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DMA ADMINISTRATIVE LETTER NO: 05-15, SOCIAL SECURITY AND VA COST-OF-LIVING ADJUSTMENT

DATE:

December 9, 2015

SUBJECT:

Social Security Cost-of-Living Adjustment (COLA) and VA Cost-Of-Living Increase

DISTRIBUTION:

County Directors of Social Services

Medicaid Eligibility Staff

I. Social Security COST-of-living adjustment (cola)

        B. Monthly Premium

Enrolled prior to 2016 $104.90

 

Enrolled in 2016 $121.80

II. Other important information for 2016

INCOME LIMITS

Remain the same; the Federal Poverty Level is not subject to change until April 2016.

Family Size

0 thru 135% FPL

Full Subsidy

136 thru 140% FPL

75% Subsidy

141 thru 145% FPL

50% Subsidy

146 thru 149% FPL

25% Subsidy

1

0 - 1325

1325.01-1374

1374.01-1423

1423.01-1472

2

0 - 1793

1793.01-1859

1859.01-1925

1925.01-1992

3

0 - 2261

2261.01-2344

2344.01-2428

2428.01-2512

4

0 - 2729

2729.01-2830

2830.01-2931

2931.01-3032

5

0 - 3197

3197.01-3315

3315.01-3433

3433.01-3552

6

0 - 3665

3665.01-3800

3800.01-3936

3936.01-4072

7

0 - 4133

4133.01-4286

4286.01-4439

4439.01-4592

8

0 - 4601

4601.01-4771

4771.01-4941

4941.01-5112

RESOURCE LIMITS

Changed as listed below.

Subsidy Calculation for One Person

Countable Resources in $

≤135%FPL

136% thru 140% FPL

141% thru 145% FPL

146% thru 149% FPL

≥150%

< 8,780

A

C

D

E

F

> 8,780 to 13,640

B

C

D

E

F

> $13,640

F

F

F

F

F

Subsidy Calculation for a Couple

Countable Resources

< 135% FPL

136% thru 140% FPL

141% thru 145% FPL

146% thru 149%

> 150%

< 13,930

A

C

D

E

F

>$13,930 to < 27,250

B

C

D

E

F

> $27,250

F

F

F

F

F

DEDUCTIBLE and CO-PAY

Change as listed below.

Subsidy

Subsidized Monthly Premium

Yearly Deductible

Pre- Catastrophic Co-pay per Prescription

Coverage Gap? Y/N

Catastrophic Co-pay per Prescription

A

100%

$0

$2.95/$7.40

N

$0

B

100%

$74

15%

N

$2.95/$7.40

C

75%

$74

15%

N

$2.95/$7.40

D

50%

$74

15%

N

$2.95/$7.40

E

25%

$74

15%

N

$$2.95/$7.40

F (No subsidy)

0%

$360

25%

Y

@5%

   

ICF/MR

      $8,960

*Hospice Care in a NF (SNF)

      $5,078

Hospice Inpatient Care (Acute hospital)

      $19,466

Period

Index for 2016

 

Period

Index for 2016

May –June 1977

.245

 

Jan. 1995 – Dec. 1995

.625

July 1977 – June 1978

.260

 

Jan. 1996 – Dec. 1996

.641

July 1978 – June 1979

.276

 

Jan. 1997 – Dec. 1997

.660

July 1979 – June 1980

.304

 

Jan. 1998 – Dec. 1998

.674

July 1980 – June 1981

.347

 

Jan. 1999 – Dec. 1999

.683

July 1981 – June 1982

.386

 

Jan. 2000 – Dec. 2000

.700

July 1982 – Dec. 1983

.415

 

Jan. 2001 – Dec. 2001

.724

Jan. 1984 – Dec. 1984

.429

 

Jan. 2002 – Dec. 2002

.743

Jan. 1985 – Dec. 1985

.444

 

Jan. 2003 – Dec. 2003

.753

Jan. 1986 – Dec. 1986

.458

 

Jan. 2004 – Dec. 2004

.769

Jan. 1987 – Dec. 1987

.464

 

Jan. 2005 – Dec. 2005

.790

Jan. 1988 – Dec. 1988

.484

 

Jan. 2006 – Dec. 2006

.822

Jan. 1989 – Dec. 1989

.503

 

Jan. 2007 – Dec. 2007

.849

Jan. 1990 – Dec. 1990

.526

 

Jan. 2008 – Dec. 2008

.868

Jan. 1991 – Dec. 1991

.555

 

Jan. 2009 – Dec. 2011

.919

Jan. 1992 – Dec. 1992

.575

 

Jan. 2012 – Dec. 2012

.953

Jan. 1993 – Dec. 1993

.593

 

Jan. 2013 - Dec. 2013

.969

Jan. 1994 – Dec. 1994

.608

 

Jan. 2014 – Dec. 2015

.983

         

If you have any questions regarding this information, please contact the Operational Support Team at ost.policy.questions@dhhs.nc.gov .

Dave Richard

Deputy Secretary for Medical Assistance

(This material was written and researched by Pam Cooper, Medicaid Eligibility Unit)

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