256L.07 ELIGIBILITY FOR MINNESOTACARE.
Subdivision 1. General requirements.
(a) Children enrolled in the original children's
health plan as of September 30, 1992, children who enrolled in the MinnesotaCare program
after September 30, 1992, pursuant to Laws 1992, chapter 549, article 4, section 17, and
children who have family gross incomes that are equal to or less than 150 percent of the federal
poverty guidelines are eligible without meeting the requirements of subdivision 2 and the
four-month requirement in subdivision 3, as long as they maintain continuous coverage in the
MinnesotaCare program or medical assistance. Children who apply for MinnesotaCare on or
after the implementation date of the employer-subsidized health coverage program as described
in Laws 1998, chapter 407, article 5, section 45, who have family gross incomes that are equal
to or less than 150 percent of the federal poverty guidelines, must meet the requirements of
subdivision 2 to be eligible for MinnesotaCare.
(b) Families enrolled in MinnesotaCare under section
256L.04, subdivision 1
, whose income
increases above 275 percent of the federal poverty guidelines, are no longer eligible for the
program and shall be disenrolled by the commissioner. Individuals enrolled in MinnesotaCare
256L.04, subdivision 7
, whose income increases above 175 percent of the
federal poverty guidelines are no longer eligible for the program and shall be disenrolled by
the commissioner. For persons disenrolled under this subdivision, MinnesotaCare coverage
terminates the last day of the calendar month following the month in which the commissioner
determines that the income of a family or individual exceeds program income limits.
(c) Notwithstanding paragraph (b), children may remain enrolled in MinnesotaCare if
ten percent of their gross individual or gross family income as defined in section
, is less than the premium for a six-month policy with a $500 deductible available
through the Minnesota Comprehensive Health Association. Children who are no longer eligible
for MinnesotaCare under this clause shall be given a 12-month notice period from the date that
ineligibility is determined before disenrollment. The premium for children remaining eligible
under this clause shall be the maximum premium determined under section
, paragraph (b).
(d) Notwithstanding paragraphs (b) and (c), parents are not eligible for MinnesotaCare if
gross household income exceeds $25,000 for the six-month period of eligibility.
Subd. 2. Must not have access to employer-subsidized coverage.
(a) To be eligible, a
family or individual must not have access to subsidized health coverage through an employer and
must not have had access to employer-subsidized coverage through a current employer for 18
months prior to application or reapplication. A family or individual whose employer-subsidized
coverage is lost due to an employer terminating health care coverage as an employee benefit
during the previous 18 months is not eligible.
(b) This subdivision does not apply to a family or individual who was enrolled
in MinnesotaCare within six months or less of reapplication and who no longer has
employer-subsidized coverage due to the employer terminating health care coverage as an
(c) 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 or
dependent, 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 and
any other employer benefits intended to pay health care costs as qualified employer subsidies
toward the cost of health coverage for employees for purposes of this subdivision.
Subd. 2a. Access to health coverage; postsecondary education student.
To be eligible,
an individual under 21 years of age who is enrolled in a program of study at a postsecondary
education institution, including an emancipated minor and an emancipated minor's spouse, must
not have access to health coverage through the postsecondary education institution.
Subd. 3. Other health coverage.
(a) Families and individuals enrolled in the MinnesotaCare
program must have no health coverage while enrolled or for at least four months prior to
application and renewal. Children enrolled in the original children's health plan and children in
families with income equal to or less than 150 percent of the federal poverty guidelines, who have
other health insurance, are eligible if the coverage:
(1) lacks two or more of the following:
(i) basic hospital insurance;
(ii) medical-surgical insurance;
(iii) prescription drug coverage;
(iv) dental coverage; or
(v) vision coverage;
(2) requires a deductible of $100 or more per person per year; or
(3) lacks coverage because the child has exceeded the maximum coverage for a particular
diagnosis or the policy excludes a particular diagnosis.
The commissioner may change this eligibility criterion for sliding scale premiums in order
to remain within the limits of available appropriations. The requirement of no health coverage
does not apply to newborns.
(b) Medical assistance, general assistance medical care, and the Civilian Health and Medical
Program of the Uniformed Service, CHAMPUS, or other coverage provided under United States
Code, title 10, subtitle A, part II, chapter 55, are not considered insurance or health coverage for
purposes of the four-month requirement described in this subdivision.
(c) For purposes of this subdivision, an applicant or enrollee who is entitled to Medicare Part
A or enrolled in Medicare Part B coverage under title XVIII of the Social Security Act, United
States Code, title 42, sections 1395c to 1395w-152, is considered to have health coverage. An
applicant or enrollee who is entitled to premium-free Medicare Part A may not refuse to apply for
or enroll in Medicare coverage to establish eligibility for MinnesotaCare.
(d) Applicants who were recipients of medical assistance or general assistance medical care
within one month of application must meet the provisions of this subdivision and subdivision 2.
(e) Cost-effective health insurance that was paid for by medical assistance is not considered
health coverage for purposes of the four-month requirement under this section, except if the
insurance continued after medical assistance no longer considered it cost-effective or after
medical assistance closed.
Subd. 4. Families with children in need of chemical dependency treatment.
families with children when a parent has been determined to be in need of chemical dependency
treatment pursuant to an assessment conducted by the county under section
, or a case plan under section
260C.201, subdivision 6
, who are eligible for
MinnesotaCare under section
256L.04, subdivision 1
, may be paid by the county of residence of
the person in need of treatment for one year from the date the family is determined to be eligible
or if the family is currently enrolled in MinnesotaCare from the date the person is determined to
be in need of chemical dependency treatment. Upon renewal, the family is responsible for any
premiums owed under section
. If the family is not currently enrolled in MinnesotaCare,
the local county human services agency shall determine whether the family appears to meet the
eligibility requirements and shall assist the family in applying for the MinnesotaCare program.
Subd. 5. Voluntary disenrollment for members of military.
256L.05, subdivision 3b
, MinnesotaCare enrollees who are members of the military and their
families, who choose to voluntarily disenroll from the program when one or more family members
are called to active duty, may reenroll during or following that member's tour of active duty.
Those individuals and families shall be considered to have good cause for voluntary termination
256L.06, subdivision 3
, paragraph (d). Income and asset increases reported at the
time of reenrollment shall be disregarded. All provisions of sections
apply to individuals and families enrolled under this subdivision upon six-month renewal.
Subd. 6. Exception for certain adults.
Single adults and households with no children
formerly enrolled in general assistance medical care and enrolled in MinnesotaCare according to
256D.03, subdivision 3
, are eligible without meeting the requirements of this section until
History: 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; 1998 c 407 art 5
s 33; 1999 c 139 art 4 s 2; 1999 c 245 art 4 s 98; 1Sp2001 c 9 art 2 s 63; 2002 c 220 art 15 s
21,22; 2002 c 277 s 30; 2002 c 379 art 1 s 113; 1Sp2003 c 14 art 12 s 78,79; 2005 c 10 art 1 s
56; 2005 c 59 s 1; 1Sp2005 c 4 art 8 s 69-72
NOTE: The amendment to subdivision 1 by Laws 2005, First Special Session chapter 4,
article 8, section 69, is effective August 1, 2007, or upon HealthMatch implementation, whichever
is later. Laws 2005, First Special Session chapter 4, article 8, section 69, the effective date.
NOTE: Subdivision 2a, as added by Laws 2005, First Special Session chapter 4, article 8,
section 70, is effective September 1, 2005, or upon federal approval, whichever is later. Laws
2005, First Special Session chapter 4, article 8, section 70, the effective date.