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DATE: NOVEMBER 09, 2007
Subject: Social Security Cost-Of-Living Adjustment (COLA) and VA Cost of Living Increase
Distribution: County Directors of Social Services
Medicaid Supervisors
Medicaid Eligibility Staff
Recipients of RSDI and/or SSI will receive a 2.3% cost of living increase in the January 2008 payment.
The FBR will increase to the following maximums effective 1/1/2008:
Individual |
Couple |
Essential Person | |
Full FBR |
$637.00 |
$956.00 |
$319.00 |
1/3 Reduced Income Limit |
$424.00 |
$641.00 |
(I.C.1.b.)
Recipients of Veteran’s benefits receive a 2.3% cost of living increase effective December 1, 2007. This increase will be reflected in the check received in January 2008.
To assist you in identifying the cases affected by the VA cost of living increase, a report entitled DHREJA COLA VA REPORT will be available on NCXPTR after November 28, 2007. This report lists the Medicaid cases in your county in which the VA indicator field is marked yes (Y). You should review these cases to determine if the recipient has notified you of a change in VA benefits. If not, contact VA to verify new amounts. All cases should be reviewed by January 28, 2008. (Pull deadline) Make necessary revisions to the case based on the amount of VA benefit change.
NOTE: Veterans who are already receiving $90 reduced improved pension will not receive an increase.
EIS does not send timely notice for the PLA VA only cases. Those who were authorized as of November 15, 2007, received timely notice with the December insert, but the VA amount was not updated in EIS. If they were in long term care and received RSDI and VA benefits and were on the Audit Report, they received timely notice. In such a case adequate notice is sufficient notification of an adjustment to PML.
Insert to Medicaid ID Cards - TIMELY NOTICE
All non-SSI cases authorized for full Medicaid benefits as of the November 2007 regular run (November 15, 2007) will be sent the following notice with the December 2007 Medicaid card. This insert serves as the timely notice for authorized cases:
NOTE: Due to system constraints, the insert will appear on the MIC, MRF, MSB and IAS cards. However, the COLA will not affect these cases. Refer to IV. in this letter.
NOTICE TO MEDICAID RECIPIENTS |
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If you receive a Social Security check or VA benefit, your check may go up in January 2008. This increase could affect your Medicaid by giving you a deductible, a patient monthly liability, or by increasing the deductible or patient monthly liability you now have. Medicaid regulations require that income from Social Security and VA benefits be counted when determining Medicaid eligibility (MA-2250, Income, and MA-3300, Income, in the Medicaid Eligibility Manuals). Social Services in your county will notify you, by January 1, of the exact change, if any, this action will have on your Medicaid. Be on the lookout for your notice. You may appeal the way Social Services determined your deductible, patient monthly liability or other change in your eligibility within 60 days from the date of the notice. | |||
December 2007 |
Division of Medical Assistance |
AVISO A LOS BENEFICIARIOS DE MEDICAID |
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Si usted recibe un cheque del Seguro Social o algún beneficio como Veterano, puede ser que reciba un aumento a partir del mes de enero del 2008. Este aumento podría afectar su Medicaid creándole un deducible o una responsabilidad financiera mensual como paciente, o aumentando el deducible o la responsabilidad financiera mensual que usted tiene actualmente. Las regulaciones de Medicaid requieren que los ingresos del Seguro Social y los beneficios de Veteranos, sean tomados en cuenta cuando se determina la elegibilidad para Medicaid (MA-2250 y MA-3300 de los Manuales de Elegibilidad de Medicaid). El Departamento de Servicios Sociales de su condado le enviará un aviso a mástardar en enero 1, de como afectará este cambio (si es que hay alguno) a su Medicaid. Esté al pendiente para recibir ese aviso. Usted puede apelar dentro de un periodo de 60 días de la fecha del aviso, la forma en la que Servicios Sociales determina su deducible, su responsabilidad financiera mensual (como paciente), o algún otro cambio en su elegibilidad. | |||
Diciembre 2007 |
División de Asistencia Médica |
The following cases are unaffected by the COLA and will not be updated.
This group includes the following Categorically Needy cases:
The COLA will not be applied to ongoing and pending MQB or MAABD PLA Categorically Needy cases until the spring of 2008. This is due to the federally mandated COLA passalong for Qualified Medicare Beneficiaries and categorically needy cases. The COLA will be applied in conjunction with the poverty income level increases. Instructions will be issued prior to the effective dates.
Because of continuous eligibility for children, the COLA will not apply to MAF-C/G and HSF-N/G cases when the only individual(s) active on the case are children. These cases are identified by the code in the family status field. When the family status code for all individuals on the case is “C”, the COLA does not apply.
The recalculation of RSDI will be automated for all counties. EIS will recalculate the RSDI amount on the night of November 27, 2007.
(V.A.)
