This article is a section taken from MA for Families with Children and Adults (MA-FCA), a part of the revisions and additions to the Minnesota Health Care Program Eligibility Policy Manual.
To be eligible for Medical Assistance for Families with Children and Adults (MA-FCA) a person’s income must be less than or equal to the applicable income limit. Income limits are based on federal poverty guidelines.
Federal Poverty Guidelines
The U.S. Department of Health and Human Services (HHS) issues federal poverty guidelines (FPG) each year. New guidelines are used beginning each July 1.
These guidelines determine income eligibility for MA-FCA. A person’s applicable income limit is based on many factors, including, but not limited to:
- The basis of eligibility for Medical Assistance (MA)
- The number of people included in the family size
- Whether the person has a medical spenddown for MA
Income Limits for Medical Assistance for Families with Children and Adults
The following income limits determine eligibility for MA -FCA:
- Pregnant women: less than or equal to 278% FPG
- Infants under 2: less than or equal to 283% FPG
- Children’s Health Insurance Program (CHIP) funded MA may be available for infants with income between 275% and 283% FPG who are not enrolled in other health insurance
- Children 2 through 18: less than or equal to 275% FPG
- Children 19 and 20: less than or equal to133% FPG
- Parent and caretaker relatives: less than or equal to 133% FPG
- Adults without children: less than or equal to 133% FPG
- Transition Year MA (TYMA) second six months: less than or equal to 185% FPG
Auto newborns and former foster children younger than age 26 have no income limit.
See the Minnesota Health Care Programs Income and Asset Guidelines (DHS-3461A) for more information regarding family size and income limits.
Five Percent FPG Disregard
When the person’s income is above the income limit, an income disregard equal to 5% FPG is applied. When the person’s income, minus the disregard, is within the income limit, they qualify for MA-FCA. This disregard effectively raises the MA-FCA income limits by 5%.
Safety Net Provision
In certain situations, a person’s income may be greater than his or her income standard for MA –FCA and be less than the MinnesotaCare income standard due to differences in how income is calculated for each program. This results in ineligibility for both programs. This may occur when:
- A lump sum is counted in the month received under the MA-FCA income methodology but counted as annual income using the MinnesotaCare income methodology.
- Sponsor income is counted in the household income using the MA-FCA income methodology, but not counted in the MinnesotaCare income methodology.
- A child younger than the age of 19 has income greater than the MA-FCA income limit but has projected annual income less than 100% FPG for MinnesotaCare eligibility. This can happen because MA-FCA and MinnesotaCare have different household composition and family size policies.
- Current income is used in the MA-FCA income methodology, but projected annual income is used for the MinnesotaCare income methodology.
When these situations arise, people are eligible for MA if their projected annual income is below 100% FPG using the MinnesotaCare income methodology. People whose projected annual income is equal to or greater than 100% FPG, but equal to or less than 133% FPG using the MinnesotaCare income methodology are eligible for MinnesotaCare.
Code of Federal Regulations, title 42, section 435.100
Code of Federal Regulations, title 42, section 435.116
Code of Federal Regulations, title 42, section 435.118
Code of Federal Regulations, title 42, section 435.119
Code of Federal Regulations, title 42, section 435.603
Minnesota Statutes, section 256B.05
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.