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Minnesota Legislature

Office of the Revisor of Statutes

Chapter 256B

Section 256B.055

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Recent History

256B.055 ELIGIBILITY CATEGORIES.
    Subdivision 1. Children eligible for subsidized adoption assistance. Medical assistance
may be paid for a child eligible for or receiving adoption assistance payments under title IV-E
of the Social Security Act, United States Code, title 42, sections 670 to 676, and to any child
who is not title IV-E eligible but who was determined eligible for adoption assistance under
Minnesota Statutes, section 259.67, subdivision 4, clauses (a) to (c), and has a special need
for medical or rehabilitative care.
    Subd. 2. Subsidized foster children. Medical assistance may be paid for a child eligible
for or receiving foster care maintenance payments under Title IV-E of the Social Security Act,
United States Code, title 42, sections 670 to 676.
    Subd. 3. AFDC families. Until March 31, 1998, medical assistance may be paid for a person
who is eligible for or receiving, or who would be eligible for, except for excess income or assets,
public assistance under the aid to families with dependent children program in effect as of July
16, 1996, as required by the Personal Responsibility and Work Opportunity Reconciliation Act
of 1996 (PRWORA), Public Law 104-193.
    Subd. 3a. Families with children. Beginning July 1, 2002, medical assistance may be paid
for a person who is a child under the age of 18, or age 18 if a full-time student in a secondary
school, or in the equivalent level of vocational or technical training, and reasonably expected
to complete the program before reaching age 19; the parent of a dependent child, including a
pregnant woman; or a caretaker relative of a dependent child.
    Subd. 4. Recipients of Minnesota supplemental aid. Medical assistance may be paid for a
person who is receiving public assistance under the Minnesota supplemental aid program.
    Subd. 5. Pregnant women; dependent unborn child. Medical assistance may be paid for a
pregnant woman who has written verification of a positive pregnancy test from a physician or
licensed registered nurse, who meets the other eligibility criteria of this section and who would be
categorically eligible for assistance under the state's AFDC plan in effect as of July 16, 1996,
as required by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996
(PRWORA), Public Law 104-193, if the child had been born and was living with the woman. For
purposes of this subdivision, a woman is considered pregnant for 60 days postpartum.
    Subd. 6. Pregnant women; needy unborn child. Medical assistance may be paid for a
pregnant woman who has written verification of a positive pregnancy test from a physician or
licensed registered nurse, who meets the other eligibility criteria of this section and whose unborn
child would be eligible as a needy child under subdivision 10 if born and living with the woman.
For purposes of this subdivision, a woman is considered pregnant for 60 days postpartum.
    Subd. 7. Aged, blind, or disabled persons. Medical assistance may be paid for a person
who meets the categorical eligibility requirements of the supplemental security income program
or, who would meet those requirements except for excess income or assets, and who meets the
other eligibility requirements of this section.
    Subd. 7a. Special category for disabled children. Medical assistance may be paid for a
person who is under age 18 and who meets income and asset eligibility requirements of the
Supplemental Security Income program if the person was receiving Supplemental Security
Income payments on the date of enactment of section 211(a) of Public Law 104-193, the Personal
Responsibility and Work Opportunity Act of 1996, and the person would have continued to
receive the payments except for the change in the childhood disability criteria in section 211(a) of
Public Law 104-193.
    Subd. 8.[Repealed, 1990 c 568 art 3 s 104]
    Subd. 9. Children. Medical assistance may be paid for a person who is under 21 years of age
and in need of medical care that neither the person nor the person's relatives responsible under
sections 256B.01 to 256B.26 are financially able to provide.
    Subd. 10. Infants. Medical assistance may be paid for an infant less than one year of age,
whose mother was eligible for and receiving medical assistance at the time of birth and who
remains in the mother's household or who is in a family with countable income that is equal to or
less than the income standard established under section 256B.057, subdivision 1.
    Subd. 10a.[Repealed, 1Sp2003 c 14 art 12 s 101]
    Subd. 10b. Children. This subdivision supersedes subdivision 10 as long as the Minnesota
health care reform waiver remains in effect. When the waiver expires, the commissioner of human
services shall publish a notice in the State Register and notify the revisor of statutes. Medical
assistance may be paid for a child less than two years of age with countable family income as
established for infants under section 256B.057, subdivision 1.
    Subd. 11. Elderly hospital inpatients. Medical assistance may be paid for a person who is
