This article is a section taken from Minnesota Health Care Programs (MHCP), a part of the revisions and additions to the Minnesota Health Care Program Eligibility Policy Manual.
Minnesota Health Care Programs (MHCP) applicants and enrollees must receive written notice of decisions affecting their case. The notice provides eligibility information and information about how to appeal decisions if the applicant or enrollee disagrees.
The following notices are required:
Approval of MHCP eligibility
Application processing delays
Denial of MHCP eligibility
Ending MHCP coverage
Change in premium
Change in spenddown
- Change in eligibility for payment of long-term care services
10-Day Advance Notice
Usually, a 10-day advance notice must be sent when taking an adverse action. Adverse actions include:
Reducing eligibility (For example, increasing a premium or a spenddown)
- Reducing covered services
When a change in an eligibility factor is known in advance the notice may be sent earlier to allow more time to resolve any issue or questions.
Five-Day Advance Notice
Usually, a five-day advance notice is required before ending coverage, reducing eligibility, or reducing covered services if there is probable fraud as determined by a fraud investigator. See the MHCP Fraud policy for more information.
Sometimes an advance notice is not required before ending coverage, reducing eligibility, or reducing benefits. The county, tribal or state servicing agency must send an adequate notice no later than the date of action if:
the enrollee sends a written and signed statement clearly indicating that they want coverage ended. However, if the enrollee requests cancellation orally and does not submit a written statement, a 10-day notice is required.
the enrollee is eligible for another Minnesota Health Care Program with better benefits or less cost sharing.
the enrollee is eligible for Medicaid (MA) in another state for the same period.
the enrollee’s whereabouts are unknown and the post office returns agency mail directed to the beneficiary indicating no forwarding address, and there is no information available on an alternate way to contact the person.
the enrollee’s eligibility changes as the result of a renewal.
the enrollee provides a signed, written statement acknowledging that the result will be reduction or closure.
- the enrollee is admitted to a city, county, state, or federal correctional and detention facility where they are ineligible for further services or coverage.
All notices must include the following information:
The action taken
The reason for the action
Which household members the action affects
The effective date of the action
The legal authority for the action
The right to appeal and instructions for filing an appeal
- In cases of an action based on a change in law, the circumstances under which a hearing will be granted
Additionally, notices for processing delays must include:
The reason the application is not yet processed
- Anything the applicant or enrollee must do to complete the process
Additionally, notices related to MA with a spenddown must include:
Completed income computation worksheet
- The monthly amount of the enrollee spenddown
In some situations, neither advance nor adequate notice is required before ending coverage, reducing eligibility, or reducing covered services. Instead, a written notice is mailed the next available business day.
Notices of ending coverage, reduction of eligibility, or reduction of services may be sent after the effective dates of the action in the following situations:
When a case opening is processed after the end of an eligibility period, such as after a six-month spenddown period, and a case is opened and closed the same day
When an LTC spenddown must be adjusted for past months to reflect actual income or deductions
When the spenddown type changes from a medical spenddown to an LTC spenddown
When an enrollee’s death has been verified
- When an enrollee requests retroactive MA and is denied coverage for the retroactive months
Code of Federal Regulations, title 42, section 431.210
Code of Federal Regulations, title 42, section 431.211
Code of Federal Regulations, title 42, section 431.213
Code of Federal Regulations, title 42, section 431.214
Code of Federal Regulations, title 42, section 435.916
Code of Federal Regulations, title 42, section 435.918
Code of Federal Regulations, title 45, section 155.230
Code of Federal Regulations, title 45, section 155.515
Minnesota Rules, part 9505.0100
Minnesota Rules, part 9505.0125
Minnesota Statutes, section 256B.056
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.