Instructions for Entering DHS-6696 into METS, 11/26 Version

This procedure provides instructions and examples for entering the June 2026 version of DHS-6696 into METS.

HO5.5 Pre-Application Entry Screening Checklist for DHS-6696, 11/26 version (PDF) - Use this checklist as a resource for determining completeness of a DHS-6696.

Page Contents

Resuming an Application in the Worker Portal
Person Search
Closed Integrated Case Steps
Registering a Person
Add SSN to a Person Record
Incomplete Application Process
New Application Form
About You Section
More About You Section
Household Section
Relationship Section
Tax Filer Section
Income Section
RSDI Section
Definitions of Income Types
Additional Household Information Section
Post Application Processing
Review Results
Additional Case Worker Actions
Case Interface and Completion
How to Add Navigator Assistor/Broker Information to Evidence
Case Note

When an application is entered into METS, the system asks follow-up questions based on the responses entered. While this document contains many of the likely questions workers encounter, this does not guarantee inclusion of every possible combination of steps/screenshots.

Resuming an Application in the Worker Portal

Before entering the new application form for the first time, review this section in the event the application process is interrupted. This may be due to timing out, accidentally closing out of the process or METS stops responding.

Use the following steps to resume an application in the worker portal.

1. Select the Care and Protection tab (Figure 1) in the Navigation bar on the Person Home page.

Figure 1.

2. Select Applications from the Page Group Navigation Panel.

3. Select the Pending Application Forms tab (Figure 2).

Figure 2.

4. Review for any listed incomplete applications.

5. Select the Options button on the far right of the incomplete application displayed.

6. Select Resume from the drop-down menu (Figure 3). The application form entry displays. The application will resume where it was last saved or at the last completed section.

Figure 3.

Person Search

1. Complete a Person Search for all persons listed on the application.

 

1. If no person record exists in METS, continue to Registering a Person.

2. If a person record exists in METS for any member of the household on the paper application do the following as applicable:

 

1. Follow the Review, Authorize or Deny Pending Cases procedure if there is an open Application Case (AC).

2. If there is an open Integrated Case (IC) with Approved (Pending) or Active Product Delivery Cases (PDCs):

 

1. Follow the Transfer a Paper Application to Another Agency procedure if the case owner is another agency to determine which agency is responsible for processing the application. Add a Case Note documenting actions taken. This completes the process.

2. Compare the paper application with the evidence on the IC to determine if the enrollee is reporting a Change in Circumstance (CIC).

3. Process all reported changes following the appropriate ONEsource procedures.

4. Send the Application Case Denial Notice and case note that a duplicate application was received. Do not enter the paper application. This completes the process.

 

3. Check to see if anyone is closed from their most recent IC for PDM non-compliance. Use steps 1-4 of the Denying Retroactive Medical Assistance (Retro MA) for PDM Non-compliance to help identify these individuals and make note of them.

Note: Individuals who are closed on their most recent IC for PDM non-compliance are not eligible for retroactive MA coverage.

Closed Product Delivery Case(s) and Integrated Case(s)

If all PDCs and the IC are closed:

1. Register only the person who signed the application if they are not already registered. Do not re-register a person already known to METS.

2. Follow the Add SSN to Person Record section of this procedure before entering the new application if the person is registered but there is no SSN evidence and it was provided on the new application. This will help prevent duplicate PMIs.

3. Review the Person Record for each household member on the application:

 

1. Edit all address evidence on the Person Record (both current and historical) and verify that the Preferred box is not checked.

2. A change of address (for either residential or mailing) should be entered during application entry. The person record address will be updated once the application is submitted.

Registering a Person

1. Identify the application filer (application signer).

Note: If the Authorized Representative (AREP) is the application filer, identify the first adult household member listed on the application and follow the remaining steps for that individual.

2. Determine if the application filer is known to METS. If the Application Filer is already known to METS, proceed to the New Application Form section of this procedure.

3. Follow the Registering a Person procedure if the Application Filer is not already known to METS.

Note: If the application is incomplete, see the detailed Incomplete Application Process section of this procedure.

Add SSN to Person Record

4. Determine if the Application Filer is already known to METS. If known to METS, review the Person Record to see if SSN evidence exists:

 

1. If SSN evidence exists on the Person Record and the application is incomplete, continue to the Incomplete Application Process section of this procedure.

2. If SSN evidence exists on the Person Record and the application is complete, continue to the New Application Form section of this procedure.

3. If SSN evidence does not exist on the Person Record and the application is complete, follow the Add Social Security Number to the Person Record procedure in ONEsource to create SSN evidence. Then continue to the New Application Form section.

4. If SSN evidence does not exist on the Person Record and the application is incomplete, continue to the Incomplete Application Process section listed below.

Incomplete Application Process

Follow this process when phone contact with the applicant is not successful and the paper application is incomplete.

1. Register the Application Filer if applicable.

2. Add SSN to Person Record if applicable.

3. Send Request for Information (RFI) (DHS-3271) and track the incomplete application following agency process.

4. Follow the Add a Person Note Procedure. Include the phone number in the person note, if provided.

5. Send a manual denial Application Case Denial Notice - Application Withdrawn or Incomplete and enter a Person Note after 45 days from the date of application, or 10 days from the date the RFI was sent, whichever is later.

Note: If the application is withdrawn by the applicant, send a manual denial Application Case Denial Notice - Application Withdrawn or Incomplete using the “Application Withdrawn” reason on the drop-down, and enter a Person Note.

New Application Form

1. Select the Options button in the upper right corner and select New Application Form (Figure 4) on the Person Home page of the application signer.

Figure 4.

2. Determine and enter the Application Date:

 

1. If the paper application has a completed Appendix C, use the application date from the certified application counselors, navigators, in-person assisters, agents, and brokers section on Appendix C.

2. If the agency received a Request to Apply for MN Health Care Programs (DHS-3417B) and the paper application was received within 30 days of the request, use the date the DHS-3417B was received by the agency.

