1997 Minnesota Statutes

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

    Subdivision 1.    General requirements.  Families and 
 individuals who enroll on or after October 1, 1992, are eligible 
 for subsidized premium payments based on a sliding scale under 
 section 256L.08 only if the family or individual meets the 
 requirements in subdivisions 2 and 3.  Children already enrolled 
 in the children's health plan as of September 30, 1992, eligible 
 under section 256L.04, subdivision 1, paragraph (a), children 
 who enroll in the MinnesotaCare program after September 30, 
 1992, pursuant to Laws 1992, chapter 549, article 4, section 17, 
 and children who enroll under section 256L.04, subdivision 6, 
 are eligible for subsidized premium payments without meeting 
 these requirements, as long as they maintain continuous coverage 
 in the MinnesotaCare plan or medical assistance.  

    Families and individuals who initially enrolled in 
 MinnesotaCare under section 256L.04, and whose income increases 
 above the limits established in section 256L.08, may continue 
 enrollment and pay the full cost of coverage. 

    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, and 
 must not have had access to subsidized health coverage through 
 an employer for the 18 months prior to application for 
 subsidized coverage under the MinnesotaCare program.  The 
 requirement that the family or individual must not have had 
 access to employer-subsidized coverage during the previous 18 
 months does not apply if:  (1) employer-subsidized coverage was 
 lost due to the death of an employee or divorce; (2) 
 employer-subsidized coverage was lost because an individual 
 became ineligible for coverage as a child or dependent; or (3) 
 employer-subsidized coverage was lost for reasons that would not 
 disqualify the individual for unemployment benefits under 
 section 268.09 and the family or individual has not had access 
 to employer-subsidized coverage since the loss of coverage.  If 
 employer-subsidized coverage was lost for reasons that 
 disqualify an individual for unemployment benefits under section 
 268.09, children of that individual are exempt from the 
 requirement of no access to employer subsidized coverage for the 
 18 months prior to application, as long as the children have not 
 had access to employer subsidized coverage since the 
 disqualifying event.  The requirement that the family or 
 individual must not have had access to employer-subsidized 
 coverage during the previous 18 months does apply if 
 employer-subsidized coverage is lost due to an employer 
 terminating health care coverage as an employee benefit.  

    (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, 
 excluding dependent coverage, 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 as 
 qualified employer subsidies toward the cost of health coverage 
 for employees for purposes of this subdivision. 

    Subd. 3.    Period uninsured.  To be eligible for 
 subsidized premium payments based on a sliding scale, families 
 and individuals initially enrolled in the MinnesotaCare program 
 under section 256L.04, subdivisions 5 and 7, must have had no 
 health coverage for at least four months prior to application.  
 The commissioner may change this eligibility criterion for 
 sliding scale premiums in order to remain within the limits of 
 available appropriations.  The requirement of at least four 
 months of no health coverage prior to application for the 
 MinnesotaCare program does not apply to: 

    (1) families, children, and individuals who apply for the 
 MinnesotaCare program upon termination from or as required by 
 the medical assistance program, general assistance medical care 
 program, or coverage under a regional demonstration project for 
 the uninsured funded under section 256B.73, the Hennepin county 
 assured care program, or the Group Health, Inc., community 
 health plan; 

    (2) families and individuals initially enrolled under 
 section 256L.04, subdivisions 1, paragraph (a), and 3; 

    (3) children enrolled pursuant to Laws 1992, chapter 549, 
 article 4, section 17; or 

    (4) individuals currently serving or who have served in the 
 military reserves, and dependents of these individuals, if these 
 individuals:  (i) reapply for MinnesotaCare coverage after a 
 period of active military service during which they had been 
 covered by the Civilian Health and Medical Program of the 
 Uniformed Services (CHAMPUS); (ii) were covered under 
 MinnesotaCare immediately prior to obtaining coverage under 
 CHAMPUS; and (iii) have maintained continuous coverage. 

    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