Policy Library

EPM

Minnesota Health Care Programs Eligibility Policy Manual

Official DHS eligibility policies for Minnesota Health Care Programs, including Medical Assistance and MinnesotaCare. Policy only — no procedural or system instructions.

Official origin: https://hcopub.dhs.state.mn.us/epm/home.htm

347 sections
  1. 1Minnesota Health Care Programs
  2. 1.1Programs Overview
  3. 1.2Applications
  4. 1.2.1Application Forms
  5. 1.2.2Application Submission
  6. 1.2.3Date of Application
  7. 1.2.4Processing Period
  8. 1.2.5Retroactive Eligibility
  9. 1.2.6Signature
  10. 1.2.7Applications for Incarcerated People Preparing for Release (Archive)
  11. 1.3Client Rights and Responsibilities
  12. 1.3.1Rights
  13. 1.3.1.1Appeals
  14. 1.3.1.2Authorized Representative
  15. 1.3.1.3Civil Rights
  16. 1.3.1.4Data Privacy
  17. 1.3.1.5Notices
  18. 1.3.2Responsibilities
  19. 1.3.2.1Change in Circumstances
  20. 1.3.2.1.1Death of an Applicant or Enrollee
  21. 1.3.2.2Cooperation
  22. 1.3.2.3Fraud
  23. 1.3.2.4Inconsistent Information
  24. 1.3.2.5Overpayments
  25. 1.4State Residency
  26. 1.4.1Interstate Residency Agreements
  27. 1.4.2State Residency for Adoption Assistance, Kinship Assistance, and Foster Care
  28. 1.4.3State Residency for People in an Institution
  29. 1.4.4Temporary Absence
  30. 1.5Mandatory Verifications
  31. 1.6Health Care Delivery
  32. 1.7Help Paying for Medicare Costs
  33. 1.7.1Medicare Buy-In
  34. 1.7.2Direct Reimbursement of Medicare Premiums
  35. 2Medical Assistance
  36. 2.1Overview
  37. 2.1.1General Requirements
  38. 2.1.1.1Mandatory Verifications
  39. 2.1.1.2Responsibilities
  40. 2.1.1.2.1Benefit Recovery
  41. 2.1.1.2.1.1Estate Recovery
  42. 2.1.1.2.1.2MA Liens
  43. 2.1.1.2.1.3Third Party Liability
  44. 2.1.1.2.1.3.1Cost-Effective Health Insurance
  45. 2.1.1.2.1.3.2Medical Support
  46. 2.1.1.2.1.3.3Other Third Party Liability
  47. 2.1.1.2.2Cooperation
  48. 2.1.1.2.3Cost Sharing
  49. 2.1.1.2.4Referral for Other Benefits
  50. 2.1.1.2.5Periodic Data Matching
  51. 2.1.2Non-Financial Eligibility
  52. 2.1.2.1Bases of Eligibility
  53. 2.1.2.2Citizenship and Immigration Status
  54. 2.1.2.2.1Citizenship
  55. 2.1.2.2.2Immigration Status
  56. 2.1.2.3County Residency
  57. 2.1.2.4Living Arrangement
  58. 2.1.2.5Social Security Number
  59. 2.1.3Financial Eligibility
  60. 2.1.3.1Asset Limits
  61. 2.1.3.2Income Limits
  62. 2.1.4Post-Eligibility
  63. 2.1.4.1Begin and End Dates
  64. 2.1.4.2Qualifying Health Care Coverage
  65. 2.1.4.3Renewals
  66. 2.2Medical Assistance for Families with Children and Adults
  67. 2.2.1General Requirements
  68. 2.2.1.1Hospital Presumptive Eligibility
  69. 2.2.1.2Mandatory Verifications
  70. 2.2.2Non-Financial Eligibility
  71. 2.2.2.1Bases of Eligibility