3. If the paper application does not have an Appendix C or a Request to Apply, use the date that the application was physically received by any agency, usually determined by a date stamp on the application. [When the application was forwarded from another agency, (to the county of residence), use the date the application was received at the initial forwarding agency].

4. If entering an application received in October, in the month of January or later, METS will not provide correct next year eligibility. Use 11/1 as the application date, and October eligibility and any retroactive requests must be determined in MAXIS for MA eligible household members.

 

3. Select Next when the page is complete.

4. Select the “I Agree” box at the bottom of the Privacy Agreement to indicate the applicant signed the paper application. Then select Next (Figure 5).

Figure 5.

About You Section

Tips:

• Use correct punctuation. Double check for correct data entry and spelling before submitting.

• If the Application Filer is not requesting health care coverage, the next household member added to the case must be requesting coverage.

Example: Mom, dad, and child are listed on the application. Only the child is applying for coverage. Enter members in this order: Mom, child, dad.

• If there is a Safe at Home (SAH) address reported on the application, follow Step 2D in the Safe at Home instructions under METS Applications to ensure the residential and mailing address are entered properly.

1. Review the About You Section and Select Next.

2. Answer: “Are you applying for yourself?”

 

1. Select Yes if the application filer is applying**.**

2. Select No if the application filer is not applying.

 

3. Complete the fields in the Your Details section.

Notes:

• If applicant is deceased, enter Date of Death.

• If defaulting Sex to female, send an RFI (DHS-3271) to inform the applicant of the following using gender-neutral language:

“Our current benefits system requires that we enter either male or female to process your application. Policy is to enter “female” by default if you are not able to select one of these two options, if your sex is unknown or if you reported you are pregnant. You can change that selection by contacting your worker. We understand that these limited selections do not fit all Minnesotans and we apologize that we must enter your information this way.”

4. Enter information in Your Home Address if it did not pull over from the Registration Process.

Notes:

• To prevent possible returned mail, the USPS Zip Code Look-up can be used to validate an enrollee’s address before updating the evidence.

• Both METS and MMIS have character limits that affect how addresses print on notices.

  • Street Address Line 1 in METS: 22 characters (including spaces).

  • Street Address Line 2 plus Apt/Suite combined in METS: 22 characters (including spaces).

  • These limits ensure addresses print correctly on notices generated in MMIS.

• When an applicant reports a change of address to a new county before the application is processed, use the address reported on the application. For an applicant to receive their mail at the correct address, enter the newly reported residential address as only the mailing address during application entry. This allows the correct Financially Responsible Agency (FRA) to be assigned.

• The address change can be processed after eligibility has been determined with active Product Delivery Case(s). Use the Add or Edit Address Evidence procedure to process the change in circumstance after initial eligibility has been determined.

1. Option A: Lives in MN, plans to make MN their home, not temporarily absent, not homeless:

 

1. Enter the address listed on the application in the Minnesota Address section. Do not use spacing or punctuation when entering addresses, unless noted below:

Notes:

• Apt/Suite: If applicable, enter the “#” character, followed by a space then the apartment number or suite number.

Examples: # A, # 200, # 20

• The “/” character is allowable in the Address Line 1 and Address Line 2 fields ONLY. Fractional addresses must contain the “/” character in order to properly interface to MMIS.

Examples: 134 ½ Main Street, 25 W 36 ½ Street

2. Option B: Lives in MN, plans to make MN home, not temporarily absent, homeless (ALWAYS mark as No).

Note: Always select No to homeless question. Enter either the County or Tribal Agency or General Delivery address in the Minnesota Address section.

3. Option C: Lives in MN, plans to make MN home, temporarily absent, not homeless.

 

1. Enter temporary absence information based on application.

2. Enter the address listed on the application in the Minnesota Address section.

 

5. Complete “Is the mailing address the same as your home address?” Complete the Your Mailing Address section as follows:

 

1. Option A: Select YES when no mailing address is provided on the application. The mailing address will be the same as the residential address.

2. Option B: Select NO when a mailing address is provided on the application. The mailing address should be entered in the mailing address fields.

Note: The Application Filer must have both residential and mailing address information.

6. Complete “Do you plan to make Minnesota your home?” Enter the response provided by the applicant.

7. Complete “Did you move to Minnesota in the last three months?” If Yes, enter the date the person moved to Minnesota.

8. Complete Other Contact Information.

 

1. Preferred Contact Method is required. Always select Mail.

Note: The options on the paper application are Email and U.S. Postal Mail, while the options for the online application are Email, Mail, and Phone.

2. Phone Number – Always enter this information when provided. It is not a mandatory field. Phone number will populate if entered during registration. Select Type: Choose appropriate choice from the drop-down menu if it did not pull over from the Registration Process.

Note: The options on the online application are Business, Fax, Home, Mobile, Other, and Pager while the options on the paper application are Cell, Home, and Work.

3. Language spoken at home defaults to English; modify as needed.

4. Written language defaults to English; modify as needed.

5. Complete “Do you want us to send you a voter registration card?”.

6. Always select Mail to answer the question: “How do you prefer to receive notices?”

 

9. Select No to the question: “Do you want us to send you a form to name someone as your Authorized Representative?”

Note: This question is not asked on the paper application. The paper application instead asks if the applicant wants to assign someone to act on their behalf as an authorized representative. If the question on the paper application is not answered or the response is “No”, follow-up is not required. If the applicant answers “Yes”, the paper application instructs them to complete Appendix C, which is attached to the application.

10. Answer: “Are you applying for yourself?” Enter the response provided on the paper application.

Note: This is worded “Are you applying for health care coverage for yourself?” on the paper application.

11. Select Next when the page is complete.

More About You Section

1. Complete the Race and Ethnicity section of the More About You page using answers provided by the applicant. These questions are optional. If they are not completed on the paper application, proceed to the next step.

