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Minnesota Legislature

Office of the Revisor of Statutes

Chapter 256B

Section 256B.057

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256B.057 ELIGIBILITY REQUIREMENTS FOR SPECIAL CATEGORIES.
    Subdivision 1. Infants and pregnant women. (a)(1) An infant less than one year of age is
eligible for medical assistance if countable family income is equal to or less than 275 percent
of the federal poverty guideline for the same family size. A pregnant woman who has written
verification of a positive pregnancy test from a physician or licensed registered nurse is eligible
for medical assistance if countable family income is equal to or less than 200 percent of the
federal poverty guideline for the same family size. For purposes of this subdivision, "countable
family income" means the amount of income considered available using the methodology of the
AFDC program under the state's AFDC plan as of July 16, 1996, as required by the Personal
Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), Public Law
104-193, except for the earned income disregard and employment deductions.
(2) For applications processed within one calendar month prior to the effective date,
eligibility shall be determined by applying the income standards and methodologies in effect
prior to the effective date for any months in the six-month budget period before that date and
the income standards and methodologies in effect on the effective date for any months in the
six-month budget period on or after that date. The income standards for each month shall be
added together and compared to the applicant's total countable income for the six-month budget
period to determine eligibility.
(b)(1) [Expired, 1Sp2003 c 14 art 12 s 19]
(2) For applications processed within one calendar month prior to July 1, 2003, eligibility
shall be determined by applying the income standards and methodologies in effect prior to July
1, 2003, for any months in the six-month budget period before July 1, 2003, and the income
standards and methodologies in effect on the expiration date for any months in the six-month
budget period on or after July 1, 2003. The income standards for each month shall be added
together and compared to the applicant's total countable income for the six-month budget period
to determine eligibility.
(c) Dependent care and child support paid under court order shall be deducted from the
countable income of pregnant women.
(d) An infant born on or after January 1, 1991, to a woman who was eligible for and
receiving medical assistance on the date of the child's birth shall continue to be eligible for
medical assistance without redetermination until the child's first birthday, as long as the child
remains in the woman's household.
    Subd. 1a.[Repealed, 1998 c 407 art 5 s 48]
    Subd. 1b.[Repealed, 1Sp2003 c 14 art 12 s 101]
    Subd. 1c. No asset test for pregnant women. Beginning September 30, 1998, eligibility for
medical assistance for a pregnant woman must be determined without regard to asset standards
established in section 256B.056, subdivision 3.
    Subd. 2. Children. (a) Except as specified in subdivision 1b, effective October 1, 2003, a
child one through 18 years of age in a family whose countable income is no greater than 150
percent of the federal poverty guidelines for the same family size, is eligible for medical assistance.
(b) For applications processed within one calendar month prior to the effective date,
eligibility shall be determined by applying the income standards and methodologies in effect
prior to the effective date for any months in the six-month budget period before that date and
the income standards and methodologies in effect on the effective date for any months in the
six-month budget period on or after that date. The income standards for each month shall be
added together and compared to the applicant's total countable income for the six-month budget
period to determine eligibility.
    Subd. 2a.[Repealed, 1997 c 203 art 4 s 73]
    Subd. 2b.[Repealed, 1997 c 203 art 4 s 73]
    Subd. 2c. Extended coverage for children. A child receiving medical assistance under
subdivision 2, who becomes ineligible due to excess income, is eligible for two additional months
of medical assistance. Eligibility under this section is effective following any coverage available
under section 256B.0625.
    A child eligible for extended coverage under this section is deemed automatically eligible
for MinnesotaCare until renewal. MinnesotaCare coverage begins in accordance with section
256L.05, subdivision 3.
    Subd. 3. Qualified Medicare beneficiaries. A person who is entitled to Part A Medicare
benefits, whose income is equal to or less than 100 percent of the federal poverty guidelines, and
whose assets are no more than $10,000 for a single individual and $18,000 for a married couple
or family of two or more, is eligible for medical assistance reimbursement of Part A and Part
B premiums, Part A and Part B coinsurance and deductibles, and cost-effective premiums for
enrollment with a health maintenance organization or a competitive medical plan under section
1876 of the Social Security Act. Reimbursement of the Medicare coinsurance and deductibles,
when added to the amount paid by Medicare, must not exceed the total rate the provider would
have received for the same service or services if the person were a medical assistance recipient
with Medicare coverage. Increases in benefits under Title II of the Social Security Act shall not be
counted as income for purposes of this subdivision until July 1 of each year.
    Subd. 3a. Eligibility for payment of Medicare Part B premiums. A person who would
otherwise be eligible as a qualified Medicare beneficiary under subdivision 3, except the person's
income is in excess of the limit, is eligible for medical assistance reimbursement of Medicare
