mnsure

applications

100

A new application is required in the following situations:

200.15.10 Application Requirements •An applicant requests an eligibility determination and no person in the applicant’s household is currently active or determined eligible for an Insurance Affordability Program (IAP). •A cash or Supplemental Nutrition Assistance Program (SNAP) enrollee or applicant requests a health care eligibility determination and no person in the household has been determined eligible for an IAP. •A person is removed from a household and that person is not pending or enrolled in an IAP, or is not joining a household that is enrolled or whose eligibility is pending for an IAP.

200

A new application is not required in the following situations:

200.15.10 Application Requirements •Denied Applicant: A denied applicant requests a new eligibility determination within 10 days of their denial. •Active or Pending Household: ◦A current enrollee requests a new type of health care coverage. ◦When adding a person to the household. ◦When removing a person who is pending or enrolled in an IAP or Qualified Health Plan (QHP). Initial or continued eligibility is determined for the remaining household members. ◦When automatic eligibility for Medical Assistance (MA) ends. ◦An active or closed enrollee requests a new eligibility determination

300

People may continue to apply for health care using ApplyMN for the following health care programs:

200.15.05 Applications for Insurance Affordability Programs •Minnesota Family Planning Program (MFPP) •Medical Assistance for Breast Cervical Cancer (MA-BC) •Payment of services in a long-term care facility (LTCF) •Medical Assistance payment of long-term care services (LTC)

400

what are certification periods

200.15.30 Certification Periods All Minnesota Insurance Affordability Programs (IAPs) require eligibility be redetermined at specific intervals. These redeterminations are called renewals. The period of time a person can be active before the next renewal is due is called a certification period. The month for which eligibility is being renewed is called the renewal month. The renewal month is the first month of the new certification period. The certification period begins the month of application. Approval of retroactive coverage does not affect the certification period.

500

Renewal Signature The application filer must sign the renewal when a renewal signature is required. true or false

200.15.35 Signature false MinnesotaCare and Advanced Premium Tax Credit The application filer must sign and return the renewal notice within 30 days. The signature ensures the enrollee accepts the financial responsibility imposed on a person accepting an advance payment of the premium tax credit as part of the reconciliation process. However, if the enrollee does not sign and return the renewal within the 30-day period, continued eligibility is determined using available information.

Advanced Premium Tax Credit

100

what are the Advanced Premium Tax Credit and Cost Sharing Reduction Begin and End Dates

400.20.05 Advanced Premium Tax Credit and Cost Sharing Reduction Begin and End Dates Generally, coverage begins on January 1. The benefit year for APTC is from January 1 through December 31.

200

Applicants and enrollees must be informed of their responsibilities. These responsibilities include:

400.05.05 Client Responsibilities for Advanced Premium Tax Credit •providing accurate and complete information as requested. •completing applications and necessary forms truthfully. •attesting to the validity of eligibility requirements. •reporting changes timely. •providing needed verifications.

300

The household composition for Advanced Premium Tax Credit (APTC) includes the following people:

400.10.15 Household Composition for Advanced Premium Tax Credit •Tax filer •Tax filer's spouse •All tax dependents the taxpayer expects to claim for the benefit year, except unborn babies

400

People enrolled or eligible to enroll in any of these MEC programs are ineligible for APTC. name 3

400.10.20 Minimum Essential Coverage for Advanced Premium Tax Credit ◦Government-sponsored coverage •Medicare Part A, Part B or Medicare Supplement •Medical Assistance •Medical Assistance in another state •Children’s Health Insurance Program (CHIP) •CHIP in another State •TRICARE •CHAMPUS •Veteran’s health care and related programs if enrolled •Coverage obtained through another state's health care marketplace •Peace Corps •Minnesota Comprehensive Health Association (MCHA) •Pre-Existing Condition Insurance Plan (PCIP) •Refugee Medical Assistance (RMA) •Medicare Advantage Plans •Non-appropriated Fund Health Benefits Program (NAF) of the Department of Defense

500

Whose Income Counts for Advanced Premium Tax Credit

400.15.10 Whose Income Counts for Advanced Premium Tax Credit •The taxpayer and spouse •Tax dependents expected to be required to file a federal income tax return

Financial Eligibility for MinnesotaCare

100

There is no asset limit for MinnesotaCare. t or f

500.15.20 Assets for MinnesotaCare There is no asset limit for MinnesotaCare.

200

Financial eligibility for Minnesota Care is determined using the ________ methodology

500.15.05.05 MinnesotaCare Income Methodology Minnesota Care is determined using the Modified Adjusted Gross Income (MAGI) methodology

300

what are assets:

500.15.20 Assets for MinnesotaCare Assets are items of value that people own like bank accounts, stocks and bonds, cars, and real estate.

