Minnesota Health Care Programs

Medical Assistance

Medical Assistance (MA) is a health care program for individuals under the age of 21, adults with children, pregnant women, disabled persons, and low–income single adults. MA pays all or most of an individual’s medical bills. It covers routine checkups, prenatal care and delivery, hospital and doctor care, prescriptions, dental care, chemical dependency treatment and mental health care. Adults may have some copays for some services, but there are no copays for children. MA will pay up to three months’ worth of past medical bills for eligible individuals.

Eligibility
Eligibility is based on income, family size, children’s ages, and whether a person is blind or disabled. See guidelines for particular eligibility criteria below:

Adults with Disabilities Not Eligible for Medicare who chooses to qualify for Medical Assistance under the expansion group will not be eligible for waiver programs or spenddowns.

Eligibility guidelines will remain at 100% FPG for Adults with Disabilities Not Eligible for Medicare who chooses to participate in waiver programs.  These individuals will continue to be eligible for a spenddown (spenddown to 80% FPG).

Eligibility guidelines will remain at 100% FPG for Adults with Disabilities Eligible for Medicare.  These individuals will continue to be eligible for a spenddown (spenddown to 80% FPG).

Medical Assistance for Employed Persons with Disabilities (MA–EPD)

Medical Assistance for Employed Persons with Disabilities (MA–EPD) is a work incentive program that allows working people with disabilities to qualify for Medical Assistance (MA) under higher income and asset limits than standard MA. People enrolled in MA–EPD has access to the same health care services as regular MA. Monthly premiums are based on earned and unearned income. The minimum premium is $35. Program HH pays MA-EPD premiums.

How to apply
Medical Assistance is administered by county human services offices. The process of applying for MA differs depending on simultaneous Medicare eligibility. There are two methods to apply for MA:

1. MNsure
Individuals without Medicare can apply online through MNsure, Minnesota’s health insurance marketplace: http://www.mnsure.org. Contact Benefits Counseling at the Minnesota AIDS Project if you have questions or would like assistance completing an online application through MNsure.

2. Application for Certain Populations
Individuals with Medicare can apply using the Application for Certain Populations (DHS-3876), located on mn.gov/dhs under General Public and Publications, forms, and resources. Individuals may also choose to apply in person at the nearest County Human Services Department or request an application from the Minnesota Department of Human Services:

Health Care Eligibility and Access
PO Box 64989
St. Paul, MN 55164-0989

Phone: (651) 431-2283 or (888) 938-3224
Fax: (651) 431-7423

A list of County Human Service Departments and their contact information are available on the Minnesota Department of Human Services website. Contact Benefits Counseling at the Minnesota AIDS Project if you have questions or need assistance in filling out an application. We also have applications available on-site: (612) 373-2468.

MA eligibility is redetermined annually. MA enrollees will receive a notice from the Department of Human Services when it is time for renewal. The notice will explain whether any action needs to be taken by the enrollee, or if the redetermination will be automatic.

Frequently Asked Questions

Do I need to be a U.S. citizen to qualify?
Applicants must either be U.S. citizens or have acceptable immigration status (lawfully present for five or more years). People without immigration documentation are not eligible for MA. However, pregnant women and people receiving services from the Center for Victims of Torture are exempt from this requirement and can receive MA if they are undocumented. Care for an undocumented pregnant woman will continue up to 60 days after delivery. Her infant may continue to receive medical care through MA.

What does it mean to be “certified disabled” for the purposes of MA eligibility?
In order to be considered disabled for the purposes of receiving MA, you must be certified as disabled. You are certified disabled if you receive Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). If you do not receive these benefits but believe you are disabled, contact your county human services agency, and they can ask the State Medical Review Team to assess your disability.

How is it possible to qualify for MA with a “spenddown”?
If you are a senior or disabled and your income is more than $1,012 a month, then you are not eligible for MA but may qualify for MA with a “spenddown.” A spenddown is like an insurance deductible. If you qualify for MA with a spenddown, you pay part of your medical expenses and MA pays the rest. Once your spenddown has been “met,” MA can pay the rest of the eligible medical expenses.

