Adult Medicaid Change Notices
A. Income Limits
B. End of COLA Disregard
A. Pending MAABD PLA Applications Dated Prior to April 1, 2005
B. Pending MAABD LTC Applications Dated Prior to April 1, 2005
C. Pending MQB Applications Dated Prior to April 1, 2005
D. Applications Dated 04/01/05 or Later
A. For 04/01/05 or later, apply the new income limits and 2005 RSDI amounts to establish eligibility for the ongoing certification period.
B. Prior to 04/01/05, apply the current income limits and 2004 RSDI amounts to establish eligibility for ongoing certification period.
A. Remove MA-400, Introduction to Medicaid, Figure 1.
B. Insert attached MA-400, Introduction to Medicaid, Figure 1 effective 04/01/05.
C. Remove MA-2260, Financial Eligibility Requirements/PLA, pages 14 – 15.
D. Insert attached MA-2260, Financial Eligibility Requirements/PLA, pages 14 – 15 effective 04/01/05.
CHANGE NOTICE FOR MANUAL No. 15-05, POVERTY LEVEL INCOME LIMITS
DATE: FEBRUARY 22, 2005
Manual: Aged, Blind, and Disabled Medicaid
Change No: 15-05
To: County Directors of Social Services
Effective: April 1, 2005
I. Content OF THE CHANGE
The purpose of this change notice is to issue the new poverty level income limits and provide implementation instructions for pending applications, new applications and ongoing cases.
II. EFFECTIVE DATE OF NEW INCOME LIMITS
A. Income Limits
Income limits for MAABD-N, MQB-Q, MQB-B, MQB-E, and MWD are revised effective April 1, 2005, to reflect the increase in the federal poverty level. The income limits were updated in EIS effective Thursday, February 25, 2005. You can now enter the new income limits.
Use the new income limits to determine eligibility beginning April 2005. Use the 2004 income limits for months prior to April 2005.
B. End of COLA Disregard
The exclusion of the RSDI cost-of-living allowance (COLA) for MAABD-N, MQB-Q, MQB-B, MQB-E, and MWD ends with the implementation of the new income limits. Begin counting the full RSDI amount, including the 2004 COLA effective April 1, 2005. Continue to disregard the COLA for January, February and March 2005.
III. IMPLEMENTATION INSTRUCTIONS FOR PENDING APPLICATIONS
A. Pending MAABD PLA Applications Dated Prior to April 1, 2005
1. For the months prior to April 2005, use the income limits and countable income for those months. For months April 2005 and later, use the income limits effective April 1, 2005, and the countable income effective for those months.
For MAABD-N cases, the RSDI COLA was disregarded through March. Begin counting it in April.
2. If the budget unit’s countable income is within the MAABD-N limit for months in the certification period prior to April 2005 and for months April 2005 and later, approve the application effective the first month of eligibility through the end of the certification period. Enter the April 1, 2005, income limits and countable income.
3. If the budget unit’s countable income prior to 04/01/05 exceeded the MAABD-N income limit, but effective 04/01/05 it is within the MAABD-N income limit and the budget unit is otherwise eligible:
a. Recalculate the medically needy deductible for the number of months in the c.p. prior to 04/01/05. When the deductible is met, authorize the case as medically needy from the date the deductible is met through 3/31/05.
NOTE: When calculating the deductible, do not disregard the COLA. The COLA disregard does not apply to medically needy.
b. Authorize the case with an N classification effective 04/01/05. The certification period will be 12 months beginning with the month of application.
NOTE: Remember that for MAABD-N, if resources exceed the MAABD resource limit at the first moment of the month, the applicant is ineligible for MAABD-N for the entire month. He must be evaluated as medically needy. Refer to MA-2230, Financial Resources.
4. If the budget unit’s countable income prior to 4/1/05 exceeded the MAABD-N income limit and it still exceeds the increased N income limit, evaluate the case for medically needy. Use the 04/01/05 income limits and the current COLA amount for any certification period that includes 04/01/05 or later, regardless of the begin date. If it is established that the deductible can be met or projected expenses are within $300.00, pend in deductible status. If it is determined that the deductible cannot be met, deny the application.
B. Pending MAABD LTC Applications Dated Prior to April 1, 2005
If countable income is above the MAABD-N income limit prior to 04/01/05 but is within the limit effective 04/01/05, and all other MAABD-N criteria are met, classify the case as N effective 04/01/05. For months prior to 04/01/05 classify as medically needy if all other eligibility factors are met.
C. Pending MQB Applications Dated Prior to April 1, 2005
1. If the classification effective 04/01/05 is different than that prior to 04/01/05, and all other criteria were met, approve effective 04/01/05 in the new classification. Enter the income limit effective 04/01/05 in EIS. The certification from date must equal the first day of the month of application. Authorize months prior to 04/01/05 on the DB/PML screen. This means due to the increased income limit an MQB-E case is now MQB-B or MQB-B case is now MQB-Q.
2. If the applicant is eligible for MQB prior to 04/01/05 and eligible for MAABD effective 04/01/05:
a. Approve the MQB as open/shut for the months prior to 04/01/05. Complete a manual DMA-5004, Buy - In Clerical Action, for the open/shut case.
b. Enter a new administrative MAABD application and approve as MAABD effective 04/01/05. Enter in EIS the income limit effective 04/01/05. The certification from date must equal the first day of the month of application.
