Insurance Affordability Programs (IAPs) Income and Asset Guidelines

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1 DHS-3461A-ENG 1-15 Insurance Affordability Programs (IAPs) Income and Asset Guidelines Prog. Family Size MA Parents, Caretaker Relative, Children age 19-20, Adults without Children Effective 7/1/14 6/30/15 Effective 1/1/15 12/31/15 MA Children Age 2 through 18 MA Pregnant Women MA Infants under age 2 MinnesotaCare Advanced Premium Tax Credit 133% FPG 275% FPG 278% FPG 283% FPG 200% FPG 400% FPG Monthly Annually Monthly Annually Monthly Annually Monthly Annually Annually Annually 1 $ 1,293 $ 15,521 $ 2,674 $ 32,092 $ 2,703 $ 32,442 $ 2,752 $ 33,026 $ 23,340 $ 46,680 2 $ 1,743 $ 20,920 $ 3,604 $ 43,257 $ 3,644 $ 43,729 $ 3,709 $ 44,515 $ 31,460 $ 62,920 3 $ 2,193 $ 26,320 $ 4,535 $ 54,422 $ 4,584 $ 55,016 $ 4,667 $ 56,005 $ 39,580 $ 79,160 4 $ 2,643 $ 31,720 $ 5,465 $ 65,587 $ 5,525 $ 66,303 $ 5,624 $ 67,495 $ 47,700 $ 95,400 5 $ 3,093 $ 37,120 $ 6,396 $ 76,752 $ 6,465 $ 77,589 $ 6,582 $ 78,985 $ 55,820 $ 111,640 6 $ 3,543 $ 42,520 $ 7,326 $ 87,917 $ 7,406 $ 88,876 $ 7,539 $ 90,475 $ 63,940 $ 127,880 7 $ 3,993 $ 47,919 $ 8,256 $ 99,082 $ 8,346 $ 100,163 $ 8,497 $ 101,964 $ 72,060 $ 144,120 8 $ 4,443 $ 53,319 $ 9,187 $ 110,247 $ 9,287 $ 111,450 $ 9,454 $ 113,454 $ 80,180 $ 160,360 Add l $ 449 $ 5,399 $ 930 $ 11,165 $ 940 $ 11,286 $ 957 $ 11,489 $ 8,120 $ 16,240 Asset Test No Asset Test No Asset Test No Asset Test No Asset Test No Asset Test No Asset Test Note: Income guidelines are approximations only. Use this chart for general reference only. Next

2 Family Size MA Elderly, Blind, Disabled (with a spenddown) MA Elderly, Blind, Disabled (No spenddown) *MA Qualified Medicare Beneficiaries (QMB) Effective 7/1/14 6/30/15 *MA Service Limited Medicare Beneficiaries (SLMB) *MA Qualifying Individuals (QI) *MA Qualified Working Disabled Individuals (QWD) Minnesota Family Planning Program 75% FPG 100% FPG 100% FPG 120% FPG 135% FPG 200% FPG 200% FPG Monthly Annually Monthly Annually Monthly Annually Monthly Annually Monthly Annually Monthly Annually Monthly Annually 1 $ 730 $ 8,760 $ 973 $ 11,676 $ 993 $ 11,916 $ 1,187 $ 14,244 $ 1,333 $ 15,996 $ 1,965 $ 23,580 $ 1,945 $ 23,340 2 $ 984 $ 11,808 $ 1,312 $ 15,744 $ 1,332 $ 15,984 $ 1,593 $ 19,116 $ 1,790 $ 21,480 $ 2,642 $ 31,704 $ 2,622 $ 31,464 3 $ 1,238 $ 14,856 $ 1,651 $ 19,812 $ 1,671 $ 20,052 $ 1,999 $ 23,988 $ 2,247 $ 26,964 $ 3,319 $ 39,828 $ 3,299 $ 39,588 4 $ 1,492 $ 17,904 $ 1,990 $ 23,880 $ 2,010 $ 24,120 $ 2,405 $ 28,860 $ 2,704 $ 32,448 $ 3,996 $ 47,952 $ 3,976 $ 47,712 5 $ 1,746 $ 20,952 $ 2,329 $ 27,948 $ 2,349 $ 28,188 $ 2,811 $ 33,732 $ 3,161 $ 37,932 $ 4,673 $ 56,076 $ 4,653 $ 55,836 6 $ 2,000 $ 24,000 $ 2,668 $ 32,016 $ 2,688 $ 32,256 $ 3,217 $ 38,604 $ 3,618 $ 43,416 $ 5,350 $ 64,200 $ 5,330 $ 63,960 7 $ 2,254 $ 27,048 $ 3,007 $ 36,084 $ 3,027 $ 36,324 $ 3,623 $ 43,476 $ 4,075 $ 48,900 $ 6,027 $ 72,324 $ 6,007 $ 72,084 8 $ 2,508 $ 30,096 $ 3,346 $ 40,152 $ 3,366 $ 40,392 $ 4,029 $ 48,348 $ 4,532 $ 54,384 $ 6,704 $ 80,448 $ 6,684 $ 80,208 Add l $ 254 $ 3,048 $ 339 $ 4,068 $ 339 $ 4,068 $ 406 $ 4,872 $ 457 $ 5,484 $ 677 $ 8,124 $ 677 $ 8,124 Asset Test $3,000 for a single $6,000 for hh of 2, plus $200 for each dependent $3,000 for a single $6,000 for hh of 2, plus $200 for each dependent $4,000 for a single $6,000 for hh of 2 None ADA1 (12-12) MA for Employed Person with Disabilities (MA-EPD) To qualify for MA-EPD: Certified disabled by the Social Security Administration (SSA) or the State Medical Review Team (SMRT). Employed and have required taxes withheld or paid from earned income. Monthly earnings of more than $65. Asset limit of $20,000 per enrollee. This information is available in accessible formats for individuals with disabilities by calling , toll free , or by using your preferred relay service. For other information on disability rights and protections, contact the agency s ADA coordinator. * A $20 disregard is included in totals. Note: Income and asset guidelines are approximations only. Use this chart for general reference only.

