MA-EPD Job Aid

MA-EPD — Quick Q&A knowledge article set

Use these Q&A pairs as ready-made knowledge article entries or Genesys quick responses. Each question is formatted as a customer-facing prompt and the answer is a concise, agent-ready response.

Overview

• Q: What is MA-EPD? A: MA-EPD is Medical Assistance for Employed Persons with Disabilities. It provides the same services as standard MA while allowing higher income and assets and requires a monthly premium based on income.
• Q: Who is MA-EPD for? A: People who are certified disabled (by SSA or SMRT), employed or self-employed, who pay Social Security/Medicare taxes, and who pay the monthly MA-EPD premium.
• Q: Are there income or asset limits for MA-EPD? A: There are no income or asset limits for MA-EPD, but reported income is used to calculate the monthly premium.

Eligibility

• Q: What are the core eligibility requirements for MA-EPD? A: Must be certified disabled by SSA or SMRT (if 65+ disability must have been certified before 65), be employed or self-employed, earn more than $65/month on average (net if self-employed), pay Social Security/Medicare taxes, be a U.S. citizen or qualifying non-citizen, pay the MA-EPD premium, and enroll in Medicare when eligible.
• Q: If someone is over age 65, can they apply for MA-EPD? A: Yes, but they must have been certified disabled prior to turning 65 and meet all other MA-EPD criteria.
• Q: How soon must a person report income changes? A: Income changes must be reported within 30 days by phone, mail, in-person, or via the renewal form.

Applying and Coverage

• Q: How does someone apply for MA-EPD if they do not have MA currently? A: If not certified disabled, apply at MNsure.org or with the DHS-6696 paper application. If already certified disabled, use the MHCP Application for Certain Populations (DHS-3876).
• Q: How does someone apply if they already have MA or MinnesotaCare? A: Depends on current coverage and disability status — use DHS-6696A for MA-AA/MA-AX, indicate MA-EPD if certified disabled; MA-DX members who are certified disabled should request MA-EPD in writing or call their Financial/Eligibility Worker; MinnesotaCare applicants use MNsure or DHS-6696 (or DHS-3876 if certified disabled).
• Q: Can MA-EPD coverage be retroactive? A: Yes. A person may request coverage for up to three months before the application month. They choose which retro months to activate and must pay premiums for those months based on actual gross income.

Premiums — Calculation and Notices

• Q: How is the MA-EPD premium calculated? A: The eligibility/financial worker calculates the premium using average monthly income and household size at initial approval and at annual renewal. Recalculations can occur between renewals for certain events (reported decreased income, FPG increases in January, or when RSDI COLA disregard ends).
• Q: Are there tools to estimate the premium? A: Yes — the MA-EPD Premium Estimate "Try It" tool for a quick estimate and the MA-EPD Estimator for a more detailed estimate. Both are estimates; the eligibility worker makes the official calculation.
• Q: What happens after the first premium is paid? A: After the county/tribal office receives the initial premium, DHS mails an Approval Notice with the ongoing premium amount, payment options, details used to determine the premium, and appeal instructions.

First-Time Premiums and Ongoing Invoices

• Q: What is the first-time premium process? A: 1) County/tribal office mails the Initial Premium Notice (may include multiple months). 2) Person pays the full initial premium to start coverage (due within 30 days). If retro months are included, they can choose which retro months to pay for. 3) Payment is sent to the county/tribal office.
• Q: When are ongoing MA-EPD invoices mailed and when are they due? A: DHS mails invoices on the 4th of each month. Each invoice is due on the 4th of the following month and covers the next month’s coverage (for example, an Aug 4 invoice is due Sept 4 for October coverage).
• Q: Do monthly invoices show past due amounts or credits? A: No. Ongoing monthly invoices include the current month’s premium only and do not show past due balances or credits.

Payment Options

• Q: What payment methods are available for MA-EPD premiums? A: Online at payments.dhs.state.mn.us (checking account, debit/credit card, one-time or auto-monthly), by mail (check/money order with payment stub to DHS P.O. Box), or in-person at the Elmer L. Andersen Building (exact cash, check, or money order accepted; Mon–Fri, 8am–4pm).
• Q: What should people know about online payments and auto-pay? A: Online payments require the Customer # from the invoice. Auto-pay must be updated if bank info or premium changes and should be canceled if eligibility ends.

Good Cause Requests

• Q: What is a Good Cause Request and how does someone submit it? A: A Good Cause Request (DHS-6939) lets a person explain why they cannot pay a premium due to unexpected circumstances. The person completes and submits the form themselves online, by fax (651-431-7563), or by mail to DHS MA-EPD Good Cause, P.O. Box 64967, St. Paul, MN 55164-0967.
• Q: What happens after someone submits a Good Cause Request? A: They receive an encrypted email confirmation for online submissions, DHS may contact them with questions, and they will get a written decision by mail within 30 days; their financial/eligibility worker is also notified.

