256L.04 Eligible persons. 

    Subdivision 1.    Children; expansion and continuation of 
 eligibility.  (a)    Children.  Prior to October 1, 1992, 
 "eligible persons" means children who are one year of age or 
 older but less than 18 years of age who have gross family 
 incomes that are equal to or less than 185 percent of the 
 federal poverty guidelines and who are not eligible for medical 
 assistance without a spenddown under chapter 256B and who are 
 not otherwise insured for the covered services.  The period of 
 eligibility extends from the first day of the month in which the 
 child's first birthday occurs to the last day of the month in 
 which the child becomes 18 years old. 

    (b)    Expansion of eligibility.  Eligibility for 
 MinnesotaCare shall be expanded as provided in subdivisions 3 to 
 7, except children who meet the criteria in this subdivision 
 shall continue to be enrolled pursuant to this subdivision.  The 
 enrollment requirements in this paragraph apply to enrollment 
 under subdivisions 1 to 7.  Parents who enroll in the 
 MinnesotaCare program must also enroll their children and 
 dependent siblings, if the children and their dependent siblings 
 are eligible.  Children and dependent siblings may be enrolled 
 separately without enrollment by parents.  However, if one 
 parent in the household enrolls, both parents must enroll, 
 unless other insurance is available.  If one child from a family 
 is enrolled, all children must be enrolled, unless other 
 insurance is available.  If one spouse in a household enrolls, 
 the other spouse in the household must also enroll, unless other 
 insurance is available.  Families cannot choose to enroll only 
 certain uninsured members.  For purposes of this section, a 
 "dependent sibling" means an unmarried child who is a full-time 
 student under the age of 25 years who is financially dependent 
 upon a parent.  Proof of school enrollment will be required.  

    (c)    Continuation of eligibility.  Individuals who 
 initially enroll in the MinnesotaCare program under the 
 eligibility criteria in subdivisions 3 to 7 remain eligible for 
 the MinnesotaCare program, regardless of age, place of 
 residence, or the presence or absence of children in the same 
 household, as long as all other eligibility criteria are met and 
 residence in Minnesota and continuous enrollment in the 
 MinnesotaCare program or medical assistance are maintained.  In 
 order for either parent or either spouse in a household to 
 remain enrolled, both must remain enrolled, unless other 
 insurance is available. 

    Subd. 2.    Cooperation.  To be eligible for 
 MinnesotaCare, individuals must cooperate with the state agency 
 to identify potentially liable third party payers and assist the 
 state in obtaining third party payments.  "Cooperation" 
 includes, but is not limited to, identifying any third party who 
 may be liable for care and services provided under MinnesotaCare 
 to the enrollee, providing relevant information to assist the 
 state in pursuing a potentially liable third party, and 
 completing forms necessary to recover third party payments. 

    Subd. 3.    Families with children.  Beginning October 
 1, 1992, "eligible persons" means children eligible under 
 subdivision 1, and parents and dependent siblings residing in 
 the same household as a child eligible under subdivision 1.  

    Subd. 4.    Continuation of eligibility.  Beginning 
 October 1, 1992, individuals who initially enrolled in the 
 MinnesotaCare program under the eligibility criteria in 
 subdivision 1 or 3 remain eligible even if their gross income 
 after enrollment exceeds 185 percent of the federal poverty 
 guidelines, subject to any premium required under section 
 256L.07, as long as all other eligibility requirements are met 
 and continuous enrollment in the MinnesotaCare program or 
 medical assistance is maintained. 

    Subd. 5.    Families with children; eligibility based on 
 percentage of income paid for health coverage.  Beginning 
 January 1, 1993, "eligible persons" means children, parents, and 
 dependent siblings residing in the same household.  Children who 
 meet the criteria in subdivision 1 or 6 shall continue to be 
 enrolled pursuant to those subdivisions.  Persons who are 
 eligible under this subdivision or subdivision 3, 4, or 7 must 
 pay a premium as determined under sections 256L.07 and 256L.08, 
 and children eligible under subdivision 1 must pay the premium 
 required under section 256L.06, subdivision 1.  Individuals and 
 families whose income is greater than the limits established 
 under section 256L.08 may not enroll in MinnesotaCare.  

