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. 1b. MinnesotaCare enrollment by county agencies.
Beginning September 1, 2006,
county agencies shall enroll single adults and households with no children formerly enrolled in
general assistance medical care in MinnesotaCare according to section
256D.03, subdivision 3
County agencies shall perform all duties necessary to administer the MinnesotaCare program
ongoing for these enrollees, including the redetermination of MinnesotaCare eligibility at
Subd. 2. Commissioner's duties.
(a) The commissioner or county agency shall use
electronic verification as the primary method of income verification. If there is a discrepancy
between reported income and electronically verified income, an individual may be required to
submit additional verification. In addition, 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.
(b) In determining eligibility for MinnesotaCare, the commissioner shall require applicants
and enrollees seeking renewal of eligibility to verify both earned and unearned income. The
commissioner shall also require applicants and enrollees to submit the names of their employers
and a contact name with a telephone number for each employer for purposes of verifying whether
the applicant or enrollee, and any dependents, are eligible for employer-subsidized coverage. Data
collected is nonpublic data as defined in section
13.02, subdivision 9
Subd. 3. Effective date of coverage.
(a) 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
, 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
month of placement. The effective date of coverage for other new members added to the family is
the first day of the month following the month in which the change is reported. 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.
(b) The initial premium must be received by the last working day of the month for coverage
to begin the first day of the following month.
(c) Benefits are not available until the day following discharge if an enrollee is hospitalized
on the first day of coverage.
(d) Notwithstanding any other law to the contrary, benefits under sections
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.
(e) The effective date of coverage for single adults and households with no children formerly
enrolled in general assistance medical care and enrolled in MinnesotaCare according to section
256D.03, subdivision 3
, is the first day of the month following the last day of general assistance
medical care coverage.
Subd. 3a. Renewal of eligibility.
(a) 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.
(b) Beginning October 1, 2004, an enrollee's eligibility must be renewed every six months.
The first six-month period of eligibility begins the month the application is received by the
commissioner. The effective date of coverage within the first six-month period of eligibility is
as provided in subdivision 3. Each new period of eligibility must take into account any changes
in circumstances that impact eligibility and premium amount. An enrollee must provide all the
information needed to redetermine eligibility by the first day of the month that ends the eligibility
period. The premium for the new period of eligibility must be received as provided in section
in order for eligibility to continue.
(c) For single adults and households with no children formerly enrolled in general assistance
medical care and enrolled in MinnesotaCare according to section
256D.03, subdivision 3
first six-month period of eligibility begins the month the enrollee submitted the application or
renewal for general assistance medical care.
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. 3c. Retroactive coverage.
Notwithstanding subdivision 3, the effective date of
coverage shall be the first day of the month following termination from medical assistance or
general assistance medical care for families and individuals who are eligible for MinnesotaCare
and who submitted a written request for retroactive MinnesotaCare coverage with a completed
application within 30 days of the mailing of notification of termination from medical assistance or
general assistance medical care. The applicant must provide all required verifications within 30
days of the written request for verification. For retroactive coverage, premiums must be paid in full
for any retroactive month, current month, and next month within 30 days of the premium billing.
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 and the possibility of disenrollment under section
, paragraphs (b) and (c), to all: (1) families enrolled in the MinnesotaCare program
whose gross family income is equal to or more than 225 percent of the federal poverty guidelines;
and (2) single adults and households without children enrolled in the MinnesotaCare program
whose gross family income is equal to or more than 165 percent of the federal poverty guidelines.
This information must be provided upon initial enrollment and annually thereafter. The
commissioner shall also include information regarding the availability of private health insurance
coverage in the notice of ineligibility provided to persons subject to disenrollment under section
256L.07, subdivision 1
, paragraphs (b) and (c).
History: 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; 1999 c 245 art 4 s 95,96;
2000 c 488 art 9 s 27; 1Sp2001 c 9 art 2 s 61; 2002 c 277 s 28; 2002 c 379 art 1 s 113; 1Sp2003 c
14 art 12 s 75,76; 1Sp2005 c 4 art 8 s 64-67
NOTE: The amendments to subdivisions 3, paragraph (a), and 3a, paragraph (b), by Laws
2005, First Special Session chapter 4, article 8, sections 66 and 67, are effective August 1, 2007,
or upon HealthMatch implementation, whichever is later. Laws 2005, First Special Session
chapter 4, article 8, sections 66 and 67, the effective dates.