The Basics
Medical Assistance (MA) is a public program that helps pay medical expenses for people with low income. How you may qualify depends on your family’s situation. The rules for qualifying are related to things like whether you have a disability, how much you have in income, how much you have in assets, whether you are pregnant, or if you are a child.
Disability-based MA is one way for people with disabilities to qualify for MA. It is not the only way that a person with a disability can qualify for MA, but if you have been determined disabled by the Social Security Administration (SSA) or by the State Medical Review Team (SMRT), disability-based MA may help you for 3 main reasons:
- It may let you get MA even if you make more money income-based MA allows.
- It may let you get MA and Medicare at the same time.
- It may cover additional services that income-based MA does not cover.
Disability-based MA is not the only way to qualify for MA. Most people who get MA qualify by other rules. You or other members of your family may qualify by those other rules, even if you don’t qualify by the disability-based rules. Learn more about the different ways of qualifying in DB101's MA overview.
You may also want to consider other options we will introduce later, including MinnesotaCare, Medicare, and private health insurance.
This article is about disability-based Medical Assistance (MA) and will help you understand:
- If it is right for you
- Other ways you may qualify for MA
- What services it covers
- How much you will have to pay, and
- How to sign up.
If after reading this article, you need more help in understanding Medical Assistance (MA), we recommend you talk to trained experts who can help you. Here are some good resources:
- Visit or call your local county or tribal human services office.
- If you have a disability, Chat with a Hub expert to learn more about health programs for people with disabilities.
- If you do not speak English, call the Minnesota Department of Human Services (DHS) Multilingual Referral Line.
- Disability-based MA doesn’t count all of your earned income, so it may be an option if your income is too high for income-based MA.
- Disability-based MA covers some extra services through MA-Waiver Programs.
- You can get it and Medicare at the same time, if you qualify.
- If your earned income goes up, you can switch to MA-EPD, which has no earned income limit.
- If your assets increase so much that you no longer qualify for disability-based MA or MA-EPD, you may be able to qualify for income-based MA, which has no asset limit.
- If Social Security or the State Medical Review Team (SMRT) determine that your disability does not qualify you for MA, you may be able to qualify for income-based MA , which has no disability requirement.
Note: DB101 keeps track of changes to health coverage and related laws. DB101 has been and will continue to be updated to reflect any changes. For news related to health coverage, visit the Minnesota Department of Human Services (DHS).
Learn more
Is it Right for You?
Almost everyone should be able to get health coverage. The question is, which plan is right for you and your family?
This article focuses on whether you can qualify for disability-based MA.
Just because you have a disability does not mean you qualify for disability-based MA. You may qualify for income-based MA or Medical Assistance for Employed Persons with Disabilities (MA-EPD), or you may not qualify for MA at all, depending on your situation.
Learn more about the different ways of qualifying in DB101's MA overview. Chat with a Hub expert or visit your local county or tribal human services office if you have questions.
Try out the little estimator below. If it says your income is at or below the limit for income-based MA (138% of the Federal Poverty Guidelines (FPG) or less), read our income-based MA article.
| Your family size: | |
Income limits for your family: | |
| Income-based MA, adults (138% FPG) | |
| Income-based MA, children/pregnant women (280% FPG) | |
| MinnesotaCare (200% FPG) | |
| Subsidized private plans, reduced fees (250% FPG) | |
| Subsidized private plans (no income limit) | -- |
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules.
Notes:
| |
Disability-Based Medical Assistance (MA) Basic Eligibility Requirements
To qualify for disability-based Medical Assistance (MA), you must:
- Have been determined blind or disabled by the Social Security Administration (SSA) or the State Medical Review Team (SMRT)
- Be a U.S. citizen or have an immigration status that is eligible for MA
- Meet certain asset requirements, and
- Meet certain income requirements
Note: If you qualify for SSI’s 1619(b) provision, you automatically qualify for MA. You do not need to worry about the qualifying rules discussed on this page. Read more about 1619(b) in this article’s How to Sign Up page.
If you have been determined disabled, but do not meet the asset or income requirements, read DB101’s MA-EPD article.
If you have low income, but do not have a disability determination, check out DB101’s income-based MA and MinnesotaCare articles.
Disability Determination
To get disability-based MA, you must be determined disabled by the Social Security Administration (SSA) or the State Medical Review Team (SMRT).
