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
, including the insurance-related barriers to enrollment under section
, shall apply
unless otherwise specified.
(b) Parents who enroll in the MinnesotaCare program must also enroll their children, if
the children are eligible. Children 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
(c) Beginning October 1, 2003, the dependent sibling definition no longer applies to the
MinnesotaCare program. These persons are no longer counted in the parental household and
may apply as a separate household.
(d) Beginning July 1, 2003, or upon federal approval, whichever is later, parents are not
eligible for MinnesotaCare if their gross income exceeds $50,000.
(e) Children formerly enrolled in medical assistance and automatically deemed eligible for
MinnesotaCare according to section
256B.057, subdivision 2c
, are exempt from the requirements
of this section until renewal.
Subd. 1a. Social Security number required.
(a) Individuals and families applying for
MinnesotaCare coverage must provide a Social Security number.
(b) The commissioner shall not deny eligibility to an otherwise eligible applicant who has
applied for a Social Security number and is awaiting issuance of that Social Security number.
(c) Newborns enrolled under section
256L.05, subdivision 3
, are exempt from the
requirements of this subdivision.
(d) Individuals who refuse to provide a Social Security number because of well-established
religious objections are exempt from the requirements of this subdivision. The term
"well-established religious objections" has the meaning given in Code of Federal Regulations,
title 42, section
Subd. 2. 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, complying with the notice requirements in section
256B.056, subdivision 9
, 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
(b) A parent, guardian, relative caretaker, 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, relative caretaker,
or guardian fails to cooperate in establishing paternity or obtaining medical support.
Subd. 2a. Applications for other benefits.
To be eligible for MinnesotaCare, individuals
and families must take all necessary steps to obtain other benefits as described in Code of Federal
Regulations, title 42, section
. Applicants and enrollees must apply for other benefits
within 30 days of notification.
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 200 percent of the federal poverty guidelines. Effective July 1, 2009, 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 215 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. 7b. Annual income limits adjustment.
The commissioner shall adjust the income
limits under this section each July 1 by the annual update of the federal poverty guidelines
following publication by the United States Department of Health and Human Services.
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 to also be applications for medical assistance.
Applicants who are potentially eligible for medical assistance, except for those described in
paragraph (a), 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. Citizenship requirements.
Eligibility for MinnesotaCare is limited to citizens
or nationals of the United States, qualified noncitizens, and other persons residing lawfully in
the United States as described in section
256B.06, subdivision 4
, paragraphs (a) to (e) and (j).
Undocumented noncitizens and nonimmigrants are ineligible for MinnesotaCare. For purposes of
this subdivision, a nonimmigrant is an individual in one or more of the classes listed in United
States Code, title 8, section 1101(a)(15), and an undocumented noncitizen is an individual who
resides in the United States without the approval or acquiescence of the United States Citizenship
and Immigration Services. Families with children who are citizens or nationals of the United
States must cooperate in obtaining satisfactory documentary evidence of citizenship or nationality
according to the requirements of the federal Deficit Reduction Act of 2005, Public Law 109-171.
Subd. 10a. Sponsor's income and resources deemed available; documentation.
determining eligibility for any federal or state benefits under sections
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 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
Subd. 11.[Repealed, 1Sp2005 c 4 art 8 s 88
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
Subd. 13. Families with relative caretakers, foster parents, or legal guardians.
January 1, 1999, in families that include a relative caretaker as defined in the medical assistance
program, foster parent, or legal guardian, the 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 and the provisions of subdivision 1,
paragraph (b), do not apply. If the 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.
History: 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; 1999 c 245 art 4 s 91-94; 1Sp2003
c 14 art 12 s 73,74; 2005 c 98 art 2 s 16; 1Sp2005 c 4 art 8 s 61-63; 2006 c 282 art 17 s 35;
2007 c 13 art 1 s 25; 2007 c 147 art 4 s 9; art 5 s 23; art 13 s 2
Subdivisions 1a and 2a, as added by Laws 2005, First Special Session chapter 4,
article 8, sections 61 and 63, are effective August 1, 2007, or upon HealthMatch implementation,
whichever is later. Laws 2005, First Special Session chapter 4, article 8, sections 61 and 63, the
The amendment to subdivision 1 by Laws 2007, chapter 147, article 13, section 2,
is effective October 1, 2008, or upon federal approval, whichever is later. Laws 2007, chapter
147, article 13, section 2, the effective date.