Part B premiums if the person's income is less than 120 percent of the official federal poverty
guidelines for the applicable family size.
    Subd. 3b. Qualifying individuals. Beginning July 1, 1998, contingent upon federal funding,
a person who would otherwise be eligible as a qualified Medicare beneficiary under subdivision
3, except that the person's income is in excess of the limit, is eligible as a qualifying individual
according to the following criteria:
(1) if the person's income is greater than 120 percent, but less than 135 percent of the official
federal poverty guidelines for the applicable family size, the person is eligible for medical
assistance reimbursement of Medicare Part B premiums; or
(2) if the person's income is equal to or greater than 135 percent but less than 175 percent
of the official federal poverty guidelines for the applicable family size, the person is eligible for
medical assistance reimbursement of that portion of the Medicare Part B premium attributable
to an increase in Part B expenditures which resulted from the shift of home care services from
Medicare Part A to Medicare Part B under Public Law 105-33, section 4732, the Balanced
Budget Act of 1997.
The commissioner shall limit enrollment of qualifying individuals under this subdivision
according to the requirements of Public Law 105-33, section 4732.
    Subd. 4. Qualified working disabled adults. A person who is entitled to Medicare Part A
benefits under section 1818A of the Social Security Act; whose income does not exceed 200
percent of the federal poverty guidelines for the applicable family size; whose nonexempt assets
do not exceed twice the maximum amount allowable under the supplemental security income
program, according to family size; and who is not otherwise eligible for medical assistance, is
eligible for medical assistance reimbursement of the Medicare Part A premium.
    Subd. 5. Disabled adult children. A person who is at least 18 years old, who was eligible
for supplemental security income benefits on the basis of blindness or disability, who became
disabled or blind before reaching the age of 22, and who lost eligibility as a result of becoming
entitled to a child's insurance benefits on or after July 1, 1987, under section 202(d) of the Social
Security Act, or because of an increase in those benefits effective on or after July 1, 1987, is
eligible for medical assistance as long as the person would be entitled to supplemental security
income in the absence of child's insurance benefits or increases in those benefits.
    Subd. 6. Disabled widows and widowers. A person who is at least 50 years old who is
entitled to disabled widow's or widower's benefits under United States Code, title 42, section
402(e) or (f), who is not entitled to Medicare Part A, and who received supplemental security
income or Minnesota supplemental aid in the month before the month the widow's or widower's
benefits began, is eligible for medical assistance as long as the person would be entitled to
supplemental security income or Minnesota supplemental aid in the absence of the widow's or
widower's benefits.
    Subd. 7. Waiver of maintenance of effort requirement. Unless a federal waiver of the
maintenance of effort requirement of section 2105(d) of title XXI of the Balanced Budget Act
of 1997, Public Law 105-33, Statutes at Large, volume 111, page 251, is granted by the federal
Department of Health and Human Services by September 30, 1998, eligibility for children under
age 21 must be determined without regard to asset standards established in section 256B.056,
subdivision 3c
. The commissioner of human services shall publish a notice in the State Register
upon receipt of a federal waiver.
    Subd. 8. Children under age two. Medical assistance may be paid for a child under
two years of age whose countable family income is above 275 percent of the federal poverty
guidelines for the same size family but less than or equal to 280 percent of the federal poverty
guidelines for the same size family.
    Subd. 9. Employed persons with disabilities. (a) Medical assistance may be paid for a
person who is employed and who:
(1) meets the definition of disabled under the supplemental security income program;
(2) is at least 16 but less than 65 years of age;
(3) meets the asset limits in paragraph (b); and
(4) effective November 1, 2003, pays a premium and other obligations under paragraph (d).
Any spousal income or assets shall be disregarded for purposes of eligibility and premium
determinations.
After the month of enrollment, a person enrolled in medical assistance under this subdivision
who:
(1) is temporarily unable to work and without receipt of earned income due to a medical
condition, as verified by a physician, may retain eligibility for up to four calendar months; or
(2) effective January 1, 2004, loses employment for reasons not attributable to the enrollee,
may retain eligibility for up to four consecutive months after the month of job loss. To receive
a four-month extension, enrollees must verify the medical condition or provide notification of
job loss. All other eligibility requirements must be met and the enrollee must pay all calculated
premium costs for continued eligibility.
(b) For purposes of determining eligibility under this subdivision, a person's assets must not
exceed $20,000, excluding:
(1) all assets excluded under section 256B.056;
(2) retirement accounts, including individual accounts, 401(k) plans, 403(b) plans, Keogh
plans, and pension plans; and
(3) medical expense accounts set up through the person's employer.
(c)(1) Effective January 1, 2004, for purposes of eligibility, there will be a $65 earned income
disregard. To be eligible, a person applying for medical assistance under this subdivision must
have earned income above the disregard level.
