Adult Medicaid Admin. Letters

DMA ADMINISTRATIVE LETTER NO: 13-13, MIC-1 CHILDREN AGE 6 THROUGH AGE 18, 107% - 133% FPL

DATE:	December 16, 2013
SUBJECT:	MIC-1, Age 6 - 18
DISTRIBUTION:	County Directors
	Medicaid Supervisors
	Medicaid Eligibility Staff

I. BACKGROUND

The Affordable Care Act (ACA) and applicable regulations consolidated many eligibility groups for children under age 19 into one group. Certain mandatory and optional groups in place prior to 2014 have been moved into the newly consolidated infants and children groups. ACA mandates a minimum Medicaid income limit of 133% FPL for children under age 19.

Children with income between 100% and 133% of the federal poverty level who are eligible for North Carolina Health Choice (NCHC –J/A) prior to January 1, 2014, are eligible for Medicaid to Infants and Children (MIC-1).

Effective January 1, 2014, children ages 6 to 19 above 107% (MIC-N) but less than 133% will also be enrolled in MIC-1.

II. MIC-1 effective january 1, 2014

Eligibility requirements:

A. Children age 6 through 18

B. Income:

1. Greater than 100% FPL but less than 133% FPL for beneficiaries who are eligible for NCHC-J/A prior to January 1, 2014, or

2. Greater than 107% FPL but less than 133% for beneficiaries whose application is dated January 1, 2014 or later.

III. current ongoing cases

On December 20, 2013, EIS and NCFAST will identify all children currently receiving NCHC-J/A with income greater than 100% FPL but equal to or less than 133% FPL and transition the cases to MIC-1. Eligibility will continue under traditional rules.

IV. Pending Applications

A. Applications taken prior to January 1, 2014 and processed by or prior to December 20, 2013.

1. Process the application using traditional income and budgeting rules.

2. Certification period is 12 months.

B. Applications taken prior to January 1, 2014 but processed on December 21, 2013 or later.

Apply Traditional (Non-MAGI) Medicaid rules for eligibility determination.

If the child’s income is greater than 100% FPL but equal to or less than 133% FPL

1. Process the application as open/shut for NCHC-J/A eligible months prior to January 1, 2014.

2. The certification period covers only the open/shut months.

3. Next day key an application and approve as MIC-1 effective 1/1/14 using the same income and budgeting rules (traditional). Do Not Apply MAGI rules. Use P2/6 rules in NCFAST to process the case.

4. Retain the original 12 month certification period (The certification period covers the open/shut period and the remainder of the continuous 12 month CP).

Example:

The Medicaid application is filed on 11/5/13 and disposed of on 12/23/13. The child is eligible under traditional rules for November and December. The caseworker will key an open/shut for 11/1/13/13 – 12/31/13. On 12/24/13 (next day) key a re-application against the NCHC-J/A application and approve for MIC-1 with a Medicaid effective date of 1/1/14 and certification period of 11/1/13 – 10/31/14.

C. Applications taken on or after January 1, 2104

Apply MAGI Medicaid rules.

If the child’s income is greater than 107% but equal to or less than 133% FPL

1. Key an application, and

2. Determine eligibility based on MAGI household and income rules following instructions in Administrative Letter 06-13, and Administrative Letter 06-13 Addendum 1.

3. Certification period is 12 months.

4. Use P7 rules in NCFAST to key the application and process.

V. redetermination

Complete the redetermination based on the MAGI household and income at the time of the review. Further instructions will be issued for redeterminations.

VI. effective date and implementation

This administrative letter is effective upon receipt.

Counties are encouraged to process all potentially eligible NCHC-J/A applications prior to the December 20, 2013 transition in EIS/NCFAST.

If you have any questions regarding this information, please contact a Medicaid Program Representative.

Sandra Terrell, MS, RN

Acting Director

ST/pc

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