2. Complete the Additional Information section of the More About You page:

 

1. Do not enter spaces or dashes when entering the Social Security number (SSN). The SSN will prepopulate if entered during registration or if added to the person record before starting of application. Verify that the SSN is correct or enter it when prompted.

Note: Correct the prepopulated SSN if it is incorrect. The system requires entering the SSN twice to confirm. To continue with application entry, both SSN fields must match. Copy and paste is not allowed for this field.

2. If the applicant answers No to “Do you have a Social Security Number?”, additional questions are displayed.

   1. If “Have you applied for an SSN?” is answered No, then an additional question is asked.

   2. If “Reason why you do not have an SSN?” has “other” selected, then an additional question is asked. If “Does [Applicant Name] want assistance in applying for an SSN?” is not answered, Default to Yes.

3. Answer: “Are you a US Citizen?” with the answer provided on the application.

Note: The paper application has “Are you a US Citizen or US national?” as one question. The online application asks it as two separate questions.

4. Answer: “Are you a US National?” with the answer provided on the application. This question only appears if the answer to being a US Citizen is answered as No.

Enter Yes or No to “Are you lawfully present in the United States?”, based on the response to “Do you have an immigration status listed here?”

Note: If the applicant answers “No” to “Do you have an immigration status listed here?”, the applicant is attesting to being not lawfully present and having an immigration status of undocumented.

5. Select the Immigration status attested on the application following Enter Immigration Status in METS procedure. If information is gathered from an active MAXIS case, include that information in your case note.

   1. If applicant answered Yes on “Do you have an immigration status listed here” but did not check a box, select “Other” during application entry and case note that response.

6. The following questions are asked based on the immigration status entered:

   1. “Date of Entry”: Enter date provided on the application.

   2. “Supporting Document”: Enter based on response to “Immigration document type”.

Notes:

• The I-94 number must be an 11-digit number.

• The SEVIS ID must start with N and followed by 10 digits.

• The Alien Number (A-Number) must start with A and followed by 9 digits (if less than 9 digits, add leading zeros).

• The Immigration Card Number should start with three capital alpha characters followed by 10 digits.

• For Nonimmigrant Visas, select Unexpired Foreign Passport.

  1. “Did you enter the Unites States before August 22, 1996”: Enter Yes or No as indicated on the application.

  2. “Have you resided in the United States for five or more years in a qualified status”: Enter Yes or No based on the response to “Have you had your current status for five years or more?”.

  3. “Did you ever have a Refugee, Asylee, Amerasian Noncitizen, Cuban/Haitian Entrant, Conditional Entrant, Victim of Severe Trafficking (LPR or T Visa), Withholding of Removal, Special Iraqi/Afghan Immigrant or American Indian Born in Canada (289 INA) immigration status”: Answer Yes or No based on response to “Have you previously had a different status? (example: refugee or asylee)”.

  4. “Are you an honorably discharged veteran or active duty member of the military”: Answer Yes or No based on the response to “Are you, or is your spouse or parent, a veteran or active-duty member of the military”.

  5. “Are you the spouse or dependent child of such a veteran or individual in active-duty status”: Enter Yes or No based on responses to “Are you, or is your spouse or parent, a veteran or active-duty member of the military?”

3. Answer : “Is this person currently pregnant or was recently pregnant?” with information provided on the application.

Note: The online application only displays this question if the applicant is a female between the ages of 13-64.

1. Select No if answered no on the application. No follow up questions are displayed.

2. If Yes:

 

1. Enter number of children expected.

2. Enter the due date.

 

1. Enter zero to answer the question “How many children is [person] expecting?” if the person was recently pregnant.

2. Enter End Date if [person] was recently pregnant.

 

4. Answer: “Is this the correct Social Security Number?” This is a mandatory field and must be completed to continue.

Note: The displayed SSN on this page is pulled over from the SSN entered on the previous page (More About You in the Additional Information section). Verify that the SSN displayed is correct.

1. Select Yes if the displayed SSN is correct and matches what the applicant provides. No follow up questions are asked.

2. Select No if the displayed SSN is incorrect and does not match what the applicant provided.

 

1. Enter in the provided SSN in the Social Security Number field.

2. Re-enter the reported SSN in the Re-enter Social Security Number field to confirm.

 

5. Complete Supporting document details if displayed based on response to “A-number or ID number” and “Document no” from the application. The fields vary based on the supporting document type selected for applicants who reported non-citizenship status.

6. Answer the following question, which only appears in METS if the person is between ages 18 and 26: “Were you in Foster Care on your 18^(th) Birthday?” This is worded “Was anyone in foster care on that person’s 18^(th)birthday?” in step 4, question 7 of the paper application.

 

1. Select No if the applicant answered No. No follow up questions are displayed.

2. Select Yes if applicant answered Yes. Additional questions will display and are required to be answered.

 

1. What state were you in Foster Care? – this defaults to Minnesota. Select the state indicated by the applicant if the state is not Minnesota.

2. “Were you getting health care through Medical Assistance or another state’s Medicaid program?” enter Yes or No based on applicant’s response to the application question, “Was this person getting healthcare through Medical Assistance or another state’s Medicaid program?”

 

7. Select Next.

Household Section

Tips

• Enter everyone who is:

 

• Living with the Application Filer. [This includes all children (younger than 19) living with the Application Filer even if someone outside of the home claims them as a tax dependent.]

• All tax dependents even if they live outside the home, including tax dependents that live outside of the United States.

• Married people who file a joint return.

 

• If a household member already exists in a legacy system, enter their name as listed in those systems unless a legal name change has been reported on the application.

• When a household member is already known to METS, enter their information exactly as it is listed in METS to prevent the creation of duplicate records.

• For tax dependents living outside of the home:

 

• The same information required for other household members is also needed for these individuals, along with their current address.

• Additional information for entering a tax dependent who lists an address outside of the U.S. is noted in the instructions.

 

• If the Application Filer is not applying for health care assistance, then the next household member added to the case must be applying for assistance.