(2) Effective January 1, 2004, to be considered earned income, Medicare, Social Security,
and applicable state and federal income taxes must be withheld. To be eligible, a person must
document earned income tax withholding.
(d)(1) A person whose earned and unearned income is equal to or greater than 100 percent
of federal poverty guidelines for the applicable family size must pay a premium to be eligible
for medical assistance under this subdivision. The premium shall be based on the person's gross
earned and unearned income and the applicable family size using a sliding fee scale established
by the commissioner, which begins at one percent of income at 100 percent of the federal poverty
guidelines and increases to 7.5 percent of income for those with incomes at or above 300 percent
of the federal poverty guidelines. Annual adjustments in the premium schedule based upon
changes in the federal poverty guidelines shall be effective for premiums due in July of each year.
(2) Effective January 1, 2004, all enrollees must pay a premium to be eligible for medical
assistance under this subdivision. An enrollee shall pay the greater of a $35 premium or the
premium calculated in clause (1).
(3) Effective November 1, 2003, all enrollees who receive unearned income must pay
one-half of one percent of unearned income in addition to the premium amount.
(4) Effective November 1, 2003, for enrollees whose income does not exceed 200 percent of
the federal poverty guidelines and who are also enrolled in Medicare, the commissioner must
reimburse the enrollee for Medicare Part B premiums under section 256B.0625, subdivision 15,
paragraph (a).
(5) Increases in benefits under title II of the Social Security Act shall not be counted as
income for purposes of this subdivision until July 1 of each year.
(e) A person's eligibility and premium shall be determined by the local county agency.
Premiums must be paid to the commissioner. All premiums are dedicated to the commissioner.
(f) Any required premium shall be determined at application and redetermined at the
enrollee's six-month income review or when a change in income or household size is reported.
Enrollees must report any change in income or household size within ten days of when the change
occurs. A decreased premium resulting from a reported change in income or household size shall
be effective the first day of the next available billing month after the change is reported. Except
for changes occurring from annual cost-of-living increases, a change resulting in an increased
premium shall not affect the premium amount until the next six-month review.
(g) Premium payment is due upon notification from the commissioner of the premium
amount required. Premiums may be paid in installments at the discretion of the commissioner.
(h) Nonpayment of the premium shall result in denial or termination of medical assistance
unless the person demonstrates good cause for nonpayment. Good cause exists if the requirements
specified in Minnesota Rules, part 9506.0040, subpart 7, items B to D, are met. Except when an
installment agreement is accepted by the commissioner, all persons disenrolled for nonpayment
of a premium must pay any past due premiums as well as current premiums due prior to being
reenrolled. Nonpayment shall include payment with a returned, refused, or dishonored instrument.
The commissioner may require a guaranteed form of payment as the only means to replace a
returned, refused, or dishonored instrument.
    Subd. 10. Certain persons needing treatment for breast or cervical cancer. (a) Medical
assistance may be paid for a person who:
(1) has been screened for breast or cervical cancer by the Minnesota breast and cervical
cancer control program, and program funds have been used to pay for the person's screening;
(2) according to the person's treating health professional, needs treatment, including
diagnostic services necessary to determine the extent and proper course of treatment, for breast or
cervical cancer, including precancerous conditions and early stage cancer;
(3) meets the income eligibility guidelines for the Minnesota breast and cervical cancer
control program;
(4) is under age 65;
(5) is not otherwise eligible for medical assistance under United States Code, title 42, section
1396a(a)(10)(A)(i); and
(6) is not otherwise covered under creditable coverage, as defined under United States
Code, title 42, section 1396a(aa).
(b) Medical assistance provided for an eligible person under this subdivision shall be limited
to services provided during the period that the person receives treatment for breast or cervical
cancer.
(c) A person meeting the criteria in paragraph (a) is eligible for medical assistance without
meeting the eligibility criteria relating to income and assets in section 256B.056, subdivisions
1a to 5b
.
History: 1986 c 444; 1989 c 282 art 3 s 48; 1990 c 568 art 3 s 33-36; 1991 c 292 art 4 s
35-39; 1992 c 513 art 7 s 39; 1992 c 549 art 4 s 12; 1993 c 345 art 9 s 11-13; 1Sp1993 c 6 s 9;
1995 c 234 art 6 s 36,37; 1997 c 85 art 3 s 16-18; 1997 c 203 art 4 s 22-24; 1998 c 407 art 5 s
3-5; 1998 c 407 art 4 s 17,18; 1999 c 245 art 4 s 33,34; 2000 c 260 s 97; 2000 c 340 s 3; 2000 c
488 art 9 s 15; 1Sp2001 c 9 art 2 s 25-29; 2002 c 379 art 1 s 113; 1Sp2003 c 14 art 12 s 19-23;
1Sp2005 c 4 art 7 s 4; 2007 c 147 art 13 s 1

NOTE: The amendment to subdivision 1 by Laws 2003, First Special Session chapter 14,
article 12, section 19, is effective February 1, 2004, or upon federal approval, whichever is later,
except where a different date is specified in the text. Laws 2003, First Special Session chapter
14, article 12, section 19, the effective date.
NOTE:Subdivision 2c as added by Laws 2007, chapter 147, article 13, section 1, is effective
October 1, 2008, or upon federal approval, whichever is later. Laws 2007, chapter 147, article 13,
section 1, the effective date.