residing in a hospital for treatment of mental disease or tuberculosis and is 65 years of age or
older and without means sufficient to pay the per capita hospital charge.
    Subd. 12. Disabled children. (a) A person is eligible for medical assistance if the person is
under age 19 and qualifies as a disabled individual under United States Code, title 42, section
1382c(a), and would be eligible for medical assistance under the state plan if residing in a
medical institution, and the child requires a level of care provided in a hospital, nursing facility,
or intermediate care facility for persons with developmental disabilities, for whom home care is
appropriate, provided that the cost to medical assistance under this section is not more than the
amount that medical assistance would pay for if the child resides in an institution. After the child
is determined to be eligible under this section, the commissioner shall review the child's disability
under United States Code, title 42, section 1382c(a) and level of care defined under this section no
more often than annually and may elect, based on the recommendation of health care professionals
under contract with the state medical review team, to extend the review of disability and level of
care up to a maximum of four years. The commissioner's decision on the frequency of continuing
review of disability and level of care is not subject to administrative appeal under section 256.045.
Nothing in this subdivision shall be construed as affecting other redeterminations of medical
assistance eligibility under this chapter and annual cost-effective reviews under this section.
(b) For purposes of this subdivision, "hospital" means an institution as defined in section
144.696, subdivision 3, 144.55, subdivision 3, or Minnesota Rules, part 4640.3600, and licensed
pursuant to sections 144.50 to 144.58. For purposes of this subdivision, a child requires a level of
care provided in a hospital if the child is determined by the commissioner to need an extensive
array of health services, including mental health services, for an undetermined period of time,
whose health condition requires frequent monitoring and treatment by a health care professional
or by a person supervised by a health care professional, who would reside in a hospital or require
frequent hospitalization if these services were not provided, and the daily care needs are more
complex than a nursing facility level of care.
A child with serious emotional disturbance requires a level of care provided in a hospital
if the commissioner determines that the individual requires 24-hour supervision because the
person exhibits recurrent or frequent suicidal or homicidal ideation or behavior, recurrent or
frequent psychosomatic disorders or somatopsychic disorders that may become life threatening,
recurrent or frequent severe socially unacceptable behavior associated with psychiatric disorder,
ongoing and chronic psychosis or severe, ongoing and chronic developmental problems requiring
continuous skilled observation, or severe disabling symptoms for which office-centered outpatient
treatment is not adequate, and which overall severely impact the individual's ability to function.
(c) For purposes of this subdivision, "nursing facility" means a facility which provides
nursing care as defined in section 144A.01, subdivision 5, licensed pursuant to sections 144A.02
to 144A.10, which is appropriate if a person is in active restorative treatment; is in need of
special treatments provided or supervised by a licensed nurse; or has unpredictable episodes
of active disease processes requiring immediate judgment by a licensed nurse. For purposes
of this subdivision, a child requires the level of care provided in a nursing facility if the child
is determined by the commissioner to meet the requirements of the preadmission screening
assessment document under section 256B.0911 and the home care independent rating document
under section 256B.0655, subdivision 4, clause (3), adjusted to address age-appropriate standards
for children age 18 and under, pursuant to section 256B.0655, subdivision 3.
(d) For purposes of this subdivision, "intermediate care facility for persons with
developmental disabilities" or "ICF/MR" means a program licensed to provide services to
persons with developmental disabilities under section 252.28, and chapter 245A, and a physical
plant licensed as a supervised living facility under chapter 144, which together are certified by
the Minnesota Department of Health as meeting the standards in Code of Federal Regulations,
title 42, part 483, for an intermediate care facility which provides services for persons with
developmental disabilities who require 24-hour supervision and active treatment for medical,
behavioral, or habilitation needs. For purposes of this subdivision, a child requires a level of care
provided in an ICF/MR if the commissioner finds that the child has a developmental disability
in accordance with section 256B.092, is in need of a 24-hour plan of care and active treatment
similar to persons with developmental disabilities, and there is a reasonable indication that the
child will need ICF/MR services.
(e) For purposes of this subdivision, a person requires the level of care provided in a nursing