They’ll say you have a disability if:
- You have a physical or mental impairment or combination of impairments
- Your impairments limit your ability to work, preventing you from earning Substantial Gainful Activity ($1,470 per month, or $2,460 per month if you’re blind), and
- Your condition has lasted or is expected to last for at least 12 months
To get a disability determination, you will have to get medical documentation specified by SSA or SMRT.
Note: If you get Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) benefits due to a disability, or if you are certified disabled by the county for the Development Disability (DD) Waiver, you automatically meet this requirement. If you don’t get SSI or SSDI benefits, you’ll have to be determined disabled by SMRT.
Citizenship and Immigration Status
You must be a U.S. citizen or have an immigration status that is eligible for Medical Assistance (MA). If you are an immigrant and unsure about whether you qualify for MA, contact your local county or tribal human services office.
If you are an immigrant who does not qualify for MA, but you are lawfully present in the United States, you may qualify for MinnesotaCare, another public program for people with low income. Read DB101’s MinnesotaCare article.
If you are an undocumented immigrant, you may qualify for MA coverage for emergencies only. To learn more about this, contact your local county or tribal human services office.
Assets
Your assets must be at or below disability-based MA's asset limit ($3,000 for one person; $6,000 for a family of two). The limit increases $200 for each additional family member. You must approve the use of the Account Validation Service (AVS) so that MA can make sure your assets are below the limit.
Note: There is no asset limit for income-based MA, but there is an asset limit for disability-based MA. If you are over the asset limit, you can still apply for income-based MA. To learn more about that, see DB101’s income-based MA article.
Also, if your disability began before you turned 26, you can open an ABLE account where you can save up to $17,000 each year and not have it counted by any Medical Assistance (MA) program. To learn more, read DB101's ABLE Accounts article.
- If you are enrolling in MA-EPD, your assets must be at or below $20,000. Read more about it in DB101’s MA-EPD article.
- If you are on MA through SSI, 1619(a), or 1619(b), your asset limit is the SSI asset limit of $2,000 ($3,000 for a family of two).
For disability-based MA, an asset is almost anything you own, including:
- Cash
- Money in bank accounts
- Vehicles you own (one will not be counted)
- Stocks and bonds
- Real estate other than the home you live in
- Your spouse’s assets, and
- Retirement accounts
There are some assets that MA doesn’t count, including:
- The home you live in
- One car
- Household and personal goods including pets, furniture, clothing, jewelry, appliances, tools and other equipment used in the home, and
- Assets in an ABLE account (if your disability started before you turned 26). Learn more about ABLE accounts.
Check out the complete list of assets MA doesn’t count.
If you own a home worth $250,000 and you live in it, the value of that home will not be counted toward your disability-based MA asset limit, but if you own a home that you rent out, its value may count toward your MA asset limit.
If you own one vehicle, the value of that car won’t count toward the limit, but if you own a second car, its value may count toward the limit.
Income
For disability-based MA, you may qualify if your countable monthly income is at or below an income limit. If your income is higher than the income limit you may still be eligible if you meet certain additional requirements.
The income limit and how your income is calculated for disability-based MA are different than the income limit and how your income is calculated for income-based MA. Read more about those rules in DB101’s income-based MA article.
To see whether your income would qualify for disability-based MA, MA will look at the number of people in your family, the amount of income your family has, and it will then compare it to the Federal Poverty Guidelines (FPG):
- If you are blind or disabled, according to Social Security or the State Medical Review Team (SMRT), your countable monthly income must be at or below 100% of FPG ($1,133 for an individual, $1,526 for a family of two).
- If your income is higher than 100% of FPG, you may still be eligible for MA, but you will have to spend some of your own income on your medical bills before MA will start paying. This is called a spenddown.
Note: If your income is over 100% of FPG, you should look into Medical Assistance for Employed Persons with Disabilities (MA-EPD) and MinnesotaCare, because they are usually much more affordable than getting MA with a spenddown.
In this article, we talk about how there is a limit for how much countable income you can have and still qualify for disability-based MA. The confusing thing is that “countable income” is not the same as your total income. For example, if you make $2,000 per month at a job and have no other income and no other deductions, that’s only $957.50 in countable monthly income.
Figuring Out Your Countable Income
This countable income calculation is only for disability-based MA. The rules for qualifying for income-based MA are totally different and much less complicated.
Follow these steps to find out your countable income:
Step 1: Add up all your monthly unearned income, including SSDI payments, Workers’ Compensation payments, cash gifts you get, and income from a trust or investments.
Do not include payments you get from SSI, the Minnesota Family Investment Program (MFIP), General Assistance (GA), Minnesota Supplemental Aid (MSA), Section 8 housing, or SNAP. Disability-based MA doesn’t count income you get from these programs.