  72. 2.2.2.1.1Auto Newborn Basis of Eligibility
  73. 2.2.2.1.2Pregnant Person Basis of Eligibility
  74. 2.2.2.1.3Former Foster Care Youth Basis of Eligibility
  75. 2.2.3Financial Eligibility
  76. 2.2.3.1Asset Limits
  77. 2.2.3.2Household Composition and Family Size
  78. 2.2.3.2.1Sponsor Deeming
  79. 2.2.3.3Income Limit
  80. 2.2.3.4Income Methodology
  81. 2.2.3.5Income Verification
  82. 2.2.3.6Medical Spenddown
  83. 2.2.4Post-Eligibility
  84. 2.2.4.1Health Care Delivery
  85. 2.2.4.2Renewals
  86. 2.2.4.3Transitional Medical Assistance and Transition Year Medical Assistance
  87. 2.3Medical Assistance for People Who Are Age 65 or Older and People Who Are Blind or Have a Disability
  88. 2.3.1General Requirements
  89. 2.3.1.1Mandatory Verifications
  90. 2.3.1.2Asset Verification Service (AVS)
  91. 2.3.1.3Authorization to Obtain Information
  92. 2.3.2Non-Financial Eligibility
  93. 2.3.2.1Bases of Eligibility
  94. 2.3.2.2Certification of Disability
  95. 2.3.3Financial Eligibility
  96. 2.3.3.1Household Composition and Family Size
  97. 2.3.3.2Assets
  98. 2.3.3.2.1Asset Limits
  99. 2.3.3.2.1.1Reasonable Compatibility Check for Assets
  100. 2.3.3.2.2Asset Deeming
  101. 2.3.3.2.2.1Sponsor Asset Deeming
  102. 2.3.3.2.3Excluded Assets
  103. 2.3.3.2.4Countable Assets
  104. 2.3.3.2.4.1.1Shared Ownership (Archive)
  105. 2.3.3.2.5Unknown Assets
  106. 2.3.3.2.6Excess Assets
  107. 2.3.3.2.7Asset Evaluation
  108. 2.3.3.2.7.1Liquid Assets
  109. 2.3.3.2.7.2Retirement Funds and Retirement Plans
  110. 2.3.3.2.7.3Health Expense Accounts
  111. 2.3.3.2.7.3.1Health Flexible Spending Arrangements
  112. 2.3.3.2.7.3.2Health Savings Accounts
  113. 2.3.3.2.7.4Real Property
  114. 2.3.3.2.7.4.1Homestead Real Property
  115. 2.3.3.2.7.4.2Non-Homestead Real Property
  116. 2.3.3.2.7.4.3Life Estates and Remainder Interests
  117. 2.3.3.2.7.4.4Other Real Property Interests
  118. 2.3.3.2.7.5Contract for Deed and Other Property Agreements
  119. 2.3.3.2.7.6Promissory Notes
  120. 2.3.3.2.7.7Automobiles and Other Vehicles Used for Transportation
  121. 2.3.3.2.7.8Annuities
  122. 2.3.3.2.7.9Trusts
  123. 2.3.3.2.7.9.1Identifying the Type of Trust
  124. 2.3.3.2.7.9.2Client-Funded Trusts
  125. 2.3.3.2.7.9.3Medical Assistance Qualifying Trust
  126. 2.3.3.2.7.9.4Special Needs Trusts
  127. 2.3.3.2.7.9.5Pooled Trusts
  128. 2.3.3.2.7.9.6Third Party Established and Funded Trusts
  129. 2.3.3.2.7.9.7Supplemental Needs Trusts
  130. 2.3.3.2.7.10Life Insurance
  131. 2.3.3.2.7.10.1Life Insurance Funded Burial Contracts
  132. 2.3.3.2.7.11Burial Contracts
  133. 2.3.3.2.7.11.1Burial Space Exclusion
  134. 2.3.3.2.7.11.2Burial Fund Exclusion
  135. 2.3.3.2.7.11.3Prepaid Burial Arrangements
  136. 2.3.3.2.7.12Continuing Care Retirement Community Entrance Fee
