MA-EPD Income and Premiums
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Income |
Determining income eligibility for MA-EPD is different from basic MA income calculation policy. Unlike basic MA enrollees, MA-EPD enrollees are required to pay a premium rather than meet a spenddown. The countable gross monthly income is used to calculate the MA-EPD premium amount.
Start by totaling all countable monthly gross earned income and unearned income of the client.
Exception: When people perform work every month but are paid once per month, there is no need to average the income over the six-month certification period.
Obtain average income by adding varying monthly income and dividing by 6 (months in the budget period), or by multiplying income received every two weeks (biweekly) by 2.16 and income received every week by 4.3. When calculating earned income for MA-EPD, either of these methods of income calculation can be used, whichever is more beneficial to the client.
To see an example of this, click on the icon below.
For more information on MAXIS system entry for MA-EPD see Poli/Temp TE04.01.
It is important to remember that when considering income for MA-EPD, count only the MA-EPD applicant or enrollee's income. There is an exception to this rule. Click on the icon below to read the exception.
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Premiums |
Most MA-EPD enrollees will pay a premium of at least $35 per month. The monthly premium is calculated by MAXIS depending on the enrollee's income and household size. There is no maximum income limit or maximum premium amount. MAXIS will calculate the premium amount based on the client's gross unearned and earned income.
If MAXIS computes a premium of less than $35 based on the sliding fee scale, the premium amount will default to $35.
There is also a web tool available online that provides monthly premium estimates. By entering information on earnings and household size, an estimated premium is calculated. To go to the Premium Estimator, click on the icon below:
Note: Keep in mind that the online estimator gives an estimated premium amount based on information provided. The actual premium amount calculated by MAXIS may vary based on verified income used in the calculation.
Exception to Premium Payment:
Exempt eligible MA-EPD applicants and enrollees who verify their American Indian status from paying a monthly premium. For instructions and information about the American Indians Exempt from MinnesotaCare and Medical Assistance for Employed Persons with Disabilities Premiums, see step by step directions in the HCPM.
Unearned Income Obligation
MA-EPD enrollees who receive unearned income, such as RSDI, will pay an additional amount called an Unearned Income Obligation or UIO. The UIO is one half of one percent of the unearned income and will be added to the premium. (This is done automatically by MAXIS). To calculate the monthly Unearned Income Obligation, multiply the total unearned income amount by 0.005 (.5%). To see an example of this, click on the icon below.
Because almost all MA-EPD enrollees must pay a premium of at least $35, it is necessary to look at eligibility for standard MA. If the applicant would be eligible for MA without a spenddown or a spenddown less than $35 and the assets are within the MA asset limit, then standard MA would be the best option for the applicant.
MA-EPD premiums (considered "H" bills) may be used to meet the spenddowns of legal dependents or relatives for whom the enrollee is financially responsible, as long as they are members of the enrollee's household and are MA applicants or enrollees.
