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DATE: |
December 16, 2013 |
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SUBJECT: |
MIC-1, Age 6 - 18 |
DISTRIBUTION: |
County Directors |
Medicaid Supervisors | |
Medicaid Eligibility Staff |
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.
Eligibility requirements:
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.
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
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.
Apply MAGI Medicaid rules.
If the child’s income is greater than 107% but equal to or less than 133% FPL
Complete the redetermination based on the MAGI household and income at the time of the review. Further instructions will be issued for redeterminations.
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).
For questions or clarification on any of the policy contained in these manuals, please contact your local county office. |
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