  137. 2.3.3.2.7.13Tribal Payments and Interests
  138. 2.3.3.2.7.14Household Goods and Personal Effects, and Other Personal Property
  139. 2.3.3.2.7.15Achieving a Better Life Experience (ABLE) Accounts
  140. 2.3.3.2.8Asset Verification
  141. 2.3.3.3Income
  142. 2.3.3.3.1Income Limits
  143. 2.3.3.3.2Income Methodology
  144. 2.3.3.3.2.1Countable Income
  145. 2.3.3.3.2.1.1Income Deeming
  146. 2.3.3.3.2.1.2Sponsor Income Deeming
  147. 2.3.3.3.2.2Disregards and Deductions
  148. 2.3.3.3.2.3Excluded Income
  149. 2.3.3.3.2.4Income Verification
  150. 2.3.3.4Medical Spenddowns
  151. 2.3.3.4.1Medical Spenddown Types
  152. 2.3.3.4.2Health Care Expenses
  153. 2.3.4Post-Eligibility
  154. 2.3.4.1Health Care Delivery
  155. 2.3.4.2Renewals
  156. 2.3.4.2.1Ex Parte Renewals
  157. 2.3.5
  158. 2.3.5.1General Requirements
  159. 2.3.5.1.1Mandatory Verifications
  160. 2.3.5.1.2Premiums
  161. 2.3.5.1.2.1Good Cause for Non-Payment of Ongoing Premiums
  162. 2.3.5.1.3Work Requirements
  163. 2.3.5.2Non-Financial Eligibility
  164. 2.3.5.2.1Bases of Eligibility
  165. 2.3.5.2.2Living Arrangement
  166. 2.3.5.3Financial Eligibility
  167. 2.3.5.3.1Assets
  168. 2.3.5.3.2Income
  169. 2.3.5.4Post-Eligibility
  170. 2.3.5.4.1Medicare Part B for MA-EPD Enrollees
  171. 2.3.6Medical Assistance under the TEFRA Option
  172. 2.3.6.1General Requirements
  173. 2.3.6.1.1Applications
  174. 2.3.6.2Non-Financial Eligibility Requirements
  175. 2.3.6.2.1Level of Care
  176. 2.3.6.3Financial Eligibility
  177. 2.3.6.4Post-Eligibility
  178. 2.3.7Medical Assistance 1619(a) or 1619(b)
  179. 2.4Medical Assistance for Long-Term Care Services
  180. 2.4.1Eligibility Requirements
  181. 2.4.1.1Long-Term Care Consultation
  182. 2.4.1.2Long-Term Care Home Equity Limit
  183. 2.4.1.3Uncompensated Transfers
  184. 2.4.1.3.1Lookback Period and Transfer Date
  185. 2.4.1.3.2Transfer Penalty
  186. 2.4.1.3.3Transfer Penalty Exceptions and Hardship Waiver
  187. 2.4.1.3.4Other Asset Transfer Considerations
  188. 2.4.1.4Annuities
  189. 2.4.1.4.1Annuity Disclosures
  190. 2.4.1.4.2Naming DHS a Preferred Remainder Beneficiary
  191. 2.4.2Financial Eligibility
  192. 2.4.2.1Asset Evaluation for Married Couples
  193. 2.4.2.1.1Asset Assessment for Planning Purposes
  194. 2.4.2.1.2Community Spouse Asset Allowance
  195. 2.4.2.1.2.1Asset Eligibility for a Long-Term Care Spouse
  196. 2.4.2.2Long-Term Care Partnership Insurance
  197. 2.4.2.3Home and Community-Based Service Waivers
  198. 2.4.2.3.1Home and Community-Based Services Waivers for People with Disabilities
  199. 2.4.2.3.2Home and Community-Based Services Waiver for People Age 65 or Older
  200. 2.4.2.4Long-Term Care Facility Services
  201. 2.4.2.5Income Calculations for Long-Term Care Services
