer terminating health care coverage as an 
 employee benefit during the previous 18 months is not eligible.  

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

    Subd. 3.    Other health coverage.  (a) Families and 
 individuals enrolled in the MinnesotaCare program must have no 
 health coverage while enrolled or for at least four months prior 
 to application and renewal.  Children enrolled in the original 
 children's health plan and children in families with income 
 equal to or less than 150 percent of the federal poverty 
 guidelines, who have other health insurance, are eligible if the 
 other health coverage meets the requirements of Minnesota Rules, 
 part 9506.0020, subpart 3, item B.  The commissioner may change 
 this eligibility criterion for sliding scale premiums in order 
 to remain within the limits of available appropriations.  The 
 requirement of no health coverage does not apply to newborns. 

    (b) For purposes of this section, medical assistance, 
 general assistance medical care, and civilian health and medical 
 program of the uniformed service, CHAMPUS, are not considered 
 insurance or health coverage. 

    (c) For purposes of this section, Medicare Part A or B 
 coverage under title XVIII of the Social Security Act, United 
 States Code, title 42, sections 1395c to 1395w-4, is considered 
 health coverage.  An applicant or enrollee may not refuse 
 Medicare coverage to establish eligibility for MinnesotaCare. 

    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; 1998 c 407 art 5 s 33 

  256L.08 Repealed, 1998 c 407 art 5 s 48 

     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) To be eligible 
 for health coverage under the MinnesotaCare program, adults 
 without children must be permanent residents of Minnesota. 

    (b) 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. Repealed, 1998 c 407 art 5 s 48 

    Subd. 4.    Eligibility as Minnesota resident.  (a) 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. 

    (b) To be eligible as a permanent resident, an applicant 
 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. 

    (c) A person who is temporarily absent from the state does 
 not lose eligibility for MinnesotaCare.  "Temporarily absent 
 from the state" means the person is out of the state for a 
 temporary purpose and intends to return when the purpose of the 
 absence has been accomplished.  A person is not temporarily 
 absent from the state if another state has determined that the 
 person is a resident for any purpose.  If temporarily absent 
 from the state, the person must follow the requirements of the 
 health plan in which the person is enrolled to receive services. 

    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, paragraph (b), 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; 1998 c 407 art 
 5 s 34-36 

     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 and 2, 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 and 2, 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 (b), 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 and 2, 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; 1998 c 407 art 5 s 37 

     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.  Managed 
 care plans must participate in the MinnesotaCare and general 
 assistance medical care programs under a contract with the 
 department of human services in service areas where they 
 participate in the medical assistance program. 

    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; 1998 c 407 
 art 5 s 38 

  256L.13 Repealed, 1998 c 407 art 5 s 48 

  256L.14 Repealed, 1998 c 407 art 5 s 48 

     256L.15 Premiums. 

    Subdivision 1.    Premium determination.  Families with 
 children and individuals 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, paragraph (b), clause (3), 
 requiring disenrollment for failure to pay premiums.  For 
 pregnant women, this exemption continues until the first day of 
 the month following the 60th day postpartum.  Women who remain 
 enrolled during pregnancy or the postpartum period, despite 
 nonpayment of premiums, shall be disenrolled on the first of the 
 month following the 60th day postpartum for the penalty period 
 that otherwise applies under section 256L.06, unless they begin 
 paying premiums. 

    Subd. 1a.    Payment options.  The commissioner may 
 offer the following payment options to an enrollee: 

    (1) payment by check; 

    (2) payment by credit card; 

    (3) payment by recurring automatic checking withdrawal; 

    (4) payment by one-time electronic transfer of funds; 

    (5) payment by wage withholding with the consent of the 
 employer and the employee; or 

    (6) payment by using state tax refund payments. 

    At application or reapplication, a MinnesotaCare applicant 
 or enrollee may authorize the commissioner to use the Revenue 
 Recapture Act in chapter 270A to collect funds from the 
 applicant's or enrollee's state income tax refund for the 
 purposes of meeting all or part of the applicant's or enrollee's 
 MinnesotaCare premium obligation for the forthcoming year.  The 
 applicant or enrollee may authorize the commissioner to apply 
 for the state working family tax credit on behalf of the 
 applicant or enrollee.  The setoff due under this subdivision 
 shall not be subject to the $10 fee under section 270A.07, 
 subdivision 1.  

    Subd. 1b.    Payments nonrefundable.  MinnesotaCare 
 premiums are not refundable. 

    Subd. 2.    Sliding scale to determine percentage of gross 
 individual or family income.  The commissioner shall establish 
 a sliding fee scale to determine the percentage of gross 
 individual or family income that households at different income 
 levels must pay to obtain coverage through the MinnesotaCare 
 program.  The sliding fee scale must be based on the enrollee's 
 gross individual or family income during the previous four 
 months.  The sliding fee scale begins with a premium of 1.5 
 percent of gross individual or family income for individuals or 
 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 or individual 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 in families with 
 income at or less than 150 percent of federal poverty guidelines.

    HIST: 1995 c 234 art 6 s 20; 1998 c 407 art 5 s 39 

     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.03, subdivision 1a. 

    HIST: 1995 c 234 art 6 s 21; 1998 c 407 art 5 s 47 

     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. 

    Subd. 6.    Waiver of maintenance of effort requirement. 
  Unless a federal waiver of the maintenance of effort 
 requirements of section 2105(d) of title XXI of the Balanced 
 Budget Act of 1997, Public Law Number 105-33, Statutes at Large, 
 volume 111, page 251, is granted by the federal Department of 
 Health and Human Services by September 30, 1998, this section 
 does not apply to children.  The commissioner shall publish a 
 notice in the State Register upon receipt of a federal waiver. 

    HIST: 1997 c 225 art 1 s 17; 1998 c 407 art 5 s 40 

     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