All Long Term Care cases that are in balance (total countable monthly income minus the maintenance amount equals the PML) will have an automated recalculation, even those with incomes at or below 100% of poverty. Be sure to evaluate the a/r for passalong eligibility in step I. The passalong of the RSDI COLA for Categorically Needy cases is not applicable in step II budgeting.
All Long Term Care cases that are out of balance will not have an automated recalculation. Total countable monthly income minus the maintenance amount does not equal the PML.
These profiles will display Form ID 1111111B, indicating that the change was made at the State Office.
(VI.A.)
EIS will update the PML amount for LTC cases that are in balance. The system will also send the DMA-5016 and DSS-8110A.
Verify the new amount by using the “Payment History” amount found in the SOLQ section of the OnLine Verification (OLV). Drop any cents showing. If there are no cents showing, use the dollar amounts given by the “Payment History.”
For example: If the “Payment History” shows $582.70, the 70 cents should be dropped and $582.00 used. If the “Payment History” shows $583.00, use $583.00. Do not round down to $582.00.
Each county will receive reports to assist with revising cases due to the RSDI COLA. The reports will be run by EIS on November 27, 2007. One copy of each report will be mailed no later than the first week of December.
These reports will also be available in NCXPTR beginning November 28, 2007. The report name as it is listed in NCXPTR is listed in parenthesis beside each report below.
(VI.C.)
NOTE: These are not ex parte review cases. SSI cases that have been terminated show zero in the payment amount. An SSI indicator “N” with an amount greater than zero indicates there is a problem in the case.
(VI.C.)
NOTE: A broadcast message will be issued when this report is available on NCXPTR.
These instructions apply to all cases in which the RSDI COLA update was automated.
Upon receipt of profiles with the RSDI amount increased by 2.3 %, void the last profile received prior to the RSDI update to prevent its use in error.
(VII.)
Bendex update sheets are not printed for the COLA.
Verify the new RSDI amount using the “Payment History” amount found in the SOLQ section of the OnLine Verification (OLV) within 30 days of receipt of the case profile.
For example, if an individual’s RSDI is $756.70 prior to January 1, 2007, SOLQ displays the monthly benefit credited as $756.00, (rounding down). However, when the 2.3% increase effective January 1, 2008, is applied, it is applied to $756.70 and the result is $774.10, which is rounded down to $774.00. EIS shows the RSDI amount as $756. We apply the 2.3% to $756.00 and our result is $773.38, which is rounded down to $773. Be sure to verify the amount through the OnLine Verification (OLV) SOLQ section when the case profile is received.
(VII.A.)
Only review OLV “Payment History” section of SOLQ to verify RSDI for cases with budgets out of balance. RSDI for other LTC cases may be verified at the next redetermination or change in situation. However, if you choose to make changes to the PML now rather than at the next redetermination or change in situation, you must send a timely notice if there is an increase in the PML.
NOTE: This procedure also applies to cases that were authorized based upon a hospital admission (DRG). Authorization because of DRG does not entitle the recipient to eligibility through the entire certification period without regard to increased income.
(VII.B.2)
October – March | |||
$880 |
RSDI |
$880 |
Old RSDI |
-20 |
Exemption |
X1.023 |
COLA Increase |
860 -242 |
900.24 |
New amt. prior to Rounding | |
618 x6 |
Months in c.p. |
||
$3,708 |
Deductible for 6 months c.p. |
October – December |
January – March | ||
$880 |
RSDI |
$ 900.00 |
New RSDI |
-20 |
Exemption |
-20 |
Exemption |
860 |
880 |
||
-242 |
Income Level for One |
-242 |
Income Level |
618 618 |
638 638 |
||
x3 |
Months in c.p. |
x3 |
Months |
$1,854 |
Deductible for 3 months |
$1,914 |
Deductible for 3 months |
New deductible for the c.p. = $1,854 + 1,914 = $3,768
• If the case has already been authorized, an additional deductible of $60 ($3,768 - $3,708 = $60) will be effective January 1, 2008.
• If the case has not been authorized, the previous deductible of $3,708 will increase to $3,768 effective January 1, 2008.
EIS will calculate the RSDI amounts and recalculate the PML for all non-SSI LTC cases if the budget balances. (See V.A.5., in this letter.) EIS will then automatically issue the DMA-5016 and the DSS-8110A to notify the recipient of the change.
The IMC must manually update the PML for other cases.
(VII.C)
Note: Program for the All-Inclusive Care of the Elderly (PACE) cases are budgeted long term care and have a PML and therefore the same computations apply.
EIS cannot identify certain types of situations, such as cases with income protected for the community spouse or dependent family members and cases with couples in the same room.
This means the updated PML may be incorrect and must be adjusted. If an adjustment is necessary, complete the adjustment at the next redetermination, change in situation or when updating the spousal income allowance. If you change it now, a timely notice is required unless the case was listed on the Audit Report and EIS has already sent a timely notice.