Step 2: Add up your gross monthly earned income (income from work before taxes are deducted), including wages, tips, bonuses, and self-employment earnings.
Subtract a $65 Earned Income Exclusion.
Then divide the result by two. The result is your countable earned income.
| Earned Income |
| Minus the $65 Earned Income Exclusion |
| Minus Impairment Related Work Expenses (IRWEs)** |
 |
| = Subtotal |
| Divide by two |
|
| = Countable Earned Income |
**Depending on your situation, Impairment Related Work Expenses (IRWEs) may be subtracted before or after dividing 2, if you have them. Chat with a Hub expert if you have any questions about this.
Step 3: Add your countable monthly unearned income to your countable monthly earned income to figure out your total monthly countable income.
| Countable Unearned Income |
| Plus Countable Earned Income |
|
| = Total Countable Income |
| Your Monthly Earned Income | $ |
| Your Monthly Unearned Income (not including SSI) | $ |
| |
| Your Monthly Countable Income | |
| |
| Federal Poverty Guideline | |
| Your Countable Income as a Percent of FPG |
If your countable monthly income is less than 100% of FPG, you may qualify for disability-based MA.
If your countable monthly income is more than 100% of FPG, you may have to pay a monthly spenddown. How a spenddown works is explained later in this article.
If you have a disability, your countable income is above 100% of FPG, and you meet all other program requirements, you may be able to get MA with a spenddown. However, a spenddown can be very expensive.
Look at these other health coverage options if you are in this situation:
- People with and without disabilities can get income-based MA it if their total income is up to 138% of FPG. Read DB101’s MA article.
- Medical Assistance for Employed Persons with Disabilities (MA-EPD) is for people with disabilities who work. It has no income limit and its premiums are cheaper than what it would cost to have disability-based MA with a spenddown. Read DB101’s MA-EPD article.
- MinnesotaCare has a 200% of FPG income limit. As with MA-EPD, you pay a monthly premium. Read DB101’s MinnesotaCare article.
MA for Children with Disabilities with Higher Family Income
MA-TEFRA is a way to get MA for children under age 19 with disability determinations from the State Medical Review Team (SMRT) who don’t qualify for income-based MA because their parents have too much income. For eligibility, MA-TEFRA only counts the child’s income, not the parents’ and there is no asset limit. However, parents may have to pay a monthly parental fee. This rule mostly helps families that have income that’s higher than 280% of FPG ($77,700 per year for a family of four). Read more about MA-TEFRA and parental fees.
Note: MA-TEFRA parental fees may be more expensive than options you could get on MNsure. Read DB101’s Buying Health Coverage on MNsure to learn more about those options.
If you have a disability, you may qualify for Medical Assistance (MA) in more than one way.
Here are some reasons you might not qualify for disability-based Medical Assistance (MA), even if you have a disability:
- Your disability does not meet Social Security’s definition of disability. Disability-based Medical Assistance (MA) is only for people who have disabilities meeting this standard.
- Your assets are greater than disability-based MA's asset limit allows.
- You make enough money that you would have to make monthly spenddown or premium payments for disability-based MA or MA-EPD under disability rules.
Reasons you might qualify for disability-based MA instead of income-based MA:
- Your income is higher than 138% of FPG. Disability-based MA’s eligibility rules don’t count all of your earned income, so you may make more than that and qualify by disability rules. Also, people with disabilities who work and have higher income may qualify through MA-EPD.
- You need certain services for people with disabilities, such as some Home and Community-Based Services (HCBS).
- You also get Medicare. Usually, income-based Medical Assistance (MA) isn’t available to most people getting Medicare, but disability-based Medical Assistance (MA) is. It may even help pay your monthly Medicare premiums.
Learn more about the different ways of qualifying in DB101's MA overview. Chat with a Hub expert or go to your local county or tribal human services office if you have questions.
MA, Employer-Sponsored Coverage, and Medicare
If you qualify for Medical Assistance (MA), you should sign up for it. Here we will look at what signing up for MA might mean if you also have, or want, private coverage or Medicare.
MA and Employer-Sponsored Health Coverage
If you qualify for Medical Assistance (MA), it will always be your best choice. However, if your employer offers health insurance, you are required to get it if the coverage is cost-effective. MA will look at the plan your employer offers to determine whether it is cost-effective and if it is, MA will pay your portion of the monthly premium for the insurance plan your employer offers. This can give you the best of both worlds – you get coverage for your medical needs from both your employer’s plan and MA at a lower cost to you. To learn more about this option, Chat with a Hub expert or contact your local county or tribal human services office.