Example: Mom and Dad are applying only for the minor child. Enter the mom as the Application Filer. The next person added to the case must be the child, then any other household members.

• A request to add an infant to an application that has not yet been processed should not be completed. This would be a change in circumstances to add the infant to the case after entering the initial application.

Example: An application is received on March 31. On April 10, the mother calls the office to report that they had the baby today. The application is being processed on April 20. The application should be entered using March 31 as the application date and stating yes to the pregnancy questions. After the application has been entered, then add the infant to the IC as a change in circumstance.

Instructions

1. Review the Household Section and Select Next.

2. Answer yes or no to the question: “Are others in the household?” Select Next.

 

1. If selecting No because there are no other household members, proceed to the Tax Filer Information section of this procedure.

2. Select Yes to continue and add additional household members starting with step 3.

3. Continue to select Yes to this question until all members are added using instructions starting with step 3.

 

3. Complete the Household Member Details page for Person and all additional household members.

4. Complete the Contact Details section for Person 2.

 

1. Complete “Does the Person live with the Applicant”?

 

1. If yes, complete “Does this Person plan to make Minnesota their home?”

2. Complete if the person is temporarily absent from Minnesota.

 

2. If Person does not live with the applicant, answer the following questions:

 

1. “Does this person live in Minnesota?”

2. “Does this person plan to make Minnesota their home?”

3. “Is this person temporarily absent from Minnesota?”

4. “Did this person move to Minnesota in the last three months?”

5. “Did this person enter Minnesota with a job commitment or to seek employment”

 

3. Address Fields: Enter the address provided for the person.

Notes:

• For tax dependents who live outside of the U.S., enter the Application Filer’s home address. After submitting the application, follow the Tax Dependents Who Live Outside the U.S. procedure to update the case with the correct address information, and case note the actions taken.

• Contact the Application Filer if the household is applying for a tax dependent living outside of the U.S. The tax dependent living outside the U.S will not be eligible for health coverage.

4. “Does this person plan to make Minnesota his/her home?”: Enter answer provided.

5. If this person is not applying, no further details are required. However, if their SSN was provided, enter their SSN on the next page.

 

5. Complete the SSN Confirmation if it displays. This will appear if an SSN is entered in the previous page. Answer “Is this the correct Social Security Number?” This is a mandatory field and must be completed to continue.

Note: The displayed SSN on this page pulled over from the SSN entered on the previous page. Verify the SSN is correct.

1. Select Yes if the displayed SSN is correct and matches what the applicant provided. No further follow up questions are asked.

2. Select No if the displayed SSN is incorrect and does not match what the applicant provided.

 

1. Enter in the reported SSN in the Social Security Number field.

2. Re-enter the reported SSN in the Re-enter Social Security Number field to confirm.

 

6. Complete the Household Member Extra Details section for Person 2:

 

1. Answer the Ethnicity and Race questions using answers provided on the application. These questions are optional. If they are not completed on the paper application, proceed to the next step.

2. Follow steps 2-6 from More About You for Person 1 to enter information for SSN, citizenship, pregnancy, and foster care.

3. Select Next.

 

7. Review More People? Application Entry Section:

 

1. Check for accuracy.

2. Select Yes to the question: “Do you need to add any more people?” if there are more household members to add.

3. Complete steps 1-6 from Household Section above for the person.

4. Continue to select Yes to the question: “Do you need to add any more people?” until all household members are added.

5. Select No to the question: “Do you need to add any more people?” once all household members have been added.

6. Select Next.

Relationships Section

1. Complete the Relationships page by identifying the relationships of each household member. Multiple pages may display dependent on the number of people in the household.

2. Select Next when all relationships to Person 1 have been identified.

3. Identify the relationships of household members to Person 2 if applicable. Select Next when complete.

4. Select Next after all Relationship pages are complete to proceed to the Tax Filer section.

Tax Filer Section

1. Complete the Tax Filer Information page by selecting all household members who intend to file a federal tax return for the current tax year.

2. Select Next when complete.

3. Complete the Tax Filing Status page if applicable by indicating if married people intend to file a joint tax return.

4. Complete the Tax Dependent Information page by indicating who, if anyone, anticipates claiming this person as a dependent. Additional Tax Dependent Information pages will display for each dependent in the household.

 

1. If the answer is Yes, select the person who will claim them.

Note: When a married couple indicates on the previous page they will file jointly, only the Application Filer will display as an option to claim the child as a dependent.

2. If the person is not claimed as a dependent by anyone in the household, additional questions appear asking if anyone outside of the household claims the person as a dependent. Answer these questions based on the responses on the application.

3. Select Next when the page is complete.

 

5. Review the Household Summary page. Workers can Add, Change or Remove information from this page for all household members except Person 1. To make changes to Person 1, select the Getting Started menu item on the left tool bar.

 

1. Select the link next to the information that requires updating.

2. Select Next once information has been reviewed, and any necessary changes are complete.

Income Section

Tips

• METS provides direction and information such as income definitions that change based on the information entered.

• Do not use any Income Information Retrieved if it is displayed, even if it matches the applicant’s attestation.

 

• Select Remove for all income if METS auto-populates any income information, then enter attested income manually on the next screen.

 

• Enter the Amount and Frequency attested to on the application. Calculations are made based on the attested information entered.

• For self-employment or farm income loss, see Business Loss Procedure.

• Income pages display for all household members. Continue to enter income information until all income from all household members is documented.

• METS is programmed to determine if a household member is required to file taxes based on the income entered and if their total taxable income is below the tax-filing threshold.

• METS is programmed to exclude the income of a child (regardless of age) who:

 

• Is included in the household of his or her biological, natural, adopted or stepparent, and:

• Is not expected to be required to file a tax return for the taxable year that MA-FCA is being determined.

 

• METS is programmed to exclude the income of a tax dependent who:

 

• Is not the spouse or child of the tax filer or joint tax filer, and:

• Is not expected to be required to file a tax return for the taxable year that MA-FCA is being determined.