NOTE: Complete an OnLine Verification (OLV) SOLQ to verify the Social Security increase for the community spouse or dependent family member. When verification is received, recompute the community spouse/dependent family member allowance following procedures in MA-2270, Long Term Care Need and Budgeting.
The PML must be manually computed for cases with RSDI and SSI indicator of “Y” and for cases with budgets out of balance (EIS will not update the PML). These cases will appear on the “Cases With CP “To Date” Less Than or Equal to 12-31-07 or Budget Out-of-Balance” report and the “Long Term Care Cases with RSDI and a SSI Indicator of Y” report referenced in VI.C.
LTC cases budgeted Step 3 with a deductible will show up on the “Cases With CP 'To Date ' Less Than or Equal to 12-31-07 or Budget Out-of-Balance” referenced in VI.C. below.
(VII.)
NOTE: Failure to enter the new PML in EIS timely may result in an overpayment to the facility. The county will be charged back for an overpayment resulting from failure to timely and correctly update EIS and send a notice to the facility.
Send a timely notice to notify the recipient of the specific change in the deductible or PML amount. Use change code 02 (notice text required) or 40 (manual notice required - enter “Y” in the Notice Override field on the DSS-8125). Send the notice in time for the timely notice to expire by pull cut-off.
Send a timely notice to notify the recipient of the increased deductible amount. Send a manual notice or use change code 02 (notice text required) for an automated timely notice. Send the notice in time for the timely notice to expire by pull cut-off in December.
If the COLA increase causes an individual who is dually eligible (MAABD with Medicaid classification B) to have a deductible, he must be transferred to MQB-B. Refer to procedures in MA-2355, MAABD/MQB Program Transfers.
(VII.)
The OLV SOLQ does not always correctly report all RSDI amounts received by an individual if the individual is entitled to benefits from more than one SSA claim. Verify dual entitlement by completing an OLV SOLQ using the claim number and beneficiary identification code (BIC) specified in the “Dual Entitlement No and BIC” fields of the OLV SOLQ. Add the benefit amounts together to determine the total monthly RSDI benefit amount.
Determine eligibility using the new RSDI amount. If the new RSDI amount causes excess income:
When the RSDI COLA results in termination of an individual’s SSI benefits (and automatic entitlement to Medicaid), complete an ex parte redetermination.
(VII.H.)
Individuals terminated from SSI because of the COLA must be evaluated under all passalong groups prior to the termination. They may remain eligible for Medicaid due to passalong provisions. Check the 503 Leads report for individuals eligible for passalong. Evaluate for Medicaid eligibility under all passalong groups and flag the case. Refer to MA-2110, Passalong.
The following instructions are for applications still pending as of November 27, 2007 (the last keying date based on the automated RSDI COLA update).
NOTE: If the application is approved on or before November 27, 2007, the RSDI amount will be updated if the case meets the criteria above for an automated update.
When processing an application, apply the RSDI COLA (if applicable per instructions below) and use the Medicare B premium of $96.40 for the deductible/PML effective January 1, 2008.
Use base period income to determine eligibility. Do not react to changes in income that occur on or after the date of application.
Follow policy in MA-3300, Income.
(VIII.D.)
EXAMPLE: Medically Needy application, certification period is October - March. Applicant provides documentation on December 7 that his deductible was met November 24. Authorize 11-24 through 3-31. The pull/check date is 12/21/07. Send a timely notice of the additional deductible effective 1/1/2008. If the timely notice period expires after the pull check date, the new deductible cannot be effective until 2/1/2008.
NOTE: The last day to send timely notice may vary according to county holiday schedule.
(VIII.D.5.)
EXAMPLE: LTC applicant has RSDI gross amount of $880. Certification period is December through May. There is no other income or unmet medical needs. The case is evaluated as Medically Needy. SSA increases to $900.24 on 1/1/2008 based on the 2.3% increase. The Medicare Part B premium has also changed to $96.40.
December PML |
January PML |
February PML |
$880.00 |
$900.00 |
$900.00 |
-30.00 pers. needs |
-30.00 pers. needs |
-30.00 pers.needs |
850.00 |
870.00 |
870.00 |
-88.50 Part B |
-96.40 Part B |
|
761.50 |
773.60 |
|
$761.50 PML |
$773.60 PML |
$870.00 PML |
This Administrative Letter obsoletes DMA Administrative Letter 16-06 dated November 16, 2006.
If you have any questions regarding this information, please contact your Medicaid Program Representative.
William W. Lawrence, Jr., M.D.
Acting Director
This material was researched and written by William Appel, Policy Consultant, Medicaid Eligibility Unit.)
For questions or clarification on any of the policy contained in these manuals, please contact your local county office. |
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