Disability-based MA and Medicare
If you are eligible for Medicare Parts A, B, and D, you have to be getting them in order to get complete disability-based MA coverage. Note: You usually cannot get income-based MA if you are get Medicare.
Getting both Medicare and disability-based MA at the same time will help you, because:
- MA will usually pay your Part B premium (and your Part A premium, if you have one) through a Medicare Savings Program or by determining that your Medicare coverage is cost-effective. In some cases it may even pay for Medicare premiums, deductibles, coinsurance, and copayments.
-
You will automatically be enrolled in a Part D benchmark plan and automatically qualify for the Part D Low Income Subsidy. The Low Income Subsidy means you won’t have to pay a premium for your Part D or any deductibles. All you would pay for prescription drugs are Part D’s copayments, which range from $1.45 to $10.35.
- Note: If you have MA with a spenddown, you will only automatically get the Low Income Subsidy after you’ve paid your spenddown during one month of the year. Then, you’ll qualify for the rest of the year.
- MA covers many more services than Medicare, so by having both you’ll have better health care coverage than you would by enrolling in just one or the other.
To learn more, read DB101’s detailed information on Medicare Savings Programs for Parts A and B and the Part D Low Income Subsidy.
Depending on your situation, you might get employer-sponsored coverage, MA, and Medicare all at the same time. This can sound confusing, but it can help you, because one form of coverage may pay for costs that your other coverage won't pay for.
The rules about how your different types of coverage pay for things are very complicated, so it’s important to check with your health coverage plans when you have questions about which plan will pay for what expenses.
Generally speaking, MA will only pay for expenses that it covers and that your other coverage won't pay for.
How Medicare works with other insurance shows how it works when you have Medicare and other coverage.
Learn more
What it Covers
If you get Medical Assistance, it will pay for a broad range of medical services, including all services that the government considers Essential Health Benefits (EHBs). If you’re not sure if a particular service is covered by MA, or if it requires prior authorization, ask your doctor or Chat with a Hub expert.
Here is a list of the main services that MA provides:
- Alcohol and drug treatment
- Chiropractic care
- Dental care (limited for adults who are not pregnant)
- Doctor/clinic visits
- Emergency room care (ER)
- Eye exams
- Eyeglasses
- Family planning services
- Hearing aids
- Home care
- Hospice care
- Hospital services (inpatient and outpatient)
- Immunizations and vaccines
- Interpreter services
- Lab and X-ray
- Licensed birth center services
- Medical equipment and supplies
- Medical transportation (access, ambulance and special)
- Mental health care
- Nursing homes and ICF-DD facilities
- Outpatient surgery
- Personal Care Assistant (PCA) services
- Podiatry
- Pregnancy-related services
- Prescriptions and Medication Therapy Management
- Private-duty nursing
- Prosthetics
- Rehabilitative therapy
- Urgent care
- Visits to a clinic or physician for preventive care, including routine physicals
Depending on your circumstances, MA may cover some long-term care services, including nursing homes. If you have specific disability-related needs, contact your local county or tribal human services office for more information.
More Services through MA-Waiver Programs
People who qualify for disability-based MA may also be eligible for MA-Waiver programs. These programs pay for additional services that help people live in their own homes instead of an institution, like a hospital or nursing facility. To apply for an MA-Waiver program, talk to your local county or tribal human services office.
To learn more, read DB101’s article about MA-Waivers.
Learn more
What You Pay
Most people who get Medical Assistance (MA) don’t have to pay a monthly premium or spenddown. If you are covered by MA, you only have to make payments when you need medical care.
Payments When You Get Services
Generally, if you are 21 years old or older, you may have to pay a small $3.80 monthly deductible and small copayments that range from $1 to $3 when you use certain medical services that MA covers.
Note: If you are not able to pay a copay or deductible, your medical provider still has to serve you. Providers must take your word that you cannot pay. Providers cannot ask for proof that you cannot pay.
There are some people who do not need to make copayments:
- Children less than 21 years old
- Pregnant women
- People in hospice care
- Refugees
- People in nursing homes or Intermediate Care Facilities for Persons with Developmental Disabilities (ICF-DDs)
MA’s deductible and copayments are much lower than the copayments required by private insurance plans. For example, many private insurance plans can have annual deductibles that require you to pay thousands of dollars before the plan will cover most services and even after the deductible is paid, many private insurance plans require $50 or more in copayments for services.