400

MinnesotaCare based on attested income and then given a reasonable opportunity to provide: name one

500.15.15 Income Verification for MinnesotaCare #4 ◦a reasonable explanation of the discrepancy, or ◦paper documentation be sent to the lead agency within 95 days.

500

The federal poverty guidelines (FPG) are issued by the U.S. Department of Health and Human Services (HHS) each ________

500.15.05 Income Standards for MinnesotaCare The federal poverty guidelines (FPG) are issued by the U.S. Department of Health and Human Services (HHS) each July.

MinnesotaCare

100

All applicants and enrollees have responsibilities under various laws. Applicants and enrollees must be informed of their responsibilities. These responsibilities include: name 2

500.05.05 Client Responsibilities for MinnesotaCare •providing accurate and complete information as requested. •completing applications and necessary forms truthfully. •attesting to the validity of eligibility requirements. •reporting changes timely. •providing needed verifications

200

Whose Income Counts for MinnesotaCare

500.10.15 Household Composition for MinnesotaCare The household composition for MinnesotaCare includes the following people: •Tax filer •Tax filer's spouse •All tax dependents the taxpayer expects to claim for the benefit year, except unborn babies

300

The following enrollees have no premium:

500.20.10 MinnesotaCare Premiums •Households that include one or more military members who have completed a tour of active duty within 24 months of MinnesotaCare eligibility are exempt from paying MinnesotaCare premiums for up to 12 months. •Households that include one or more American Indians or Alaska Natives are exempt from paying a MinnesotaCare premium. •Children younger than 21, with household income equal to or less than 200% FPG, are exempt from paying monthly premiums

400

Who is a Noncitizen?

500.10.10 MinnesotaCare for Citizens and Noncitizens Certain noncitizens are eligible for MinnesotaCare. Consult the Immigration Status and Minnesota Insurance Affordability Program Eligibility table to determine whether eligibility exists.

500

Citizenship may be verified electronically through the Social Security Administration (SSA) data match or through the _________________.

500.10.10 MinnesotaCare for Citizens and Noncitizens Verification of Citizenship Citizenship may be verified electronically through the Social Security Administration (SSA) data match or through the Federal Data Hub.

Minnesota Insurance Affordability Programs

100

MinnesotaCare is available for people who have income above the ___________ income standards and do not have affordable insurance available through an employer.

200.05 Programs Overview MinnesotaCare is available for people who have income above the Medical Assistance income standards

200

Eligibility for IAPs is evaluated in the following order:

200.10 Hierarchy for Program Eligibility 1.Medical Assistance (MA) 2.MinnesotaCare 3.Advanced Premium Tax Credit (APTC) 4.Qualified Health Plan (QHP) without Subsidy

300

what is LEP

400.05.05 Client Responsibilities for Advanced Premium Tax Credit Limited English Proficiency (LEP)

400

The applications for Medical Assistance (MA) must be processed within the following number of days from the date of application:

200.15.25 Processing Periods •15 working days for a pregnant woman •60 days for people requesting an MA eligibility determination under a disability basis of eligibility •45 days for all other applicants

500

Establishing Minnesota Residence To meet the state residency requirement, a person must:

200.25 State Residence for Minnesota Insurance Affordability Programs •reside and intend to live in Minnesota; or •if absent from the state, is still considered a resident of Minnesota. People under age 21 meet the state residency requirement if: •they live in Minnesota, or •have a non-Minnesota address but reside with a parent or caretaker who is a Minnesota resident. A person is not a resident of Minnesota if he or she is: •visiting Minnesota for medical care or other reasons. •receiving healthcare from another state.