Medical Assistance (MA), Minnesota’s Medicaid program, provides payment for health care services provided to low-income persons who belong to an eligible group, and who meet income and asset limits and other eligibility requirements.

Eligible groups include the elderly, persons with disabilities or who are blind, families and children, pregnant women, and adults without children. MA income and asset limits vary across the different eligibility groups.

The federal government pays a share of the cost of state MA expenditures. This is referred to as the federal medical assistance percentage (FMAP). Minnesota’s FMAP for covered services is 50 percent. Minnesota pays the remaining 50 percent for most services (some services have a county share).1

Eligibility for the elderly

In order to be eligible for full coverage of MA services as elderly, an individual must:

  • be age 65 or older;
  • have net income that does not exceed the program income limit for the elderly of 100 percent of federal poverty guidelines (FPG) ($990/month for one-person households and $1,337/month for two-person households);2
  • meet the program asset limit of $3,000 for an individual and $6,000 for two persons in a household, with $200 added for each additional dependent3 (The homestead, household goods, and other specified items are not considered assets when determining eligibility); and
  • meet requirements related to citizenship and residency.

Individuals who do not meet the MA income limit may qualify through a spenddown. An individual who is elderly can qualify under a spenddown by incurring medical bills in an amount that is greater than the amount by which his or her income exceeds the MA spenddown limit for the elderly of 80 percent of FPG ($792/month for one-person households and $1,070/month for two-person households).

Spousal asset division

When one spouse of a married couple seeks MA coverage for care in a nursing facility or other long-term care services under the Elderly Waiver, or alternative care, for a continuous period expected to last at least 30 consecutive days, the MA program divides the total assets of the married couple and calculates a protected spousal share for the spouse remaining in the community. The protected spousal share is equal to one-half of all nonexempt assets owned by either spouse, subject to a minimum and maximum amount set by law.4

The spouse remaining in the community can retain the protected spousal share. The spouse receiving long-term care services must reduce his or her assets to the MA asset limit of $3,000, but may in some cases transfer assets to the community spouse, either to bring the assets of the community spouse up to the spousal share minimum or to raise the income of the community spouse and dependent family members to specified minimum levels.

Eligibility for Medicare cost-sharing

Certain Medicare enrollees who do not meet the income and asset standards for full coverage of MA services are eligible for MA coverage of Medicare cost-sharing only. Medicare enrollees who qualify for full coverage of MA services also qualify for coverage of Medicare cost-sharing as QMBs.

Medical assistance cost-sharing

Federal law requires Medicaid cost-sharing to be “nominal.” Cost-sharing does not apply to pregnant women and children, and other exceptions apply. MA enrollees are subject to the following cost-sharing:

  • $3 for nonpreventive visits
  • $3.50 for nonemergency visits to a hospital ER
  • $3 per brand-name drug/$1 per generic ($12 per month limit). Antipsychotic drugs are exempt from copayments when used to treat mental illness.
  • A monthly family deductible of $2.85 (adjusted annually by the increase in the medical care component of the Consumer Price Index for all Urban Consumers)

In Minnesota, the MA payment rate for providers is reduced by the amount of the copayment. Providers cannot deny services to enrollees who do not pay the copayment. Total monthly cost-sharing is limited to 5 percent of family income.

The content of this and any related posts has been copied or adopted from the Minnesota House of Representatives Research Department’s Information Brief, Long-Term Care Services for the Elderly, written by legislative analyst Danyell Punelli.

1 For example, counties are responsible for 20 percent of the cost of nursing facility placements of persons with disabilities under age 65 that exceed 90 days. For this and other required county shares, see Minnesota Statutes, section 256B.19, subdivision 1.

2 The federal poverty guidelines are updated every year, usually in February. New DHS income standards based on the updated guidelines are effective July 1 of each year.

3 In addition, if an applicant for MA payment of long-term care services has exhausted benefits under a private sector long-term care insurance policy issued on or after July 1, 2006, that qualifies under the state’s long-term care partnership program, an amount of assets equal to the dollar amount of benefits paid out under the qualifying policy is disregarded for purposes of determining eligibility for MA payment of long-term care services. These assets are also protected against estate recovery and are not subject to asset transfer penalties.

4 For more information on the division of spousal assets, see the House Research information brief Medical Assistance Treatment of Assets and Income, August 2016.

5 Ongoing funding for coverage of qualifying individuals was provided by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), H.R. 2, Pub. L. No. 114-10, signed into law on April 16, 2015. Prior to this, funding was renewed periodically by the U.S. Congress.

6 The Supplemental Security Income asset limit is $2,000 for an individual and $3,000 for a married couple.