  202. 2.4.2.5.1LTC Income Calculation Deductions
  203. 2.5Medical Assistance for Certain Populations
  204. 2.5.1Medical Assistance for a Person with Breast or Cervical Cancer
  205. 2.5.1.1General Requirements
  206. 2.5.1.1.1Applications
  207. 2.5.1.1.2Mandatory Verifications
  208. 2.5.1.2Non-Financial Eligibility
  209. 2.5.1.2.1Basis of Eligibility
  210. 2.5.1.3Financial Eligibility
  211. 2.5.1.4Post-Eligibility
  212. 2.5.1.4.1Health Care Delivery
  213. 2.5.1.4.2Renewals
  214. 2.5.2Medical Assistance for People Receiving Services at the Center for Victims of Torture
  215. 2.5.2.1General Requirements
  216. 2.5.2.1.1Mandatory Verifications
  217. 2.5.2.2Non-Financial Eligibility
  218. 2.5.2.2.1Bases of Eligibility
  219. 2.5.2.3Financial Eligibility
  220. 2.5.2.4Post-Eligibility
  221. 2.5.2.4.1Health Care Delivery
  222. 2.5.2.4.2Renewals
  223. 2.5.3Emergency Medical Assistance
  224. 2.5.3.1General Requirements
  225. 2.5.3.1.1Mandatory Verifications
  226. 2.5.3.2Non-Financial Eligibility
  227. 2.5.3.3Financial Eligibility
  228. 2.5.3.4Post-Eligibility
  229. 2.5.3.4.1Health Care Delivery
  230. 2.5.4Program for People Living in Institutions for Mental Diseases
  231. 2.5.4.1General Requirements
  232. 2.5.4.2Non-Financial Eligibility
  233. 2.5.4.3Financial Eligibility
  234. 2.5.4.4Post-Eligibility
  235. 2.5.4.4.1Medicare
  236. 2.5.4.4.2Health Care Delivery
  237. 2.5.4.4.3Leave Days
  238. 2.5.5Medical Assistance for People Who Are Incarcerated
  239. 2.5.5.1General Requirements
  240. 2.5.5.1.1Applications
  241. 2.5.5.2Non-Financial Eligibility
  242. 2.5.5.3Financial Eligibility
  243. 2.5.5.4Post-Eligibility
  244. 2.5.5.4.1Health Care Delivery
  245. 2.5.6Medical Assistance for Children Receiving Northstar Adoption Assistance (NAA), Northstar Kinship Assistance (NKA), and Children in Foster Care (FC)
  246. 2.5.6.1Medical Assistance Northstar Adoption Assistance
  247. 2.5.6.1.1General Requirements
  248. 2.5.6.1.1.1Mandatory Verifications
  249. 2.5.6.1.2Non-Financial Eligibility
  250. 2.5.6.1.2.1Basis of Eligibility
  251. 2.5.6.1.3Financial Eligibility
  252. 2.5.6.1.4Post-Eligibility
  253. 2.5.6.1.4.1Health Care Delivery
  254. 2.5.6.1.4.2Title IV-E and Medicare
  255. 2.5.6.1.4.3Renewals
  256. 2.5.6.2Medical Assistance for Children Receiving Northstar Kinship Assistance (MA-NKA)
  257. 2.5.6.2.1General Requirements
  258. 2.5.6.2.1.1Mandatory Verifications
  259. 2.5.6.2.2Non-Financial Eligibility
  260. 2.5.6.2.2.1Basis of Eligibility
  261. 2.5.6.2.3Financial Eligibility
  262. 2.5.6.2.4Post-Eligibility
  263. 2.5.6.2.4.1Health Care Delivery
  264. 2.5.6.2.4.2Renewals
  265. 2.5.6.3Medical Assistance for Children in Foster Care (MA-FC)
  266. 2.5.6.3.1General Requirements
  267. 2.5.6.3.1.1Mandatory Verifications
  268. 2.5.6.3.2Non-Financial Eligibility
  269. 2.5.6.3.2.1Basis of Eligibility
  270. 2.5.6.3.3Financial Eligibility
  271. 2.5.6.3.4Post-Eligibility
  272. 2.5.6.3.4.1Health Care Delivery
  273. 2.5.6.3.4.2Renewals
  274. 2.5.7Refugee Medical Assistance
  275. 3MinnesotaCare
  276. 3.1General Requirements
  277. 3.1.1Mandatory Verifications
  278. 3.1.2Responsibilities
  279. 3.1.2.1Cooperation
  280. 3.1.2.2Premiums and Cost Sharing
  281. 3.1.2.3Periodic Data Matching
  282. 3.2Non-Financial Eligibility
  283. 3.2.1Citizenship and Lawful Presence
  284. 3.2.1.1Citizenship
  285. 3.2.1.2Lawful Presence and DACA
  286. 3.2.2Incarceration Status
  287. 3.2.3Insurance Barriers
  288. 3.2.3.1Health Care Coverage Barriers
  289. 3.2.3.2Employer-Sponsored Coverage
  290. 3.2.4Social Security Number
  291. 3.2.5Age
  292. 3.3Financial Eligibility
  293. 3.3.1Household Composition and Family Size
  294. 3.3.2Income Limit
  295. 3.3.3Income Methodology
  296. 3.3.4Income Verification
  297. 3.4Post-Eligibility
  298. 3.4.1Begin and End Dates
  299. 3.4.2Qualifying Health Care Coverage
  300. 3.4.3Renewals
  301. 4Other Health Care Programs
  302. 4.1Minnesota Family Planning Program
  303. 4.1.1General Requirements
  304. 4.1.1.1Application
  305. 4.1.1.2Mandatory Verifications
  306. 4.1.1.3Presumptive Eligibility
  307. 4.1.1.4Responsibilities
  308. 4.1.1.4.1Change in Circumstances
  309. 4.1.1.4.2Cooperation
  310. 4.1.1.4.3Medical Support
  311. 4.1.1.4.4Other Health Insurance
  312. 4.1.1.5Rights
  313. 4.1.1.5.1Eligibility Appeals
  314. 4.1.2Non-Financial Eligibility
  315. 4.1.2.1Barriers
  316. 4.1.3Financial Eligibility
  317. 4.1.3.1Household Composition
  318. 4.1.3.2Income Limit
  319. 4.1.3.3Income Methodology
  320. 4.1.4Post-Eligibility
  321. 4.1.4.1Health Care Delivery
  322. 4.1.4.2Renewals
  323. 4.2Medicare Savings Programs
  324. 4.2.1General Requirements
  325. 4.2.1.1Applications
  326. 4.2.1.2Cooperation
  327. 4.2.1.3Mandatory Verifications
  328. 4.2.1.4Medicare Overview
  329. 4.2.1.5Referral for Other Benefits
  330. 4.2.1.6Retroactive Eligibility
  331. 4.2.1.7Types of Medicare Savings Programs
  332. 4.2.2Non-Financial Eligibility
  333. 4.2.3Financial Eligibility
  334. 4.2.3.1Assets
  335. 4.2.3.2Household Composition and Family Size
  336. 4.2.3.3Income
  337. 4.2.4Post-Eligibility
  338. appendicesAppendices
  339. AAppendix A Types of Assets
  340. BAppendix B Types of Income
  341. CAppendix C Medicare Cost Sharing Amounts
  342. DAppendix D Community Living Arrangements
  343. EAppendix E Institutions for Mental Diseases
  344. FAppendix F Standards and Guidelines
  345. GAppendix G Life Estates Mortality Table
  346. HAppendix H Lawfully Present Noncitizens
  347. IAppendix I Life Insurance Concepts