This article is a section taken from Medical Assistance (MA), a part of the revisions and additions to the Minnesota Health Care Program Eligibility Policy Manual.
Medical Assistance (MA) Begin and End Dates
Medical Assistance (MA) eligibility and coverage are separate concepts:
Eligibility refers to when a person meets the MA eligibility rules.
Coverage refers to when a person can receive MA benefits.
Generally, MA eligibility and coverage begin and end dates are the same. However, there are situations where eligibility and coverage do not begin or end on the same day. Differences are explained on the policy pages for the types of MA listed below. The eligibility and coverage begin and end dates may not be the same in the following situations:
The coverage and eligibility end date exceptions described below
When an MA enrollee received coverage for a month they were not eligible for MA, an overpayment may exist. See the MHCP Overpayment policy for more information.
Eligibility Begin Date
MA eligibility begins the first day of the month that a person meets the program eligibility rules. It can begin no earlier than the first day of the month of application if a person does not request retroactive coverage or is not eligible for retroactive coverage. Retroactive coverage can begin no earlier than the first day of the month, three months before the month of application. People must meet all eligibility requirements in each retroactive month to have coverage in that month, and people may be eligible for some but not all months prior to the month of application.
If a request for an eligibility determination does not require a new application, the month the request for coverage is received is the application month.
Generally, people who meet all eligibility requirements at any time during a month are eligible for the entire month. The exceptions are:
When a person is born, eligibility can begin no earlier than the date the person was born.
When a person moves to Minnesota, eligibility can begin no earlier than the date the person became a Minnesota resident.
When a person is approved for a spenddown, eligibility begins the date the person meets their spenddown.
Coverage Begin Date
MA coverage begins the same date MA eligibility begins.
Eligibility End Date
When an MA enrollee reports a change in circumstances that results in the loss of MA eligibility, the MA eligibility generally ends on the last day of the month in which the change occurred. The exceptions are:
When an MA enrollee dies, eligibility ends the date the person died.
When the change occurred too late in the month to send a 10-day advance notice, MA eligibility ends the last day of the month following the month in which the change occurred.
When an MA enrollee reports a change in circumstance that maintains MA eligibility but results in a beneficial or adverse action, the existing MA eligibility ends the day before the new eligibility begins.
Coverage End Date
MA coverage ends if an MA enrollee no longer meets the eligibility requirements or becomes incarcerated.
Coverage End Date due to Ineligibility
When a MA enrollee reports a change in circumstance that results in the loss of MA eligibility, MA coverage ends the last day of the month for which advance notice can be given. Generally, 10-day advance notice is needed to end MA coverage. See the MHCP Notices policy for specific situations that require less than 10-day advance notice.
Coverage End Date due to Incarceration
When a MA enrollee is incarcerated in a state prison, county detention facility, or city jail the enrollee must report the incarceration. MA coverage ends the date of incarceration.
Code of Federal Regulations, title 42, section 431.213
Code of Federal Regulations, title 42, section 435.907
Code of Federal Regulations, title 42, section 435.915
Minnesota Rules, part 9505.0110
Minnesota Rules, part 9505.0015, subpart 5
Minnesota Rules, part 9505.0085
Minnesota Statutes, section 256B.04
Minnesota Statutes, section 256B.08
Minnesota Statute 256B.056, subd.7
Minnesota Statute 256B.061
CREDIT: The content of this post has been copied or adopted from the Minnesota Healthcare Programs Eligibility Policy Manual, originally published by the Minnesota Department of Human Services.
This is also part of a series of posts on Minnesota Healthcare Eligibility Policies.