RSDI income

Retirement, Survivors, and Disability Insurance (RSDI) is counted for both MA and MinnesotaCare. It is part of the Modified in MAGI income methodology.

Note: RSDI income for certain children and tax dependents may be excluded. The DHS-6696 no longer asks applicants to report if Social Security income is non-taxable.

1. Consider the following when a child or tax dependent has RSDI income:

 

1. When a child or tax dependent receives only RSDI income and no other income, enter the total RSDI amount as tax-exempt in the income section.

Note: Enter the Projected Annual Income (PAI) as $0.01, and after submitting the application, edit the PAI evidence and change it to $0.00.

2. When a child or tax dependent receives RSDI income and other income, use the Child and Tax Dependent Income Deeming resource to determine the tax-filing threshold and if their income is taxable. If the income is taxable, enter all income into METS. Do not list any income as tax-exempt.

Note: Include all income in the PAI.

Definitions of Income Types

Information displays during application entry based on the income type selected for an individual. The details below reflect what METS displays and how each income type should be interpreted.

Wages before taxes

“Report how much [person] currently makes in wages and tips before taxes are deducted. Do not include amounts deducted from wages by the employer for childcare, health insurance or retirement plans that are not taxable (sometimes called ‘pre-tax deductions’).”

“If [person] is seasonally employed, report the amount of wages you expect [person] will receive in the next 12 months. If [person] expects to receive unemployment in the next 12 months, be sure to select “Yes” on the last question and you will be able to enter an unemployment record with the amount of unemployment you expect [person] will receive in the next 12 months.”

Alimony

“Report how much [person] currently receives each month in alimony if the divorce or separation agreement is dated on or before December 31, 2018. Do not report alimony received as income if the divorce or separation agreement is dated after December 31, 2018. For more information, see IRS Publication 17 at www.irs.gov.”

Alimony is a payment made to a former spouse under a divorce or legal separation court document.

• Alimony received from a divorce decree or separation agreement finalized on or after January 1, 2019, is not taxable and is not countable income under the MAGI Methodology.

• Alimony received from a divorce decree or separation agreement finalized before January 1, 2019, is countable income under the MAGI Methodology.

• If a divorce decree or separation agreement modified on or after January 1, 2019, and the modification expressly applies the new tax law, alimony received after the modification date is not countable.

American Indian Alaska Native Income

The following income is excluded under the MA-FCA income methodology for American Indian and Alaska Native people:

• Alaska Native Corporations and Settlement Trusts.

• Property held in trust located within the boundaries of a prior Federal reservation or under supervision of the Secretary of the Interior.

• Rents, leases, rights of way, royalties, usage rights, natural resource extraction or harvest from trusts or properties, or resulting from the exercise of federally protected rights.

• Real property ownership interests related to natural resources and improvements.

• Ownership interests or usage rights to items of religious, spiritual, traditional, or cultural significance or which support subsistence or traditional lifestyle.

• Student financial assistance provided by the Bureau of Indian Affairs educations programs.

Interest/Dividends

“Report how much [person] currently receives in interest and dividend payments. Include both taxable and tax-exempt income. If [person] anticipates receiving this income in the next 12 months, list an annual amount of how much you expect [person] will receive in the next 12 months.”

Self-Employment

“Report [persons] current monthly net income from self-employment. Net income is gross revenue minus expenses. If the income varies from month to month, report the amount you expect to receive in the next 12 months.”

Retirement/Pension

“Report how much [person] currently receives each month in retirement or pension income. Report the gross amount.”

Farm Income

“Report [persons] monthly net income from farming. Net income is gross revenue minus expenses. If the income varies from month to month, report the amount you expect to receive in the next 12 months.”

Rental or royalty income

“Report [persons] current monthly net rental or royalty income. Net income is gross revenue minus expenses. If the income varies from month to month, report the amount you expect to receive in the next 12 months.”

Taxable Scholarships, Awards and Grants

“Report how much [person] currently receives in taxable scholarships, awards, and grants income.”

Social Security Benefits

“Report how much [person] currently receives each month in Social Security benefits. Social Security benefits are Title II income. Title II Social Security benefits include retirement, disability and Railroad Retirement benefits.”

“Supplemental Security Income (SSI) is not Title II income.”

“Report the gross amount before any deductions. Include both taxable and tax-exempt income.”

Taxable One-Time Income (i.e., prizes, awards, gambling winnings)

“Report any one-time or lump sum taxable income [person] received this month or expects to receive this month. This includes prizes, awards, and gambling winnings.”

Note: Enter using “One Time Only” as the income frequency. Lump sum income is counted only in the month received for MA. It must always be included in the PAI.

Minnesota Paid Leave

“Report how much <first name> currently receives from Minnesota Paid Leave. If the Minnesota Paid Leave is for medical reasons, report the taxable amount.”

Unemployment Insurance

“Report how much [person] currently receives each week in unemployment insurance (UI). Report the gross amount before taxes.”

When determining UI for PAI, include the amount already received plus remaining expected payments for the year.

“If [person] is seasonally employed and receives UI, record UI as yearly. After entering the UI as a yearly amount select “Yes” on the last question and enter the seasonal income as a yearly amount you expect [person] will receive in the current year.”

Other Taxable Income

“Report how much [person] currently receives each month in other taxable income. If unsure whether the income is taxable, visit the IRS website at www.irs.gov (link to the Internal Revenue Service website). If [person] anticipates receiving this income in the next 12 months, provide an average monthly amount of how much you expect [person] will receive over the next 12 months.”

Post 9/11 Veteran Service Bonus Payments

Post 9/11 Veteran Service Bonus payments are not taxable and must not be counted as income for MA or included in PAI.

Instructions

1. Review the Income Section and Select Next.

Note: When Wages before taxes is selected for income type, an Employer Details section displays. Enter the employer name listed on the proofs, if provided. Enter the Employer Identification Number (EIN) when available. The EIN must be 9 digits. A validation message will display when entered incorrectly.