Medical Assistance (MA) with a Spenddown
Some people who qualify for disability-based MA and have countable income that is higher than 100% of the Federal Poverty Guidelines (FPG) may have to pay a spenddown each month.
| Your Monthly Earned Income | $ |
| Your Monthly Unearned Income (not including SSI) | $ |
| Your Monthly Impairment Related Work Expenses (IRWEs) | $ |
| |
| Your Monthly Countable Income | |
| Your Annual Countable Income | |
| |
| Your Countable Income as a Percent of FPG |
A spenddown is like a deductible: you have to pay some of your medical expenses each month before MA will start paying for the rest. If your medical bills don’t reach the spenddown amount in a particular month, you don’t have to pay the whole spenddown for that month.
If you have disability-based MA with a spenddown, you have to “spend down” until your countable income is down to 100% of FPG to keep MA coverage (100% of FPG is $1,133 for an individual, $1,526 for a family of two).
Note: MA with a spenddown is often very expensive. In many cases, it is more affordable to pay a monthly premium and get Medical Assistance for Employed Persons with Disabilities (MA-EPD), MinnesotaCare, or even a private individual insurance plan through MNsure. Before you get MA with a spenddown, look into those other options in DB101’s Health Programs section.
Thomas has a $400 monthly spenddown. In April, he has $700 in medical expenses. Thomas is responsible for paying the first $400 and MA will pay the remaining $300.
In May, Thomas has only $50 in medical bills. He has to pay that $50 himself, but he doesn’t have to pay the whole $400 spenddown amount for May. MA will not pay for any medical expenses in May.
Retroactive Coverage
MA allows new enrollees to ask for coverage retroactively. This means that you can ask to have your MA coverage begin three months before the month you apply. So if you enroll in MA in April but have unpaid medical bills from the previous three months (January, February, and March), you could have MA pay for those unpaid bills.
Learn more
How to Sign Up
You should sign up for Medical Assistance (MA) at your county or tribal human services office if you:
- Are 65 years old or older
- Get Supplemental Security Income (SSI) benefits, or
- Have Medicare coverage.
If you are not in one of those situations, there are three ways to apply for health coverage:
- Online using MNsure, a one-stop shop where you can learn about your public and private coverage options.
- In person at your local county or tribal human services office.
- Filling out a paper application and faxing it to 1-651-431-7750, or mailing it to the address listed on the form.
MNsure will check to see if you might qualify for disability-based MA if you answer "yes" to at least one of these questions when you fill out your MNsure application:
- Are you blind?
- Do you have a physical, mental, or emotional health condition that limits your activities (like bathing, dressing, daily chores, etc.)?
- Do you need help staying in your home or help paying for care in a long-term care facility such as a nursing home?
- Have you been determined disabled by the Social Security Administration (SSA) or the State Medical Review Team (SMRT)?
- Do you want help from Medical Assistance (MA) to pay for medical bills from the last three months?
MNsure will also check for disability-based MA eligibility if you say you're on Medicare.
If you have a disability and don't answer these questions correctly, you might not get the best health coverage for you. If you have any questions about applying, Chat with a Hub expert.
How Your Application is Reviewed for Eligibility
-
Your application will be reviewed to see if you qualify for income-based MA.
- If you do qualify, you’ll start getting MA coverage.
- If you do not qualify, your application will be reviewed to see if you might qualify for disability-based MA. If so, you will be need to give additional information to complete your application, such as how much you have in assets. You may need to get a disability determination from the State Medical Review Team (SMRT) and provide other medical documentation of your disability.
- If there is no way you can qualify for MA, you may have other options, like MinnesotaCare or a private insurance plan, depending on your situation. For more information about these, see DB101’s articles about MinnesotaCare and Buying Health Coverage on MNsure.
Staying on MA
Usually, once you are approved for Medical Assistance (MA), you will continue to get it for 12 months. At any time, if your income, immigration status, residency, or household size changes, the best way to update your information is by letting your county or tribal human services office know. When you report your changes, they’ll tell you whether you will continue getting MA or if you have new health coverage options. There should always be at least one health coverage option for your family.
If you need help applying for health coverage, try the following options:
- Visit or call your local county or tribal human services office.
- If you have a disability, Chat with a Hub expert to learn more about health programs for people with disabilities.
- If you do not speak English, call the Minnesota Department of Human Services (DHS) Multilingual Referral Line.
