Many people may apply for Minnesota’s Insurance Affordability Programs (IAP) using the MNsure online or a paper application. However, there are different application forms designed to collect the information needed based on the applicant's situation. Applicants must not be asked to answer questions that are not applicable to determining their eligibility. Using the correct application form helps speed up the eligibility determination. When using a paper application form, it is important to choose the most appropriate form and to follow the instructions about where to send the form.
A secure, web-based application is at MNsure.org. The online application for financial assistance in obtaining health care is a smart and dynamic application that asks questions based on an applicant’s response to previous questions. The online application displays all required information about an applicant's rights and responsibilities. It is the preferred application for IAPs because a real-time eligibility determination may be possible.
Applicants using the MNsure online application have eligibility determined for all Minnesota Health Care Programs (MHCP) and advanced premium tax credits.
Eligibility is evaluated in the following order:
People who are eligible for MA are not eligible for MinnesotaCare or APTC. Likewise, people who are eligible for MinnesotaCare are not eligible for APTC. Eligibility for help getting health care is not a barrier to purchasing a QHP without financial help.
Applicants who are potentially eligible for other types of MA are referred for a further eligibility determination.
Applicants may use the paper version of the MNsure online application. Applicants submit DHS-6696 to their county or tribal servicing agency. It is available in English, Hmong, Russian, Somali, Spanish and Vietnamese.
Applicants using DHS-6696 must have eligibility determined for all Minnesota Health Care Programs (MHCP) and advanced premium tax credits.
Eligibility is evaluated in the following order:
People who are eligible for MA are not eligible for MinnesotaCare or APTC. Likewise, people who are eligible for MinnesotaCare are not eligible for APTC. Eligibility for help getting health care is not a barrier to purchasing a QHP without financial help.
Applicants who are potentially eligible for other types of MA are referred for a further eligibility determination.
Applicants in households where everyone in the household is a member of one of the following populations use the MHCP Application for Certain Populations:
DHS-3876 is available in English, Hmong, Russian, Somali, Spanish and Vietnamese. Applicants submit DHS-3876 to their county or tribal servicing agency.
The Supplement to the MHCP Application DHS-3417 or DHS-3876 (DHS-6696B) must also be completed when a submitted DHS-3876 includes household members not listed above.
The Application for Payment of Long-Term Care Services (DHS-3531) is for MA applicants who have a basis of eligibility other than MA-FCA and:
Applicants submit DHS-3531 to their county or tribal servicing agency. Applicants who are potentially eligible for MA-FCA are referred for a further eligibility determination.
The Minnesota MA Application/Renewal Breast and Cervical Cancer form is for people who were screened by the Sage Screening Program and have breast or cervical cancer and are seeking MA coverage. Enrollees also use this form to renew eligibility for coverage. Applicants submit DHS-3525 to their county or tribal servicing agency.
This form is for applicants who are only seeking coverage under the Minnesota Family Planning Program (MFPP.) Applicants submit DHS-4740 to DHS Health Care Eligibility Operations. It is also available in Spanish.
A supplemental form may be required to collect additional information needed to determine eligibility. Agencies may only require an applicant to provide information necessary to make an eligibility determination and cannot require applicants to provide information they already provided. Therefore, an applicant or enrollee who already completed an application cannot be required to submit a new application unless their eligibility is denied or coverage closed. Instead, a supplement is used to make a complete eligibility determination.
Applicants who submit their application through the MNsure online or paper application (DHS-6696) may need to provide additional information if their eligibility cannot be determined in METS or if further evaluation is needed to determine their eligibility for MA-ABD, long-term care services or Medicare Savings Programs. The MHCP Request for Information (DHS-3271) must accompany the DHS-6696A when an applicant needs a subsequent determination.
This supplement is form is also used to gather the information needed to redetermine eligibility for current MA-FCA enrollees who have a change in circumstances and no longer qualify for their current MA basis of eligibility at or between renewals, or who request a determination under an MA-ABD basis of eligibility. The MHCP Request for Information to Determine Eligibility for Certain Populations (DHS-8431) must accompany the DHS-6696A when an enrollee needs a new determination.
This paper supplement gathers information not requested on the MNsure application, needed to determeine eligibility for:
DHS-6696A is available in English, Hmong, Russian, Somali, Spanish and Vietnamese. Applicants submit DHS-6696A to their county or tribal servicing agency.
When an applicant submits the MHCP Application for Certain Populations (DHS-3876) and they do not meet the criteria to use DHS-3876, they must complete this short supplement to have an eligibility determination. The MHCP Request for Information (DHS-3271) must accompany the DHS-6696B when an applicant needs a subsequent determination.
This form is also used to gather the information needed to redetermine eligibility for enrollees who lose their basis of eligibility at or between renewals, or who request a determination for a different MA basis of eligibility or program. The MHCP Request for Information to Determine Eligibility for Families with Children and Adults (DHS-8432) must accompany the DHS-6696B when an enrollee needs a new determination.
This paper supplement gathers information needed to determine eligibility for:
DHS-6696B is available in English, Hmong, Russian, Somali, Spanish and Vietnamese. Applicants submit DHS-6696B to their county or tribal servicing agency.
This form is a supplement to DHS-6696 for inmates requesting MA payment of hospital services while incarcerated. The correctional facility assists with the application. Applicants submit DHS-6696G and a completed DHS-6696 to DHS Health Care Eligibility Operations.
This form is a supplement for people leaving prison to help determine health care eligibility upon release. Applicants must submit DHS-3443 with a completed application; a DHS-6696, DHS-3876, DHS-5038 or DHS-3531. Applicants submit the two forms to the county or tribal servicing agency in which the applicant resided before entering the correctional system.
MA enrollees using the Families with Children and Adults bases of eligibility use this form to request payment for services in a long-term care facility. Enrollees submit DHS-3543A to their county or tribal servicing agency.
MA enrollees using the People Who are Age 65 or Older, Blind or Disabled bases of eligibility use this form to request payment for services in a long-term care facility or a home and community-based waiver program. Enrollees submit DHS-3543 to their county or tribal servicing agency.
This form is used to request MA coverage reopen after the person was incarcerated less than a year. Applicant submit DHS-5038 to the county or tribal servicing agency in which:
This form request missing information about employer subsidized health insurance availability. People can take this form to their human resources department to be filled out. It is included in DHS-6696 and the MNsure online application. Applicants submit DHS-6696D to their county or tribal servicing agency.
This form obtains a signature from a Minnesota Health Care Programs applicant or enrollee when the person fails to sign the application or renewal. Applicants submit DHS-6696C to their county or tribal servicing agency.
This form sets the date of application. An applicant must submit a complete application within 30 days of the written request. Applicants submit DHS-3417B to their county or tribal servicing agency.
Code of Federal Regulations, title 42, section 435.907
Code of Federal Regulations, title 45, section 155.405
Code of Federal Regulations, title 45, section 155.310
Minnesota Statutes, section 256B.04
Minnesota Statutes, section 256B.08
Published: June 1, 2023