DATE: FEBRUARY 23, 2004
Manual: Family and Children’s Medicaid
Change No: 14-04
To: County Directors of Social Services
Effective: April 1, 2004
The 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) and to provide implementation instructions for pending applications, new applications, and ongoing cases.
MA-3315, Medicaid Deductible, has also been updated to reflect the new medical reimbursement rate for medically related transportation.
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 Wednesday, February 25, 2004. You can now enter the new income limits.
Cases keyed with a Medicaid effective date of 4/01/04 or later require use of the new income limits in EIS.
If eligible using the new income limits and all other eligibility factors are met, approve the application and authorize effective 4/01/04. Authorize through the end of the 60 day post-partum period. Refer to MA-3310, MPW Budgeting. Evaluate months prior to 4/01/04 for other Medicaid.
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 4/01/04 or later.
Note: Administrative applications, which are entered to authorize MIC 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 4/01/04 using the new income limits. Evaluate individuals under age 19 for MIC-N and NCHC. Evaluate pregnant women for MPW.
Apply these changes at the next redetermination or change in situation to determine eligibility for MIC-N, NCHC, or MPW if the case is ineligible for MAF or has a deductible.
Apply these changes at the next redetermination or, if the certification period began prior to 4/01/04, the next change in situation. If the Medicaid Effective
Date is prior to April 1, 2004, use the old limits. See MA-3305, MAF, MIC, HSF Budgeting, for instructions regarding changes that affect the MIC.
Apply these changes at the next reenrollment.
Use the new 185% of poverty limit for Transitional Medicaid for months beginning April 1, 2004.
If you have any questions, please contact your Medicaid Program Representative.
Gary H. Fuquay
[This material was researched and written by Angela Saddler, Policy Consultant, Medicaid Eligibility Unit.]
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.