Here’s an example: Joseph is blind, 65 years old or older, or disabled. Joseph earns $1,010 per month. He must spenddown is to 80% of the Federal Poverty Guideline (FPG). (Note: the %FPG requirement of your spenddown is dependent upon your eligibility category). Joseph’s spenddown: $1,020 – $810 = $210/month

Each month, Joseph will pay the first $210 in medical expenses and MA will pick up medical expenses above $210.

Emergency Medical Assistance

Emergency Medical Assistance (EMA) is limited health coverage available to people in an emergency or those with a chronic illness. An emergency is an injury that will result in death if not immediately treated; this includes giving birth. EMA covers physical or mental health emergencies as well as chronic medical conditions, including some very limited HIV complications which place the person’s health in serious jeopardy. EMA also covers dialysis. EMA typically does not cover preventive care, immunizations, family planning, or organ transplants.

Eligibility
EMA coverage is limited to care related to an emergency. EMA is available to immigrants regardless of their immigration status. Outside of immigration status, the guidelines for EMA are the same as Medical Assistance (MA).

How to Apply
Hospitals and Transitional Care Units employ staff that can help individuals apply for EMA at the time of an emergency.  EMA coverage can backdate three months. If you have an emergency-related medical bill from the last three months and were not on EMA at the time of service, you may apply for EMA using the Application for Certain Populations (DHS-3876). EMA is administered by county human services offices. Individuals can apply in person at the nearest County Human Services Department, download and print applications from the Minnesota Department of Human Services website: https://edocs.dhs.state.mn.us or request an application from the Minnesota Department of Human Services at:

Health Care Eligibility and Access
PO Box 64989
St. Paul, MN 55164-0989

Phone: (651) 431-2283 or (888) 938-3224
Fax: (651) 431-7423

You can contact the Benefits Counseling Program at the Minnesota AIDS Project if you have questions or need assistance in filling out an application: (612) 373-2468.

MinnesotaCare

MinnesotaCare (MCRE) is a reduced–cost health coverage program for families with children and some adults who do not have access to employer–sponsored insurance, Medicare, or whose employer-sponsored or private insurance does not meet affordability standards under the Affordable Care Act. People on MCRE are responsible for copays of $6 for generic and $20 brand-name drugs, $15 for office visits, and a $25 copay for eyeglasses. MCRE does not pay for any past medical bills.

MCRE enrollees are responsible for a monthly premium. Coverage usually begins the month after the first premium is paid. Persons under 21, American Indians or Alaska Natives, and military personnel who have completed a tour of duty in the last 24 months are not required to pay a premium. MCRE premiums are based on income and family size and can be no more than $80. A Premium Estimator Table is available online on the Minnesota Department of Human Services website.

*Children 18 and under who qualify for MA will no longer be eligible for MinnesotaCare. Children 19 and 20 may only qualify for MinnesotaCare if their income is between 138% and 200% FPG, with no asset limit. Children ages 19 and 20 may purchase insurance through Minnesota’s health insurance marketplace, MNsure, if their or their parents’ income exceeds 200% FPG.

How to apply
Individuals can apply online through MNsure, Minnesota’s health insurance marketplace (www.mnsure.org). Contact Benefits Counseling at the Minnesota AIDS Project with questions or if you would like assistance completing an application through MNsure.

FAQs

Do applicants need to be U.S. citizens to qualify? Applicants must still be U.S. citizens or legally residing residents of the United States to qualify for MinnesotaCare. They must also be residents of Minnesota. Everyone applying for MinnesotaCare (including children) must have a Social Security number or be willing to apply for one. Individuals who would otherwise be eligible for Medical Assistance because of income but who have not had lawful status in the US for five years may enroll in MCRE.

What are the “affordability guidelines” necessary for employer-sponsored insurance plans to meet to make applicants ineligible for MCRE? Applicants with employer-subsidized insurance that meets the following requirements will not be eligible for MinnesotaCare: 1)The insurance plan covers at least 60% of the total allowable health costs. 2) The employee pays no more than 9.69% of his/her income on the insurance premium.