Staying on MA through SSI 1619(b)
If you get Supplemental Security Income (SSI) and MA, and your SSI benefit goes to zero because you go back to work, an SSI rule called “1619(b)” lets you to keep your MA coverage if you:
- Were eligible for an SSI cash payment for at least one month
- Were eligible for MA in the month before your SSI benefit went to zero
- Need MA coverage to keep working
- Still meet all the other SSI requirements, such as being disabled and having assets below $2,000, and
- Have less than $68,071 in total earned income. (If you have medical expenses higher than the state average, this figure may be higher.)
MA coverage under 1619(b) has no premium or spenddown and covers the same services as standard MA.
For additional information, read the DB101 section on SSI, check out Social Security’s webpage on 1619(b), or Chat with a Hub expert.
Note: If you don’t qualify for MA through 1619(b) because your income or assets are too high, you may qualify for MA through Medical Assistance for Employed Persons with Disabilities (MA-EPD). Read DB101’s MA-EPD article to learn more.
Joe had been getting SSI for several years when his health improved and he decided to go back to work. After he started working, his income increased to $3,000 per month ($36,000 a year) causing his monthly SSI benefit to drop to zero.
Even though his income is now well above 100% of the Federal Poverty Guidelines, he is still eligible for MA through 1619(b) because his annual income is less than $68,071.
Learn more
Frequently Asked Questions
This is really confusing. Where can I get help?
- Visit or call your local county or tribal human services office.
- If you have a disability, Chat with a Hub expert to learn if you have additional options.
- If you do not speak English, call the Minnesota Department of Human Services (DHS) Multilingual Referral Line.
- Minnesota has detailed information about the changes happening with health care reform.
Where can I sign up?
You should sign up for Medical Assistance (MA) at your county or tribal human services office if you:
- Are 65 years old or older
- Get Supplemental Security Income (SSI) benefits, or
- Have Medicare coverage.
If you are not in one of those situations, there are three ways to apply for health coverage:
- In person at your local county or tribal human services office. This is the best way to apply.
- Filling out a paper application and faxing it to 1-651-431-7750, or mailing it to the address listed on the form.
- Online using MNsure.
If I apply for MA using MNsure, how will it know I have a disability?
MNsure will check to see if you might qualify for disability-based MA if you answer "yes" to at least one of these questions when you fill out your MNsure application:
- Are you blind or do you have a physical, mental, or emotional health condition that limits your activities (like bathing, dressing, daily chores, etc.)?
- Do you need help staying in your home or help paying for care in a long-term care facility such as a nursing home?
- Do you want help from Medical Assistance (MA) to pay for medical bills from the last three months?
MNsure will also check for disability-based MA eligibility if you say you're on Medicare.
If you have a disability and don't answer these questions correctly, you might not get the best health coverage for you. If you have any questions about applying, Chat with a Hub expert.
I have been getting MA because I have a disability. Will my MA change?
No. You can continue to get the Medical Assistance (MA) benefits you currently get.
Does it matter how I qualify for MA?
In most cases, no. The actual medical coverage you get from MA will basically be the same, no matter how you qualified. Generally speaking, the big difference is that people with disabilities have extra ways to qualify and if you have a disability and start working, you can earn more while still getting MA coverage.
DB101 has four articles about different ways to get MA:
- DB101's MA overview compares the different ways of qualifying.
- The income-based MA article explains the most common way to qualify, which does not require you to have a disability.
- The disability-based MA explains a common way that people with disabilities who have low incomes can qualify.
- The MA-EPD article explains a way that people with disabilities can get MA coverage by paying a premium, no matter how high their income.
If you are not sure how you qualified for MA, you can ask your local county or tribal human services office.
What is “countable income?” Is it just how much I make?
No, it is not the same as how much you make. When many public programs look at your income to figure out if you should qualify, they don’t always count all of your income. What they do count is called “countable income.” This benefits you, because it means that you might have more income than the income limit for a program, but still qualify.
When your income is reviewed for disability-based Medical Assistance (MA), only about half of your earned income (money you get from work you do) is counted. For example, if you make $2,000 per month at a job and have no other income, that’s only $957.50 in countable monthly income.
| Your Monthly Earned Income | $ |
| Your Monthly Unearned Income (not including SSI) | $ |
| Your Monthly Impairment Related Work Expenses (IRWEs) | $ |
| |
| Your Monthly Countable Income | |
| Your Annual Countable Income | |
| |
| Your Countable Income as a Percent of FPG |
Note: Countable income is used to see if you qualify for disability-based MA. If you do not have a disability, income-based MA will count all of your earned income. See DB101’s income-based MA article for more information.
