Navigating Medicaid in Minnesota [A guide to Medical Assistance, MA-TEFRA and MA-EPD]

Medicaid is a vital program that provides health care access for millions of Americans with low income. In Minnesota, this program is known as Medical Assistance (MA) and includes Medical Assistance under TERFA (MA-TEFRA) and Medical Assistance for Employed Persons with Disabilities (MA-EPD) programs. To help you navigate these programs, we are sharing details on eligibility requirements, service delivery, application processes and their connection to Home and Community-Based Services (HCBS) that are offered at PICS (Partners in Community Supports).

Medical Assistance and covered services

Medical Assistance (MA) – Minnesota’s largest health care plan – serves children and families, pregnant women, older adults, people who are blind or have a disability, and adults who meet eligibility requirements.  It covers a broad range of health care services, including doctor visits, hospital stays, prescription medication, preventative care, mental health services, and more. The program is designed to ensure that eligible individuals have access to necessary medical services.

Eligibility requirements

To enroll in MA, there are certain eligibility requirements you need to meet. To receive health care through MA, an individual must:

• Be a Minnesota resident
• Be a U.S. citizen or a qualifying noncitizen
• Provide a Social Security number
• Meet the income limit and asset limit, if any
• Meet any other program rules.

To understand the income eligibility limits specific to Minnesota's Medicaid program, individuals can refer to the income and asset limits.

Medical Assistance under TEFRA

The Tax Equity and Fiscal Responsibility Act (TEFRA), or Medical Assistance under TEFRA (MA-TEFRA), offers health care coverage to children with disabilities who would be ineligible for Medicaid due to their parent's income. This program enables families to "buy into" Medical Assistance, which provides access to necessary medical services for children with significant disabilities. The eligibility for MA-TEFRA is based on the child's medical condition and disability, rather than solely on the family's income. To qualify, the child must require a level of care typically provided in a hospital or nursing facility, and the family's income must meet certain guidelines.

Medical Assistance for Employed Persons with Disabilities (MA-EPD)

The Medical Assistance for Employed Persons with Disabilities (MA-EPD) program is designed to assist employed individuals with disabilities in maintaining health coverage. This program helps bridge the gap for individuals with disabilities who might otherwise lose their health care coverage due to increased income from employment. To qualify for MA-EPD, individuals must meet specific criteria related to their disability status, income and employment. This includes having a qualifying disability, being employed, and meeting the income limits set by the program. 

Funding Home and Community-Based Services (HCBS)

One notable feature of Medicaid in Minnesota is that it provides funding for Home and Community-Based Services (HCBS) for individuals with disabilities and older adults. HCBS includes a range of services – including Consumer Directed Community Support (CDCS), Consumer Support Grant (CSG) and Individualized Home Supports (IHS) – designed to offer individuals with disabilities and older adults the opportunity to receive care and support in their homes and communities rather than in institutional settings.

PICS offers services for the following HCBS programs:

• Consumer Directed Community Supports (CDCS) empowers individuals to have greater control over their care services. Participants have the flexibility to hire and manage their own support workers, allowing for personalized care that meets their unique needs.
• Consumer Support Grant (CSG) provides individuals with funding to purchase a variety of supports and services. This program emphasizes individual choice and control, enabling participants to tailor their services to their preferences and requirements.
• Individualized Home Supports (IHS) focuses on providing support for individuals with disabilities to live independently in their homes. This can include assistance with daily activities, home modifications and other necessary services to enhance the individual's quality of life.

These programs are often referenced as self-directed and licensed services, as they offer choice and flexibility for the individuals who want to design their own support structures.

How to apply

The application process through the Minnesota Department of Human Services involves providing information about income, assets and other relevant details for the following groups: 

• Individuals who are 65 years of age or older.
• Individuals with disabilities who are younger than 65 years old.
• Individuals in families with children and individuals who are adults under age 65 who do not have children living with them and do not have a disability.

MA is a crucial resource for individuals who depend on it. It ensures that one out of every five Minnesotans has access to essential health care services. This includes comprehensive Home and Community-Based Services for individuals with disabilities and older adults. 

If you or one of your family members is eligible for MA and would like to get started with self-directed or licensed services, learn more about the enrollment process.