Medical Assistance

Medical Assistance

Medicaid is a federal program in which the federal government matches money from the state to help people pay for their health care. In Minnesota, the Medicaid program is called Medical Assistance (MA). It is overseen at the state level by the Minnesota Department of Human Services (DHS) and is administered at the local level by each county in the state.

MA covers all medically necessary health care services, including long term care services needed by many people with disabilities. Each person must meet a basis of eligibility and must then also meet income and asset limits. MA can pay retroactively for up to three months of health care services (from the date of application) if the person meets eligibility requirements.

For information specific to your situation, contact your county financial worker or your county economic assistance office.

General information about Medical Assistance for Minnesotans with disabilities

Each person must meet a basis of eligibility. Eligibility bases are established by federal eligibility categories. To be eligible, you must be:

  • Certified blind or disabled through the Social Security Administration or the State Medical Review Team (SMRT) age 65 or over
  • Pregnant
  • Under age 21
  • A parent or caretaker of a dependent child

Income and Asset Limits for Minnesotans with disabilities

After the person establishes a basis of eligibility (disabled, aged, etc.), they must then meet asset and income limits.

Asset limits for Minnesotans with disabilities

  • $3,000 limit for a single person
  • $6,000 limit for a family of two
  • $200 for each additional dependent

Assets can include checking and savings accounts, stocks, bonds, 401(k) accounts, other savings and retirement plans or things like a house, car, burial funds, life insurance, etc. Some assets do not count for MA purposes, such as:

  • $1,500 prepaid burial or Cash Surrender Value (CSV) life insurance
  • Burial space items
  • A vehicle under certain conditions
  • The home you live in
  • Household, personal goods and some business assets

Income limits for Minnesotans with disabilities

In addition to the asset limits, the individual must also meet income limits. There are many sources of income that the MA program does not count, including, but not limited to:

  • Food support
  • Loans (except student loans)
  • Section 8 Housing Assistance
  • Vocational Rehabilitation Payments
  • Disaster relief
  • MFIP, GA and MSA
  • SSI and all income used to determine SSI eligibility, including 1619(b) eligibility
  • Tax rebates

If a person with a disability has countable income under the limit shown below for their household size, they are eligible for Medical Assistance at no cost, except co-pays (effective 7/1/17 – 6/30/18):

Household size

Maximum Countable Income per Month (100% of Federal Poverty Guidelines)

1

$1,005

2

$1,354

3

$1,703

4

$2,052

5

$2,401

6

$2,750

If a person with a disability has countable income greater than the amount listed above, they may still be eligible for MA, However, they may need to pay a spend down in order to receive assistance. A spend down is the amount of money a person has to pay out-of-pocket for health care expenses each month before MA starts to pay for the rest of their health care bills. Certain types of income are not counted in determining the spend down amount.

The limits are as follows (effective 7/1/17 – 6/30/18):

Household size

If countable income is above…

Must spend down to 80% of the Federal Poverty Guidelines…

1

$1,005

$804

2

$1,354

$1,083

3

$1,703

$1,362

4

$2,052

$1,641

5

$2,401

$1,920

6

$2,750

$2,199

People with disabilities who work may be eligible for Medical Assistance for Employed People with Disabilities (MA-EPD). Those on MA-EPD pay a premium each month, which is generally less than the spend down they would have to pay for regular MA. Click here for information on MA-EPD.

Co-pays for MA

Whether an individual receives MA at no cost or has to pay a spenddown, they must make co-payments when they receive certain services:

  • $3 for non-preventive office visits
  • $3 for eye exams, eye glasses
  • $3.50 for non-emergency ER visits
  • $1 for generic prescription drugs and $3 for name-brand drugs, with a maximum monthly co-pay of $12 for all MA-funded prescription drugs

Contact your health care providers to find out if you have to pay a co-pay for their services. There are no co-pays or dollar limits at all on services for children under 21, people in long term care facilities or pregnant women.

Medical Assistance coverage

Some of the services covered by MA in Minnesota are:

  • Physicians services
  • Inpatient and outpatient hospital care
  • Lab and x-ray
  • Home health and personal care assistance services
  • Physical, occupational, speech, respiratory and rehabilitative therapies
  • Prescription drugs
  • Group homes for people with mental retardation
  • Mental health treatment
  • Eye exams, glasses, and hearing aids
  • Medical equipment and supplies
  • Dental services
  • Medical transportation services
  • Chemical dependency treatment
  • Private duty nursing
  • Chiropractic
  • Nursing facilities
  • Family planning
  • Hospice care
  • Other health care services

If you have other health insurance that the State determines is cost effective, MA may also pay the premiums for that insurance.

How to apply for Medical Assistance (MA)

Call or go to your county economic assistance office. If you only want to apply for MA, you will be asked to complete a Health Care Programs Application Form (HCAPP). If you also want to apply for Minnesota Supplemental Aid, Food Support or other cash assistance, you will be asked to complete a Combined Application Form (CAF) and have an interview.

Continuing Medical Assistance (MA) coverage

Every six months, MA recipients are asked to complete and return a Household Report Form with updated information about income, assets and family size. The county financial worker reviews each individual's situation to determine continuing eligibility for MA. Always complete, sign and date all forms sent by MA. If you do not respond, you could lose your MA coverage.

Additional information

More information can be found on the Medical Assistance page at the MN Department of Human Services.