facility if the person requires 24-hour monitoring or supervision and a plan of mental health
treatment because of specific symptoms or functional impairments associated with a serious
mental illness or disorder diagnosis, which meet severity criteria for mental health established by
the commissioner and published in March 1997 as the Minnesota Mental Health Level of Care for
Children and Adolescents with Severe Emotional Disorders.
(f) The determination of the level of care needed by the child shall be made by the
commissioner based on information supplied to the commissioner by the parent or guardian,
the child's physician or physicians, and other professionals as requested by the commissioner.
The commissioner shall establish a screening team to conduct the level of care determinations
according to this subdivision.
(g) If a child meets the conditions in paragraph (b), (c), (d), or (e), the commissioner must
assess the case to determine whether:
(1) the child qualifies as a disabled individual under United States Code, title 42, section
1382c(a), and would be eligible for medical assistance if residing in a medical institution; and
(2) the cost of medical assistance services for the child, if eligible under this subdivision,
would not be more than the cost to medical assistance if the child resides in a medical institution
to be determined as follows:
(i) for a child who requires a level of care provided in an ICF/MR, the cost of care for the
child in an institution shall be determined using the average payment rate established for the
regional treatment centers that are certified as ICF's/MR;
(ii) for a child who requires a level of care provided in an inpatient hospital setting according
to paragraph (b), cost-effectiveness shall be determined according to Minnesota Rules, part
9505.3520, items F and G; and
(iii) for a child who requires a level of care provided in a nursing facility according to
paragraph (c) or (e), cost-effectiveness shall be determined according to Minnesota Rules,
part 9505.3040, except that the nursing facility average rate shall be adjusted to reflect rates
which would be paid for children under age 16. The commissioner may authorize an amount up
to the amount medical assistance would pay for a child referred to the commissioner by the
preadmission screening team under section 256B.0911.
(h) Children eligible for medical assistance services under section 256B.055, subdivision
12
, as of June 30, 1995, must be screened according to the criteria in this subdivision prior to
January 1, 1996. Children found to be ineligible may not be removed from the program until
January 1, 1996.
    Subd. 13. Residents of institutions for mental diseases. Beginning October 1, 2003,
persons who would be eligible for medical assistance under this chapter but for residing in a
facility that is determined by the commissioner or the federal Centers for Medicare and Medicaid
Services to be an institution for mental diseases are eligible for medical assistance without federal
financial participation, except that coverage shall not include payment for a nursing facility
determined to be an institution for mental diseases.
    Subd. 14. Persons detained by law. (a) Medical assistance may be paid for an inmate of a
correctional facility who is conditionally released as authorized under section 241.26, 244.065, or
631.425, if the individual does not require the security of a public detention facility and is housed
in a halfway house or community correction center, or under house arrest and monitored by
electronic surveillance in a residence approved by the commissioner of corrections, and if the
individual meets the other eligibility requirements of this chapter.
    (b) An individual who is enrolled in medical assistance, and who is charged with a crime and
incarcerated for less than 12 months shall be suspended from eligibility at the time of incarceration
until the individual is released. Upon release, medical assistance eligibility is reinstated without
reapplication using a reinstatement process and form, if the individual is otherwise eligible.
    (c) An individual, regardless of age, who is considered an inmate of a public institution as
defined in Code of Federal Regulations, title 42, section 435.1009, is not eligible for medical
assistance.
History: Ex1967 c 16 s 6; 1969 c 841 s 1; 1973 c 717 s 18; 1974 c 525 s 1,2; 1975 c 247 s
10; 1976 c 236 s 3; 1977 c 448 s 6; 1978 c 760 s 1; 1979 c 309 s 4; 1980 c 509 s 106; 1980 c 527 s
1; 1981 c 360 art 2 s 28; 1Sp1981 c 2 s 14; 3Sp1981 c 2 art 1 s 32; 3Sp1981 c 3 s 17; 1982 c 553
s 6; 1982 c 640 s 5; 1983 c 312 art 5 s 15; 1984 c 422 s 1; 1984 c 534 s 22; 1984 c 654 art 5 s 58;
1985 c 248 s 70; 1985 c 252 s 21; 1986 c 444; 1Sp1986 c 1 art 8 s 5; 1987 c 403 art 2 s 79,80;
1988 c 689 art 2 s 144,145,268; 1989 c 282 art 3 s 43,44; 1990 c 568 art 3 s 23-27; 1991 c 292 art
4 s 33,34; 1Sp1993 c 1 art 5 s 30; 1994 c 631 s 31; 1995 c 207 art 6 s 27; 1995 c 234 art 6 s 35;
1996 c 451 art 2 s 7; 1997 c 85 art 3 s 10-12; 1997 c 203 art 4 s 19; 1998 c 407 art 4 s 13,14; 1999
c 245 art 4 s 31; 1Sp2001 c 9 art 2 s 15; 2002 c 379 art 1 s 113; 1Sp2003 c 14 art 12 s 15; 2004 c
288 art 3 s 21; 2005 c 10 art 1 s 47; 2005 c 56 s 1; 1Sp2005 c 4 art 8 s 19; 2007 c 147 art 4 s 3