To qualify for MA, is there a limit on the amount of assets my family can have?
It depends on how you qualified for Medical Assistance (MA). Income-based MA has no asset limit. However, some people with disabilities and seniors may qualify for disability-based MA or MA-EPD, which do have asset limits. If there's an asset limit, you must approve the use of the Account Validation Service (AVS) so that MA can make sure your assets are below the limit.
DB101's MA overview compares the different ways of qualifying.
I’m on Supplemental Security Income (SSI). Can I qualify for MA?
Yes. If you're getting SSI, you probably qualify for MA as well, but you have to apply for SSI and MA separately. Apply for MA at your county or tribal human services office and for SSI at your local Social Security office.
If you’re on SSI and MA and your monthly SSI cash benefit drops to zero because your earned income goes up, Social Security’s 1619(b) provision will let you keep your MA coverage, without having to pay a spenddown. Minnesotans with a disability on 1619(b) can have up to $68,071 in earned income and still keep their MA coverage as long as their assets don’t go above the SSI asset limit ($2,000 for an individual, $3,000 for a couple).
What is the difference between MA, MA with a spenddown, and MA-EPD?
MA: You only pay small copayments for medical services. You may qualify for income-based MA or disability-based MA, depending on your situation. You also qualify for MA if you qualify for SSI’s 1619(b) provision.
MA with a spenddown: You "spend down" your income by paying the first part of your medical costs. The amount you are responsible to pay before disability-based MA starts paying is the difference between your countable income and the "income standard." The income standard is 100% of the Federal Poverty Guidelines (FPG) ($1,133 for an individual, $1,526 for a family of two). Note: Usually, if you qualify, MA-EPD will be a better option than MA with a spenddown.
Medical Assistance for Employed Persons with Disabilities (MA-EPD): You pay small copayments and a monthly premium based on your income and household size. Generally, if you are certified disabled by the Social Security Administration or the State Medical Review Team (SMRT) and are working you will qualify for MA-EPD.
DB101's MA overview compares these different ways of qualifying for MA.
If my job offers me health coverage, am I allowed to sign up for MA?
Yes. If your family’s income is low enough for you to qualify for Medical Assistance (MA), you may do so even if your job offers insurance. If you are in this situation, you must tell your county or tribal human services office about the insurance your employer offers. If your employer-sponsored plan is considered cost-effective, MA will pay your portion of the private plan’s monthly premium. If you have questions about this, Chat with a Hub expert.
Note: If your job offers you affordable insurance, you and your family cannot get MinnesotaCare or get subsidies for purchasing an individual health plan through MNsure.
I have private health coverage. Is there any reason I’d need to enroll in MA?
Yes. In most cases it makes sense to enroll in both private health coverage and MA, if you qualify because:
- You’ll get better coverage if you have both private insurance and MA.
- If the county determines that your private coverage is cost-effective, MA will even pay the premiums, copayments, and deductibles for your private coverage.
If the county determines that your private policy is not cost-effective, you should decide whether enrolling in MA, private coverage, or both best meet your medical and financial needs.
If you have questions, Chat with a Hub expert.
I’m on Medicare. Why do I need MA?
Disability-based MA covers many services that Medicare doesn’t. If you have both MA and Medicare, you’ll have better health coverage. If you are eligible for Medicare Parts A and B, you have to keep them in order to enroll in MA. In most cases, MA will pay the Medicare premiums for you. With Medicare Part D, you’ll likely have cheaper prescription drug costs by enrolling in both programs.
Note: You usually cannot qualify for income-based MA if you get Medicare.
I’m an immigrant. Can I get MA?
- Undocumented immigrants do not qualify for full Medical Assistance (MA) coverage, though in some cases they may qualify for MA coverage for emergencies.
- Some noncitizens who have legal immigration status in the United States do not qualify for full MA coverage. However, if their income is below 200% of the Federal Poverty Guidelines (FPG), they may qualify for MinnesotaCare, a different public program.
- Immigrants who have been legal residents for 5 years or longer and some other noncitizens with legal immigration status qualify for all of the same programs that citizens can get.
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Common Pitfalls
Not getting health coverage because you think it will be too expensive
In the past, some people found it impossible to find health coverage that was affordable and met their needs. Now, there should be an option for almost everybody, even if you have a disability. The exact health coverage that will be right for you will depend on things like your family’s income, whether you have access to employer-sponsored coverage, your age, where you live, if you use tobacco products, and whether you have a disability.