EXAMPLE: Applicant applies for Medicaid on March 1, 2005. His countable income is $797. The application is processed on March 15, 2005. You determine he is eligible for MAABD-Q effective April 1, 2005, based on the new income limits and he is eligible for MQB-B for March. Approve the MQB-B application open/shut for March 2005. Then enter a new administrative MAABD application and approve as MAABD effective 04/01/05. Remember that authorization for Q classification always begins the month following the month of disposition.
3. If the case’s countable income prior to 04/01/05 makes the case ineligible for MQB-Q, B or E, but will be eligible based on the new income limits, approve the application in the appropriate classification with a Medicaid effective date of 04/01/05. The certification from date must equal the first day of the month of application.
D. Applications Dated 04/01/05 or Later
1. Apply the new income limits to establish eligibility for the ongoing certification period.
2. Use the old income limits to establish eligibility for the retro months prior to April 1, 2005.
IV. IMPLEMENTATION INSTRUCTIONS FOR ONGOING ADULT MEDICAID (MAABD-N, F, G, H, Q & B, MQB-Q, B & E CASES)
A. For 04/01/05 or later, apply the new income limits and 2005 RSDI amounts to establish eligibility for the ongoing certification period.
A report will display on NCXPTR. The title of the report is Poverty Potential Eligibles for Program Review. To view the report in XPTR, type: ‘DHREJA POV POT ELIG FOR PROG REV’. This report compares the New Countable Income to the New Poverty Level for the Aid Program/Category and Medicaid classification. For MQB-B and MQB-E cases, it also compares the New Countable Income to the new Minimum Income Limit for their current aid program/category. The Minimum Income Limit column lists the new “minimum” amount of the federal poverty level for the recipient’s current aid program/category.
EIS will not automatically update the cases on this report. You must pull these cases.
1. For each case listed on the report, complete a SOLQ to verify the RSDI amount.
a. If there is no amount in the RSDI field in EIS, the increase could not be calculated correctly. These cases will show on the report with zeroes in the EIS RSDI field.
(1) Calculate the new countable income.
(2) Compare the New Countable Monthly Income with the New Poverty Level.
(3) If income is greater than the new poverty level limit, evaluate eligibility under other aid program/categories.
(4) Take appropriate action and send a timely notice. React to the change in the case by the pull cutoff date in April.
b. For cases with no amount listed in the Minimum Income Limit column, do the following:
(1) Compare the New Countable Monthly Income with the New Poverty Level.
(2) If the poverty level increase causes a recipient’s income to be greater than the New Poverty Level amount, evaluate for Medicaid under other aid program/categories.
(3) Take appropriate action and send a timely notice. React to the change in the case by the pull cutoff date in April.
c. For cases with an amount listed in the Minimum Income Limit column (current MQB-B and MQB-E recipients), do the following:
(1) Compare the New Countable Monthly Income with the New Poverty Level.
(a) If the poverty level increase causes a recipient’s income to be greater than the New Poverty Level amount, evaluate for Medicaid under other aid program/categories.
(b) Take appropriate action and send a timely notice. React to the change in the case by the pull cutoff date in April.
(2) Compare the New Countable Monthly Income with the Minimum Income Limit.
(a) If the poverty level increase causes a recipient’s income to be equal to or less than the Minimum Income Limit, evaluate for greater benefit aid program/categories.
(b) Transfer the case to the appropriate program/category and send an adequate notice.
2. If an individual who is dually eligible (MAABD with Medicaid class B or Q) has a deductible, he must be transferred to MQB-B. Refer to MA-2355, MAABD/MQB Program Transfers.
3. If the individual is not entitled to Medicare, change to deductible status if it is established that the deductible can be met or projected expenses are within $300.00 of meeting the deductible. If the deductible cannot be met, send a timely notice to terminate the case.
B. Prior to 04/01/05, apply the current income limits and 2004 RSDI amounts to establish eligibility for ongoing certification period.
If the budget unit’s countable income is within the MAABD-N income limit prior to 04/01/05 and all other criteria are met, approve effective the first month of eligibility.
Use the 04/01/05 income limits and the current COLA amount for any certification period that includes 04/01/05 or later, regardless of the begin date. Please note that to enter the case in EIS, when months April 2005 or later are covered, you must enter the income limits effective 04/01/05.
EXAMPLE: You are completing a February 2005 review. The total countable income is $770.00, due to your disregarding the RSDI COLA. You determine he is eligible for MAABD for March 2005 using the 2004 income limits. For April 2005 and later, you must include the RSDI COLA as countable income. Therefore, the new total countable income is 792.00. You determine he remains eligible for MAABD effective April 1, 2005 based on the new income limits. The new certification period is March 2005-August 2006. To enter April 2005 and later months into EIS, you must enter the income limits effective 04/01/05.
V. INSTRUCTIONS FOR MAINTENANCE OF THE MANUAL
A. Remove MA-400, Introduction to Medicaid, Figure 1.
C. Remove MA-2260, Financial Eligibility Requirements/PLA, pages 14 – 15.
If you have any questions, please contact your Medicaid Program Representative.
Mark Benton
Interim Director
(This material was researched and written by Charlotte Gibbons, Policy Consultant, Medicaid Eligibility Unit.)