Self‑Employment and MA-EPD

• Q: What qualifies as self-employment for MA-EPD? A: Self-employment means the person sets their own schedule, is not an employee, is not covered by employer liability or worker’s comp, and pays SSA/Medicare taxes and files federal self-employment tax returns.
• Q: How is self-employment income counted for MA-EPD? A: Net earnings equal gross income minus allowable IRS business expenses; net earnings are used to determine eligibility and premiums.
• Q: What documentation verifies self-employment income? A: Acceptable verification includes filed federal tax forms (1040 with Schedule SE or 1040-ES Line 11), business records or receipts, the Self-Employment Gross Income Report Form, simplified records for informal work, previous year tax forms if current year not filed, two-years-prior taxes when newer docs aren’t available, or an accountant’s signed statement projecting income/expenses.
• Q: What are common examples of acceptable self-employment activities? A: Dog walking/pet sitting, babysitting, yard work, snow shoveling, and selling crafts or jewelry.
• Q: What should people know about tax obligations for self-employment? A: They must pay Social Security and Medicare taxes (at least annually, quarterly if required) and file federal self-employment tax returns; they should keep clear income and expense records.

Work, Job Changes, and Eligibility Scenarios

• Q: What happens if a person stops meeting MA-EPD work rules or has not worked 4+ months? A: Eligibility will be redetermined under MA-ABD (MA for Aged, Blind, and Disabled).
• Q: If someone is redetermined eligible under MA-ABD, are there asset rules? A: There is no asset limit for the first 12 months after redetermination; standard MA-ABD policies resume after 12 months. Some assets are excluded if MA-ABD eligible.
• Q: How are seasonal or variable incomes treated? A: Income is counted only in months a person works. They may still be eligible for up to four months under the job loss rule.
• Q: What happens if someone voluntarily quits their job? A: They are not eligible for MA-EPD and eligibility will be redetermined under MA-ABD.
• Q: What if someone is laid off or has a medical emergency that prevents working? A: They may be eligible for up to four months under job loss or medical leave rules, with an additional four months if they are terminated or laid off during medical leave.

Turning or Over Age 65

• Q: If a person on MA-EPD turns 65, what happens? A: They may remain eligible for MA-EPD if they continue to meet all MA-EPD criteria and must enroll in Medicare when eligible.
• Q: What if someone was never on MA-EPD before turning 65 but wants to apply after 65? A: They must have been certified disabled before age 65 and meet all MA-EPD criteria to apply after age 65.
• Q: What if a person had 24 consecutive months of MA-EPD before age 65 and then stops meeting work rules? A: Eligibility will be redetermined under MA-ABD. The spouse’s income/assets are not counted and certain assets (retirement accounts, HSAs, joint accounts, etc.) may be excluded if MA-ABD eligible.

Contacts, Appeals, and Where to Refer

• Q: Who do I refer customers to for questions about premium amount or calculation? A: County or Tribal financial/eligibility worker in their county/tribal nation office.
• Q: Who handles past due balances or billing questions? A: DHS Health Care Billing (phone numbers are usually listed on DHS resources or the invoice).
• Q: Where should someone go if they can’t pay the premium due to an unexpected circumstance? A: Submit a Good Cause Request (DHS-6939).
• Q: How does a person report changes in income or circumstances? A: Report changes to the county or tribal nation office by phone, mail, in-person, or via the renewal/change forms.
• Q: How does someone appeal a premium decision? A: The Approval Notice includes appeal instructions; appeals generally use the Appeal to State Agency form (DHS-0033).

Resources and Tools (agent-facing)

• Q: What online or external tools/articles are useful to help people estimate premiums and plan? A: MA-EPD Premium Estimate "Try It" tool and the MA-EPD Estimator (both give estimates only); DB101 pages on MA-EPD basics and the Estimator; Disability Hub MN MA-EPD pages and Work Toolkit for employment planning.
• Q: What self-employment resources can agents refer people to? A: Job Accommodation Network (JAN), Minnesota DEED Startups & Small Businesses guidance, Launch Minnesota, and local Small Business Assistance Office resources.
• Suggested Genesys snippets / templates
• Q: Template — “I want to apply for MA-EPD.” A: “I can help with that. If you are already certified disabled, you can apply using the MHCP Application for Certain Populations (DHS-3876). If not certified, apply at MNsure.org or with DHS-6696. Would you like the application name or next steps for your situation?”
• Q: Template — “My invoice is due soon; what do I do?” A: “MA-EPD invoices arrive from DHS on the 4th of the month and are due the 4th of the following month for the next month’s coverage. You can pay online at payments.dhs.state.mn.us with the Customer # from your invoice, mail a check/money order with the stub, or pay in-person at the Elmer L. Andersen Building.”
• Q: Template — “I can’t pay right now because of an emergency.” A: “You can submit a Good Cause Request (DHS-6939). The person must complete and submit the form themselves online, by fax, or by mail. They’ll receive a written decision within 30 days.”