    Subd. 6.    Children with lower incomes.  Beginning July 
 1, 1993, the definition of "eligible persons" is expanded to 
 include children who are one year of age or older but less than 
 18 years of age who have gross family incomes that are equal to 
 or less than 150 percent of the federal poverty guidelines and 
 who are not eligible for medical assistance without a spenddown 
 under chapter 256B and who are not otherwise insured for the 
 covered services.  The period of eligibility extends from the 
 first day of the month in which the child's first birthday 
 occurs to the last day of the month in which the child becomes 
 18 years old.  The commissioner shall exclude all earned income 
 of dependent children who: 

    (1) are full-time or part-time students; 

    (2) are employed for less than 37.5 hours per week; and 

    (3) earn less than $10,000 a year in total from all sources 
 of employment, when calculating gross family incomes for 
 applicants who would otherwise be eligible under this 
 subdivision.  

    Subd. 7.    Addition of single adults and households with 
 no children.  (a) Beginning October 1, 1994, the definition of 
 "eligible persons" is expanded to include all individuals and 
 households with no children who have gross family incomes that 
 are equal to or less than 125 percent of the federal poverty 
 guidelines and who are not eligible for medical assistance 
 without a spenddown under chapter 256B.  

    (b) Beginning July 1, 1997, the definition of eligible 
 persons is expanded to include all individuals and households 
 with no children who have gross family incomes that are equal to 
 or less than 175 percent of the federal poverty guidelines and 
 who are not eligible for medical assistance without a spenddown 
 under chapter 256B. 

    (c) All eligible persons under paragraphs (a) and (b) are 
 eligible for coverage through the MinnesotaCare program but must 
 pay a premium as determined under sections 256L.07 and 256L.08.  
 Individuals and families whose income is greater than the limits 
 established under section 256L.08 may not enroll in the 
 MinnesotaCare program. 

    Subd. 8.    Applicants potentially eligible for medical 
 assistance.  Individuals who apply for MinnesotaCare who 
 qualify under section 256L.04, subdivision 7, but who are 
 potentially eligible for medical assistance without a spenddown 
 shall be allowed to enroll in MinnesotaCare for a period of 60 
 days, so long as the applicant meets all other conditions of 
 eligibility.  The commissioner shall identify and refer such 
 individuals to their county social service agency.  The enrollee 
 must cooperate with the county social service agency in 
 determining medical assistance eligibility within the 60-day 
 enrollment period.  Enrollees who do not apply for and cooperate 
 with medical assistance within the 60-day enrollment period, and 
 their other family members, shall be disenrolled from the plan 
 within one calendar month.  Persons disenrolled for 
 nonapplication for medical assistance may not reenroll until 
 they have obtained a medical assistance eligibility 
 determination for the family member or members who were referred 
 to the county agency.  Persons disenrolled for noncooperation 
 with medical assistance may not reenroll until they have 
 cooperated with the county agency and have obtained a medical 
 assistance eligibility determination.  The commissioner shall 
 redetermine provider payments made under MinnesotaCare to the 
 appropriate medical assistance payments for those enrollees who 
 subsequently become eligible for medical assistance. 

    Subd. 9.    General assistance medical care.  A person 
 cannot have coverage under both MinnesotaCare and general 
 assistance medical care in the same month. 

    Subd. 10.    Sponsor's income and resources deemed 
 available.  When determining eligibility for any federal or 
 state benefits under sections 256L.01 to 256L.16, the income and 
 resources of all noncitizens whose sponsor signed an affidavit 
 of support as defined under United States Code, title 8, section 
 1183a, shall be deemed to include their sponsors' income and 
 resources as defined in the Personal Responsibility and Work 
 Opportunity Reconciliation Act of 1996, title IV, Public Law 
 Number 104-193, sections 421 and 422, and subsequently set out 
 in federal rules. 

    Subd. 11.    MinnesotaCare outreach.  (a) The 
 commissioner shall award grants to public or private 
 organizations to provide information on the importance of 
 maintaining insurance coverage and on how to obtain coverage 
 through the MinnesotaCare program in areas of the state with 
 high uninsured populations.  

    (b) In awarding the grants, the commissioner shall consider 
 the following: 

    (1) geographic areas and populations with high uninsured 
 rates; 

    (2) the ability to raise matching funds; and 

    (3) the ability to contact or serve eligible populations. 

    The commissioner shall monitor the grants and may terminate 
 a grant if the outreach effort does not increase the 
 MinnesotaCare program enrollment. 

    HIST: 1986 c 444; 1992 c 549 art 4 s 5,19; 1993 c 247 art 4 s 
 5; 1993 c 345 art 9 s 4-6; 1994 c 625 art 8 s 52-55,72; art 13 s 
 2; 1995 c 234 art 6 s 6-9; 1997 c 85 art 3 s 9; 1997 c 203 art 
 12 s 1; 1997 c 225 art 1 s 4-8