2. Complete the Income Information page and select Next when the page is complete.

3. Complete the Enter Income Details page when a person has income:

 

1. Use the amount and frequency attested to on the application. If hourly is indicated, calculate the annual income.

Notes:

• Bi-Weekly is equivalent to every two weeks (26 pay periods per year).

• Semi-Monthly is twice a month (24 pay periods per year).

• Do not use the Daily option.

2. Continue until all sources of income are entered for the person.

 

1. Select Yes for “Does [person] have any more income” to enter another income type.

2. When all income has been entered for the person Select No for “Does [person] have any more income?”

 

4. Select Next to display Additional Income Details page.

5. Complete the Additional Income Details page for questions displayed.

 

1. Complete the question: “Did hours decrease or was wages/salary reduced in the last 6 months?” based on information reported on the application.

2. Select Next when complete.

 

6. Complete the Income Adjustments page which will display when a person has previously entered income.

 

1. Select Yes if the applicant has Adjustments, then select Next.

2. Select No if the applicant has no Adjustments, then select Next.

Income Adjustment Types

Alimony Paid

Alimony paid under a divorce decree or separation agreement finalized on or after January 1, 2019, is not an allowable adjustment under the MAGI methodology for MA or MinnesotaCare.

Alimony paid from a divorce decree or separation agreement finalized before January 1, 2019, is an allowable adjustment under the MAGI Methodology for MA or MinnesotaCare.

Alimony paid from a divorce decree or separation agreement modified on or after January 1, 2019, and the modification expressly provides for the alimony tax law changes apply, then the alimony received on or after the date of modification is not an allowable adjustment under the MAGI Methodology.

Moving Expenses

The moving expense adjustment is permitted only for households that include active-duty military members who move due to a military order and permanent change in station.

For all other households, moving expenses adjustments are not permitted under the MAGI methodology for MA or MinnesotaCare.

Instructions

1. Complete the Income Adjustment Items page if the applicant has adjustments.

 

1. Enter all Income Adjustments as an annual amount.

2. If more than one adjustment of the same is reported, add them together and enter a single amount.

Example: Fred states student loan interest #1 of $100 monthly and Student loan interest # 2 interest of $100 per quarter. This must be entered as one Student Loan Interest Income Adjustment of $1,600 annually.

3. Each adjustment type selected will display help text directly below the household members.

4. Continue until all Adjustment Types are entered, and select No for “Does [Person] have any more income adjustments?”

6. Select Next when each entry is complete.

 

2. Complete the Projected Annual Income Page for all household members.

 

1. METS uses the income and adjustment information previously entered to calculate PAI.

2. Compare the system calculated PAI to the amount listed on the application.

 

1. If the applicant lists a different amount on the application:

 

1. Select No.

2. Enter the expected PAI as reported on the application.

3. Select Next.

 

2. If the PAI is as expected, select Yes.

Notes:

• Do not check the Worker Estimated PAI Checkbox for current year PAI. Applicants always need to attest to a current year PAI.

• Use the Worker Estimated PAI Checkbox Scenario procedure to help identify situations where it is appropriate to check this box.

3. Enter next year’s PAI when processing in METS from October through December, as the system will require both current year and next year PAI evidence for all household members.

Note: The date METS begins requiring next year PAI is the same date that January MA/MinnesotaCare cases are selected for renewal in October.

Additional Household Information Section

1. Review the Additional Household Information Section and Select Next.

Note: The screens mentioned in this section may not all display or may be displayed in a different order based on information entered during the application entry process.

2. Complete the Additional Information for Medicaid/CHIP page by selecting the box under any person that meets the criteria.

 

1. Do not select anyone for the following questions, as they are not asked on the paper application:

 

1. “Do any of these people have a communicable disease (HIV, AIDS, tuberculosis, hepatitis, etc.)?”

2. “Do any of these people have a terminal illness?”

3. “Have any of these people been determined as being seriously and persistently mentally ill or as being severely emotionally disturbed?”

4. “Is anyone applying receiving Minnesota Supplemental Aid (MSA)?”

 

2. “Do any of these people have a sponsor?” – only select if the person has reported an LPR status and has indicated they have a sponsor.

3. The question “Do any of these people need health care coverage to pay for a medical emergency?” may appear at the bottom of this screen based on the household member’s immigration status.

   1. Do not select anyone here, even if they reported an emergency on the application.

   2. Case note the medical emergency request in METS.

   3. County Worker: Process the medical emergency request in MAXIS following Process Requests for Emergency Medical Assistance (EMA) procedure after the application is entered.

   4. HCCS: Create a Task:

SUBJECT: EMA Determination Needed.
TYPE: Follow-Up Needed.
PRIORITY: High.
DEADLINE: 30 days from today.
CASE PARTICIPANT: List the member requesting EMA.
CASE REFERENCE: List the IC number.
ASSIGNMENT DETAILS: Assign to the county of financial responsibility.
COMMENTS: EMA determination needed for (list member requesting EMA).

Note: No EMA task will generate for this case because no person is selected here.

4. The question “Does any child on the application have a parent living outside of the home” may appear at the bottom of this screen based on household relationships.

 

1. Select “Yes” if a child under age 19 in the household is applying for assistance and there is a parent living outside of the home.

 

5. Select Next.

 

3. Complete the Employer Sponsored Coverage Information page.

 

1. Select all household members who currently have coverage or access to coverage through an employer.

2. Select Next.

Note: If no household members have coverage or access to coverage through an employer, leave all household members unchecked and select Next.

4. Review the answer to the question “Is [household member] enrolled in health insurance through an Employer?”.

Notes:

• If the Employer Name is unknown, enter unknown.

• If the Employer Identification Number (EIN) is unknown, enter 999999999.

• If the Employer Address is unknown, enter Unknown, Saint Paul, Ramsey, MN 55101.

