Navigating the Minnesota Health Care Programs Eligibility Policy Manual

Welcome to the comprehensive guide to the Minnesota Department of Human Services (DHS) Minnesota Health Care Programs Eligibility Policy Manual (EPM). This manual serves as the definitive source for official DHS policies governing eligibility for Minnesota Health Care Programs, including both Medical Assistance and MinnesotaCare. It is important to note that while this manual details eligibility policies, it does not include procedural instructions or system-specific information. The policies outlined are rooted in the state and federal laws and regulations that oversee these crucial programs. For detailed legal references, please refer to the Legal Authority section.

Stay Updated with the Latest Policy Changes

To ensure you have the most current information, the DHS utilizes an Email Subscription service to announce policy clarifications and additions, effective from June 1, 2023. We encourage anyone interested in staying informed about the Minnesota Health Care Programs to sign up for the Email Subscription.

Recent Policy Updates:

Here’s a summary of recent key updates to the Minnesota Health Care Programs Eligibility Policy Manual:

February 27, 2025:
- 2.3.3.3.2.3 MA-ABD Excluded Income: Expanded the definition of excluded income to include:
  - Long-Term Services and Supports workforce incentive payments under the Minnesota Care Force Incentive program.
  - Mille Lacs Band of Ojibwe General Welfare Assistance Program benefits for Band Members who are 65 or older, or who are blind or have a disability.
- 2.3.3.2.7.9.7 MA-ABD Supplemental Needs Trust: Clarified the evaluation of trust assets, specifically noting that supplemental needs trusts established on or after July 1, 1983, may be deemed unenforceable under certain conditions. Unenforceable trusts will be evaluated as third-party established and funded trusts.
February 10, 2025:
- 2.3.3.2.7.13 MA-ABD Tribal Payments and Interests: Added a new section, Tribal General Welfare, to provide clarity on policies regarding tribal general welfare payments.
- 2.3.3.4.1 MA-ABD Spenddown Type: For Monthly Spenddown, it was clarified that eligibility for monthly spenddown requires meeting the spenddown requirement in only one month within the application processing period or any retroactive month.
December 20, 2024:
- 4.1.4.2 Minnesota Family Planning Program (MFPP) Renewals: Clarified the Reconsideration Period policy for renewals under the Minnesota Family Planning Program (MFPP).
November 27, 2024:
- Policy from Bulletin #23-21-21 DHS Eliminates Parental Fees for Children Receiving MA under the TEFRA Option and HCBS Waivers has been incorporated into:
  - 2.3.6 MA under the TEFRA Option
  - 2.3.6.1.2 MA under the TEFRA Option Parental Fees: (This section has been removed).
- 2.3.3.2.7.2 MA-ABD Retirement Funds: Clarification regarding retirement plans converted to income streams: exclusion is only applicable if the plan restricts withdrawals beyond the periodic income payments.
- Appendix F Standards and Guidelines: Revised standards and guidelines in Appendix F, effective January 1, 2025.
November 15, 2024:
- Policy from Bulletin #23-21-28 DHS Announces Key MHCP Eligibility Policies during the Unwinding Period has been incorporated into:
  - 3.2.3.2 Employer Sponsored Coverage: Updated the Affordability Standard for Employer-Sponsored Coverage. The employee’s share of annual premiums should not exceed 9.02% of the annual household income to be considered affordable.
November 1, 2024:
- 2.1.2.3 Medical Assistance County Residency : Clarified the responsibilities of the County of Service post-eligibility determination, including case management actions. The county of service is generally based on the enrollee’s residence, but for METS applications, the servicing agency is assigned by METS during pending or approved eligibility.
- 2.3.3.3.2.3 Medical Assistance for People Who Are Age 65 or Older and People Who Are Blind or Have a Disability Excluded Income: Replaced Consumer Support Grant (CSG) payments with Community First Services and Supports (CFSS) payments in the list of excluded income. Also added Long-Term Services and Supports workforce incentive payments under the Minnesota Care Force Incentive program to the excluded income list.
- 2.4.2.5 Medical Assistance for Long Term Care Income Calculations: Removed the provision that Waiver Obligation adjustments could be made retroactively without a 10-day notice.
- Appendix H Lawfully Present Noncitizens: Clarified the definition of noncitizens considered lawfully present for Minnesota Health Care Programs (MHCP) eligibility, aligning with federal guidance effective November 1, 2024. This update includes technical adjustments to the list of immigration statuses and circumstances defining lawfully present noncitizens.

Important Note: DHS stopped using manual letters for policy announcements after June 1, 2023. For manual letters published between June 1, 2016, and June 1, 2023, please refer to the EPM Archive. The front page archive is no longer maintained as of June 1, 2023, as it no longer contains eligibility policy.

Bulletins and Temporary Policy Modifications

DHS Bulletins provide timely updates on policy changes for county and tribal health and human services agencies, and other DHS partners. Keep in mind that bulletins older than two years are considered obsolete according to DHS policy. You can subscribe to the Bulletins mailing list to stay informed.

Bulletins supersede the information in this manual until they are formally incorporated. Currently, the following bulletin types are pending incorporation into the EPM:

COVID-19 Emergency Bulletins: These bulletins introduced temporary policy modifications during the COVID-19 emergency. As these are temporary guidelines, they will not be integrated into the permanent manual.

Prior versions of EPM sections are available upon request. This manual is a consolidated and updated version of the Health Care Programs Manual (HCPM) and Insurance Affordability Programs Manual (IAPM). Previous versions of policies from HCPM and IAPM can be obtained upon request.

Contact Information and Support

For any inquiries regarding the Minnesota Health Care Programs Eligibility Policy Manual, please direct your questions to the DHS Health Care Eligibility and Access (HCEA) Division. You can reach them by mail at P.O. Box 64989, 540 Cedar Street, St. Paul, MN 55164-0989, or via fax at (651) 431-7423.

Healthcare eligibility workers are required to use their agency-specific procedures for submitting policy-related questions through HealthQuest.

Legal Foundation of the Programs

The Minnesota Health Care Programs operate under a robust legal framework, including but not limited to:

Title XIX of the Social Security Act
Titles 26, 42, and 45 of the Code of Federal Regulations
Minnesota Statutes chapters 256B and 256L
Regulations from the Centers for Medicare & Medicaid Services (CMS)

Each section within the EPM includes relevant legal citations at the bottom of the page for your reference. While DHS has strived to include all pertinent legal authorities, any errors or omissions should not be interpreted as a lack of applicable legal basis. This manual is intended to provide program eligibility policy and should not be considered legal advice.

EPM Email Subscription Service

Stay informed about updates to the Minnesota Health Care Programs Eligibility Policy Manual by subscribing to email notifications. Once you create an account, you can select “Minnesota Health Care Programs Eligibility Policy Manual” to receive updates for all sections or customize your notifications by choosing specific sections of the EPM. You have the flexibility to modify your subscription preferences at any time by logging into your account.

Explore Previous Versions:

For historical policy information, you can access previous versions of the manual: