A. One purpose of this change notice is to issue the new poverty level income limits for MPW, MIC, Transitional Medicaid and NC Health Choice for Children (NCHC). Implementation instructions for pending applications, new applications, and ongoing cases are also included.
B. Current Medicaid Budgeting rules require that the putative father be included in the budget unit when a pregnant woman applies for Medicaid, if he lives with the woman or is temporarily absent, unless he is a Work First, SSI or CAP recipient. However, a recent review of Federal law revealed that including the income of a putative father of an unborn child when determining the eligibility of a pregnant woman is prohibited.
C. In addition, MA-3305, MAF, MIC, HSF Budgeting, II.F.4, erroneously stated that eligibility continues for 12 months for “children age 19 and under” without regard to changes in assets or income or household composition. The correct age is “up to age 19 and under.”
A. Income limits for MPW, MIC, NCHC and Transitional Medicaid have been revised to reflect the increase in the federal poverty level. EIS edits were updated effective February 27, 2008. The new income limits may now be entered into EIS. You may enter the new income limits on or after that date. Cases keyed with a Medicaid effective date of 4/01/08 or later must use the new income limits in EIS.
B. Exclude the income of a putative father in pregnant women cases effective April 1, 2008. Apply this change to applications taken and redeterminations started on or after April 1, 2008, as well as to those presently in process.
C. Use “up to age 19 and under” in determining 12 month continued eligibility without regard to changes in assets, income or household composition in MAF, MIC and HSF cases effective April 1, 2008. Apply this change to applications taken and redeterminations started on or after April 1, 2008, as well as to those presently in process.
DATE: FEBRUARY 25, 2008
Manual: Family and Children’s Medicaid
Change No: 07-08
To: County Directors of Social Services
Effective: April 1, 2008
If eligible using the new income limits and all other eligibility factors are met, approve the application and authorize effective 04/01/08. Authorize through the end of the 60 day post-partum period. Refer to MA-3310, MPW Budgeting. Evaluate months prior to 04/01/08 in other Medicaid aid program/categories.
Always evaluate for eligibility under any other aid/program category (including MAF-M) prior to evaluating for NCHC.
Enter the new income limits in EIS if the Medicaid effective date is 04/01/08 or later.
Note: Administrative applications, which are entered to authorize MIC, NCHC, or MPW coverage, do not count in the average processing time for application processing standards
For MAF applications pending with a deductible or for reserve verifications, evaluate eligibility effective 04/01/08 using the new income limits. For individuals ages 0-5, evaluate for MIC-N or MIC-1. For individuals ages 6-18, evaluate for MIC-N and NCHC. Evaluate pregnant women for MPW.
Apply these changes at the next redetermination to determine eligibility for MIC-N, MIC-1, NCHC or MPW if the case is ineligible for MAF or has a deductible.
Apply these changes at the next redetermination. If the Medicaid Effective Date is prior to April 1, 2008, 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, 2008.
If you have any questions regarding this information, please contact your Medicaid Program Representative. For any issues that are not able to be handled through that venue, Mrs. Angela Floyd, Assistant Director for Recipient and Provider Services, will be your point of contact and can be reached at (919) 855-4000.
William W. Lawrence, Jr., M.D.
(This material was researched and written by Janice M. Dexter and William Appel, Policy Consultants, Medicaid Eligibility Unit.)
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.