1. Answer “Yes” when the person is enrolled in employer sponsored coverage. Coverage may be through the person’s own employer or through another person’s employer.

 

1. Complete the Additional Information of Employer page using information from Step 3 of the DHS-6696.

2. Under the Coverage Details section, select all household applicants that are enrolled in this employer sponsored plan.

 

1. Complete entry of employer sponsored coverage information for any additional household members that may have been selected.

 

2. Answer No when the person is not enrolled, but has access to the employer sponsored coverage.

 

1. Complete the Additional Information on the Employer Sponsored Coverage page for each household member with access to employer sponsored coverage as reported on Appendix A.

   1. If the applicant is not the employee, only answer Yes to “Is [household member] the spouse or tax dependent of the employee?” if the applicant is married and files taxes jointly with the employee or is a tax dependent of the employee.

   2. Self-only and family cost must be entered as whole numbers with a value greater than zero. Enter $1 if either plan is reported as costing $0 or free.

   3. The conditional self-only and family coverage questions do not generate if the employer does not offer a self-only plan that meets the minimum value standard (MVS).

   4. If a person is marked as the spouse or tax dependent of the employee, and the self-only coverage meets MVS, the application will ask the appropriate family coverage questions to determine MVS and affordability for those household members.

Note: Applicants who have access to employer sponsored coverage that meets both the minimum value and affordability standards are ineligible for MinnesotaCare.

5. Select Next when all information has been entered and completed.

6. Complete the Additional Information for all Applicants.

 

1. Answering Yes by selecting the check boxes for relevant household members.

2. Select the box for anyone who meets the criteria for the question.

3. Select No to the question “Does anyone applying want to request a full Medicaid eligibility determination?”

4. Answer “Is anyone applying an American Indian or Alaska Native (AI/AN)?” based on the applicant attestation to the question, “Are you or is anyone in your family American Indian or Alaska Native?” in step 4 of the Paper Application*.* If not answered, default to no.

Note: Do not use demographic information to answer this question as demographics are optional and applicants have the option to not apply as an AI/AN if they choose to regardless of their demographics.

1. Complete the Additional Information as listed below for each selected person using the attested information on the Appendix B.

 

1. Select Yes or No for “Is applicant a member of a federally recognized tribe?”

 

2. If Yes, enter the tribal name and whether or not the applicant lives on a reservation.

 

3. Tribal Identification Number: Leave blank if not provided. This field is not required.

4. Enter No to the question “Is client receiving or have they ever received a service from the Indian Health Service, a tribal health program, or through a referral from one of these programs?”

5. Select Next.

 

5. The question “Does anyone applying have Medicare or other non-employer health insurance?” may need to be answered “Yes” when entering cases into METS.

Notes:

• Hospital Presumptive Eligibility (HPE) is not considered other health insurance.

• Do not select Yes for a child under 21 during a re-entry if Continuous MA eligibility must be continued from the previous case.

• Examples for when to answer Yes to this question include:

 

• Migration (person is closing in MAXIS/MMIS and migrating to METS).

• Applications.

• If the person has recently moved to Minnesota and had Medicaid from another state.

• Case Re-Entry cases.

Exception: When a child(ren) under age 21 was eligible for MA on a previous case and must have Continuous MA eligibility continued on the new case.

1. Complete the Additional Information as follows for each selected person:

 

1. Select Medicaid in another state for “What kind of health insurance does [person] have?”

2. Select the appropriate state for “Which state is providing the service?”

Note: Select Minnesota if the person is closing in MAXIS/MMIS, such as for Migration or Case Re-entry.

3. If coverage is ending in next two months, select Yes and enter the Coverage End Date.

4. Select Yes or No for “Does [person] have additional insurance?”

 

6. Answer Yes or No to “The start date for Medical Assistance (MA) can go back up to three months from your application date if you have medical bills from that time and meet the MA eligibility requirements. Is anyone applying seeking MA for past months?” based on the applicant’s response to “Do you want help from Medical Assistance (MA) to pay for medical bills from the past three months?”

Note: If any applicants who are requesting retro MA were identified as closing on their most recent IC due to PDM non-compliance, do not select that applicant as seeking MA for past months. METS will not automatically deny that request when processed by the system alone and individuals are not eligible for retroactive coverage during months of PDM non-compliance. Send the (DHS-3954) Retro MA Denial notice to these individuals informing them their retro MA request was denied due to PDM non-compliance.

1. Enter the answers based on the information on the application or obtained from the applicant:

 

1. “Please select the past month(s) in which you have medical bills.”

2. If the exact months are the only missing item, use the following default:

• Select all three months displayed for “Please select the past month(s) in which you have medical bills?”

• Select No for “Is everything you told us on the application the same for past months?”

Note: The months displayed for selection during application entry are generated based on the application date entered. Select any combination of the months requested.

3. Enter Yes or No to “You are seeking MA coverage for a past month, is everything you told us on this application the same for the past months?”

 

7. Answer No to “Should any child receive continuous eligibility for MA?” if the question appears at the bottom of this screen.

Note: This question is only answered Yes when directed in the Case Re-Entry procedure.

8. Answer Yes or No to “Did <member> meet an exception to the federal work or community engagement requirement last month?” with the response provided on the application form.

Note: If the questions were not answered on the application received, follow the Work or Community Engagement Worker Checklist to determine if the agency is already aware of exceptions or qualifying activities.

1. Answer Yes if the person met an exception last month.

   1. Select the checkbox for each exemption.

   2. Select Next.

2. Answer No if the person did not meet an exception last month.

   1. Select Next.

 

9. Answer Yes or No to “Did <member> complete a qualifying activity last month?”.

   1. Answer Yes if the person completed a qualifying activity last month.

      1. Select the checkbox for each qualifying activity.

      2. Select Next.

   2. Answer No if the person did not complete a qualifying activity last month.

      1. Select Next.

10. Review the Summary data. Workers can Add, Change or Remove information from this page for all household members except to Person 1. To make changes to Person 1, select the Getting Started on the left tool bar.