3 DHS Advisory Groups Name Statute Federal law or funding that requires Group American Indian Advisory Council on Chemical Dependency American Indian Child Welfare Advisory Council Children s Justice Act Task Force Development and Implementation Council for community first services and support Drug Utilization Review Board Medical Assistance Drug Formulary Committee Medicaid Citizens Advisory Committee 254A.035, subd. 2 Federal requirements dictate the state consult with tribes on the implementation for the state chemical dependency plan Federal requirements dictate the state consult with tribes on the implementation of the state Title IV-B plan to protect and promote the welfare of Indian children. 256B.85, subd B.0625, subd. 13i 256B.0625, subd. 13c Required to receive federal Children s Justice Act funds. State must also be eligible for Child Abuse and Prevention Treatment Act (CAPTA) Basic State Grant funds. CFR Title 42, Ch IV, Sub chapter C, Part 441, Subpart K. 42 U.S.C. 1396r 8 (Section 1927 of Social Security Act); (d) (4) 42 U.S.C. 1396r 8 (Section 1927 of Social Security Act); (g) (3) Mandated by federal Medicaid law and regulation to advise the state Medicaid agency on issues affecting populations served by Medicaid. Mental Health Advisory Council Required as a condition of accepting federal community mental health services block grant funds: Community Mental Health Services Block Grant - Section 1911 of Title XIX, Part B, Subpart I and III of the Public Health Service (PHS) Act.

4 DHS Advisory Groups Page 2 Name Statute Federal law or funding that requires Group Minnesota Board on Aging (MBA) MBA is the designated State Unit on Aging under the federal Older Americans Act. The board develops, coordinates, evaluates and administers federal and state funds for programs for the aging; makes grants to 7 area agencies on aging and nonprofit agencies; and serves as advocate for older Minnesotans.

5 Residency requirements for various Minnesota human services programs MFIP: Residency established when a child or caregiver has resided in the state for 30 consecutive days with the intention of making the s home in the state and not for any temporary purpose. The 30-day residency requirement may be waived where there is an unusual hardship, which means, 1) assistance unit is without alternative shelter; or 2) is without available resources for food. (MS 256J.12) General Assistance: Residency required for 30 days with the intention of making the s home in the state and not for any temporary purpose. Time spent in a battered women s shelter can satisfy this requirement. Applicants must demonstrate this intent by showing that the applicant maintains a residence at a verified address other than a place of public accommodation. An applicant must verify his or her residence; methods for residency verification are governed by Minnesota Rules, part , subpart 3, item C. The 30-day residency requirement may be waived where there is an unusual hardship, which means: 1) assistance unit is without alternative shelter; or 2) is without available resources for food. (MS 256D.02, Subd. 12a) Minnesota Supplemental Aid: Must be a resident of Minnesota and a citizen of the United States, or a legal noncitizen eligible to receive benefits from the federal Supplemental Security Income program. (MS 256D.385) Group Residential Housing: No residency provisions in statute. MinnesotaCare: Must meet residency requirements provided by Code of Federal Regulations (CFR) Title 42, section Generally, a must live in the state with the intention to remain in the state permanently. (MS 256L.09, Subd. 2) Medical Assistance: A must reside in Minnesota, or, if absent from the state, be deemed to be a resident of Minnesota, in accordance with CFR Title 42, section (MS 256B.056, Subd. 1) Supplemental Nutrition Assistance Program (SNAP): No durational residency required. Must meet general residency requirement where the has the intention of making the s home in Minnesota and not for any temporary purpose. MN Department of Human Services April 2, 2015