DATE: FEBRUARY 21, 2013
Manual: Family and Children’s Medicaid
Change No: 03-13
To: County Directors of Social Services
Effective: April 1, 2013
This change notice issues the new poverty level income limits and provides implementation instructions for pending applications, new applications, and ongoing cases.
Centers for Medicare and Medicaid Services (CMS) and other federal agencies use the term beneficiary instead of recipient, to match their terminology, as policy changes recipient and A/R will be changed to beneficiary and A/B.
Income limits for MPW, MIC, NCHC and Transitional Medicaid are revised effective April 1, 2013, to reflect the increase in the federal poverty level. The income limits were updated in EIS effective February 28, 2013. You may enter the new income limits on or after March 1, 2013.
Use the new income limits to determine eligibility beginning April 1, 2013. Use the 2012 income limits to determine eligibility for months prior to April 2013.
If eligible using the new income limits and all other eligibility factors are met, approve the application and authorize effective 04/01/13. Authorize through the end of the 60 day post-partum period. Refer to MA-3310, MPW Budgeting. Evaluate months prior to 04/01/13 in other Medicaid aid program/categories.
Always evaluate for eligibility under any other aid/program category (including MAF-M) prior to evaluating for NCHC. When a child is potentially eligible for MAF-M and NCHC, authorize him for MAF-M if medical expenses to meet the deductible have been incurred as of the date of application.
Enter the new income limits in EIS if the Medicaid effective date is 04/01/13 or later.
For MAF applications pending with a deductible or for reserve verifications, evaluate eligibility effective 04/01/13 using the new income limits. For individuals ages 0 through 5, evaluate for MIC-N or MIC-1. For individuals ages 6 through 18, evaluate for MIC-N and NCHC. Evaluate pregnant women for MPW.
Apply these changes at the next redetermination. If the case is ineligible for MAF or has a deductible, evaluate for eligibility under any other aid/program. Remember to consider continuous eligibility for children 0 through 18.
Apply these changes at the next redetermination. If the Medicaid Effective Date is prior to April 1, 2013, use the old limits. See MA-3305, MAF, MIC, HSF Budgeting, for instructions regarding changes that affect MIC.
Use the new 185% poverty limit for Transitional Medicaid for months beginning April 1, 2013.
If you have any questions, please contact a Medicaid Program Representative.
Carol Steckel, MPH,
(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.