Note: This is the last opportunity to make changes before submission.

11. Select the link next to any information that requires updating.

12. Select Next when complete.

13. Complete the Submit Application Form page by selecting all 5 checkboxes.

 

1. “Select the Acknowledgement of yearly renewal.”

2. “Select the Acknowledgement of Rights and Responsibilities.”

3. “Select the Acknowledgement to report changes.”

4. “Select the Acknowledgement of penalty of perjury.”

5. “Select the Acknowledgement of the following:

 

1. Consent/Sharing of Information

2. Medicaid Payment

3. Parent/Medical Support

4. Medicaid Repayment (Overpayment or Fraud)”

 

6. Select Submit.

 

14. Submit the Application.

 

1. Select the length of time to renew coverage with Federal Tax Information (FTI) from the drop-down as indicated on the application.

Note: If the answer is blank on the application, default to 5 years.

2. Select the checkbox confirming the client has been made aware of the renewal options and has selected the same.

3. Select Submit.

Post Application Processing

Review Results

METS displays the Person Home screen for the Application Filer.

1. Select the Home tab to view Pending Application and Current Cases information.

Note: Background processing may require some time. Refresh the session if unable to view the Integrated Case and eligibility results.

2. Review for the creation of an IC.

 

1. If an IC was created, continue to step 3.

2. If an IC was not created:

 

1. Follow Review, Authorize or Deny Pending Cases procedure to authorize an Application Case (AC) when METS did not create an IC.

2. Follow Re-entering Problem Applications if an AC is repeatedly stuck in the following statuses:

• Authorization Failed.

• Authorization in Progress.

• Disappears into the PIE queue more than once.

3. Review the eligibility results using the Review Eligibility Results procedure.

   1. If results remain pending in the system, Review for items to verify.

      1. If the agency has proof of any items to verify, continue to step 4.

      2. If the agency does not have proof of any items to verify, continue to step 5.

      3. If the eligibility is not as expected, utilize the ONEsource chapter Health Care Helpful Information.

4. Follow the Add Proof to a Verification Item procedure to resolve any items to verify of which the agency has proof.

Note: At initial application an applicant can be approved for MA or MinnesotaCare before providing proof of Post Eligibility Verification Items. For MHCP, the post-eligibility items that a servicing agency must verify are:

• SSN.

• Citizenship.

• Immigration status or lawful presence.

• PAI.

5. Follow the Reasonable Opportunity Period (ROP) Verification Items procedure to review a case that has outstanding post eligibility items to verify.

   1. If the agency does not have proof for any items to verify, continue to step 6.

   2. If able to resolve all pre-eligibility verification items follow the Activate Approved MA PDC procedure.

6. Follow the Review Eligibility Results procedure to confirm eligibility determinations are correct and that no conflicting PDC determinations exist for any household members. Check determinations to ensure that all eligibility begin dates are correct on the PDCs.

7. Follow Review System Generated Notices procedure for accuracy. Follow the Manually Create a Health Care Notice procedure to create and send the applicable notice in the following situations:

   1. No system notice is generated.

   2. The system generated notice is inaccurate.

   3. A program change, change in basis of eligibility, or closure of any public program occurred or will occur before the next renewal date.

Notes:

• Provide the enrollee with the effective date their current coverage will end.

• Send a Request for Information (RFI) (DHS-3271) if there are items to verify that are not listed on the system generated notice.

8. Follow the Authorized Representative Information on the Integrated Case procedure to add AREP information on the IC.

Additional Case Worker Actions

Once an application has been submitted, either by an applicant using the citizen portal or through the worker portal from a paper application or case re-entry, assigned agencies are required to take additional actions. Follow the Case Assignment and Initial Worker Actions procedure.

Note: When the question, “Does any child on the application have a disability determination or a condition you believe is disabling, and need additional services or supports?” is answered yes, the DHS-6696 must be used to process an eligibility determination for TEFRA if the child is not eligible for MA-FCA because the household income is above the MA-FCA income limit. An additional application is not required. Follow the Processing MA-TEFRA in MAXIS procedure. Determine if a SMRT referral is needed.

Case Interface and Completion

1. Review MMIS to confirm coverage interfaced correctly from METS. If interface was not successful, track and review MMIS again after 24 hours. Follow the Interface and Unhandled Server Errors Guide if interface was not successful after 24 hours.

2. Follow the Managed Care Enrollment Guide to mail information or update a managed care plan, if necessary.

3. Follow the Temporary Absence MMIS Exclusion and Disenrollment procedure to determine if an MA applicant or enrollee needs to be excluded from managed care due to a Temporary Absence.

4. Review Financially Responsible Agency (FRA) evidence if any household members have become newly MA eligible. If evidence does not exist, add it using Add, Edit or Correct Financially Responsible Agency Evidence instructions and apply the new evidence.

How to Add Navigator/Assistor/Broker Information to Evidence

1. When Appendix C is included with the paper application, follow the instructions in the Add or Edit Navigator Assistor Broker Evidence procedure to add this information to the IC, then apply changes.

Case Note

1. Add a Case Note to an IC using the following template.

Subject: Application entry process complete.** ** Body:
Application Date:
Date entered in METS:
Income:
PAI:
Resolved Items to Verify (Y/N):
If Yes, what was resolved?
Tasks created (if any):
Changes processed after application entry:
Eligibility:
Notices sent (if any):
Required post-entry follow up actions:
Other: (Pregnant/Auto Newborn information, immigration status information, other actions taken, etc.)
Interface:

2. Add a separate case note for adult without children enrollees to record all work or community engagement exceptions and/or qualifying activities that are attested to using the following templates:

 

1. Case Note Template: Adult Without Children Work or Community Engagement Exemptions.

 

2. Case Note Template: Adult Without Children Work or Community Engagement Qualifying Activities.

3. Case Note Template: Adult without Children No Work or Community Engagement Attestation.