If you do not have the option of employer-sponsored coverage, you may be able to get government help through tax credits paying for an individual plan on MNsure. If you cannot afford private individual coverage, your best options will be public programs, like Medical Assistance, MinnesotaCare, or Medicare, if you qualify.
Note: It is very important to have health coverage, but starting in 2019 there is no tax penalty if you don't have coverage.
Not answering the disability-related questions on MNsure correctly
MNsure will check to see if you might qualify for disability-based MA if you answer "yes" to at least one of these questions when you fill out your MNsure application:
- Are you blind or do you have a physical, mental, or emotional health condition that limits your activities (like bathing, dressing, daily chores, etc.)?
- Do you need help staying in your home or help paying for care in a long-term care facility such as a nursing home?
- Do you want help from Medical Assistance (MA) to pay for medical bills from the last three months?
MNsure will also check for disability-based MA eligibility if you say you're on Medicare.
If you have a disability and don't answer these questions correctly, you might not get the best health coverage for you. If you have any questions about applying, Chat with a Hub expert.
Not going back to work because you fear losing your coverage
In the past, people feared that if they got a job while on public health coverage, like Medical Assistance (MA) or MinnesotaCare, they’d lose that coverage, because they would no longer have low enough income to qualify.
Now, if you lose one health coverage option, there should be another one you can get. If you lose your current coverage, you should either become eligible for employer-sponsored coverage, another public coverage program, or private individual coverage. And, if you can’t afford the individual coverage, the government may help you pay for it through tax credits.
The bottom line: There is a coverage option for almost everybody. Do not worry that getting a job will leave you without health coverage.
Not enrolling in MA because you have private coverage
It’s not always obvious, but there are times when you should consider having both private coverage and Medical Assistance (MA). For example, there may be services you need that MA covers but your private plan doesn’t.
If you enroll in MA and you also have cost-effective private coverage, the state will pay the premium for your private policy for you.
Dropping or not enrolling in Medicare when you qualify for MA
If you are eligible for Medicare Parts A and B, you have to keep them in order to enroll in disability-based MA. MA covers many services that are not covered by Medicare, and in many cases a Medicare Savings Program will pay your Medicare premium for you. By having both MA and Medicare, you’ll have better health care coverage than you would by enrolling in just one or the other.
You don’t have to participate in Medicare Part D to qualify for disability-based MA, but if you’re eligible for Medicare Part A or B, MA cannot pay for your prescription drugs. This means that if you're on MA and you refuse Part D coverage, you won't have any prescription drug coverage (unless you have your own private drug coverage). Being enrolled in MA and Medicare makes you a dual eligible and automatically qualifies you for the Medicare Part D Low Income Subsidy (LIS). This means you wouldn’t have a Part D premium or any Part D deductibles. All you would pay for your prescription drugs is a copayment of $1.45 – $10.35 per prescription at the pharmacy.
Note: Most people cannot qualify for income-based MA if they are on Medicare.
Learn more
Next Steps
Learn more about Medical Assistance (MA)
To learn more about health coverage:
- Visit your local county or tribal human services office.
- If you have a disability, Chat with a Hub expert to learn if you have additional MA options.
- Visit the Minnesota Department of Human Services (DHS) website for general information on Minnesota health care programs.
- For general information on health care reform and the ACA, a good place to start is Health Reform information at the Kaiser Family Foundation.
Apply for Medical Assistance (MA)
You should sign up for Medical Assistance (MA) at your county or tribal human services office if you:
- Are 65 years old or older
- Get Supplemental Security Income (SSI) benefits, or
- Have Medicare coverage.
If you are not in one of those situations, there are three ways to apply for health coverage:
- Online using MNsure.
- In person at your local county or tribal human services office. This is the best way to apply.
- Filling out a paper application and faxing it to 1-651-431-7750, or mailing it to the address listed on the form.
Learn About Work and Benefits - Chat with a Hub expert!
When you have questions or need help, use Chat with a Hub expert. This feature connects you to a DB101 Expert using live chat, phone, or secure email. Anything you talk about is private.
- Understand your current benefits
- Get help using DB101.org
- Connect to resources
- Plan next steps
Free Legal Help
The Minnesota Disability Law Center (MDLC) provides free assistance to people with civil legal issues related to their disability. Call the MDLC Intake Line at 1-612-334-5970 (Twin Cities metro area), 1-800-292-4150 (Greater Minnesota), or 1-612-332-4668 (TTY).
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