Adult Medicaid Change Notices
A. Pending MAABD PLA Applications Dated Prior to April 1, 2011
B. Pending MAABD LTC/PACE Applications Dated Prior to April 1, 2011
C. Pending MQB Applications Dated Prior to April 1, 2011
D. Applications Dated April 1, 2011 or Later
A. Remove: MA- 400, Introduction to Medicaid, Figure 1.
B. Remove: MA-2110, Passalong, pages 3-8 and attachment 3.
C. Remove: MA-2260, Financial Eligibility Requirements/PLA, pages 14-15.
D. Remove: MA-2311, LIS Processing and Case Maintenance, pages 7-8 and Figure 1.
CHANGE NOTICE FOR MANUAL NO. 04-11, FPL INCOME LIMIT CHANGES
DATE: FEBRUARY 23, 2011
Manual: Aged, Blind, and Disabled Medicaid
Change No: 04-11
To: County Directors of Social Services
Effective: April 1, 2011
I. CONTENT OF CHANGE
This change notice issues the new poverty level income limits and provides implementation instructions for pending applications, new applications and ongoing cases.
II. EFFECTIVE DATE OF NEW INCOME LIMITS
Income limits for MAABD-N, MQB-Q, MQB-B, MQB-E, MWD and HCWD are revised effective April 1, 2011 to reflect the increase in the federal poverty level. The income limits were updated in EIS effective February 25, 2011. You may enter the new income limits on or after that date.
Use the new income limits to determine eligibility beginning April 1, 2011. Use the 2010 income limits to determine eligibility for months prior to April 2011.
III. IMPLEMENTATION INSTRUCTIONS FOR PENDING APPLICATIONS
A. Pending MAABD PLA Applications Dated Prior to April 1, 2011
1. For the months prior to April 2011, use the income limits and countable income for those months. For months April 2011 and later, use the income limits effective April 1, 2011 and the countable income effective for those months.
2. If the budget unit’s countable income is within the MAABD-N limit for months in the certification period prior to April 2011 and for months April 2011 and later, approve the application effective the first month of eligibility through the end of the certification period. Enter the April 1, 2011, income limits and countable income.
3. If the budget unit’s countable income prior to April 1, 2011 exceeded the MAABD-N income limit, but effective April 1, 2011 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 April 1, 2011. When the deductible is met, authorize the case as medically needy from the date the deductible is met through March 31, 2011.
b. Authorize the case with an N classification effective April 1, 2011. 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 April 1, 2011 exceeded the MAABD-N income limit and it still exceeds the increased N limit, evaluate the case for medically needy. Use the April 1, 2011 income limits for any certification period that includes April 1, 2011 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/PACE Applications Dated Prior to April 1, 2011
If countable income is above the MAABD-N income limit prior to April 1, 2011 but is within the limit effective April 1, 2011, and all other MAABD-N criteria are met, classify the case as N effective April 1, 2011. For all months prior to April 1, 2011, classify as medically needy if all other factors are met.
C. Pending MQB Applications Dated Prior to April 1, 2011
1. If the classification effective April 1, 2011 is different than that prior to April 1, 2011 and all other criteria are met, approve effective April 1, 2011 in the new classification. Enter the income limit effective April 1, 2011 in EIS. The certification from date must equal the first day of the month of application. Authorize months prior to April 1, 2011 on the DB/PML screen. This may mean that an MQB-E case is now MQB-B or an MQB-B case is now MQB-E.
2. If the applicant is eligible for MQB prior to April 1, 2011 and eligible for MAABD effective April 1, 2011:
a. Approve the MQB as open/shut for the months prior to April 1, 2011. 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 April 1, 2011. Enter in EIS the income limit effective April 1, 2011. The certification from date must equal the first day of the month of application.
EXAMPLE: Applicant applies for Medicaid on March 1, 2011. His countable income is $907. The application is processed on March 15, 2011. You determine he is eligible for MAABD-Q effective April 1, 2011, based on the new income limits and he is eligible for MQB-B for March. Approve the MQB-B application open/shut, for March 2011. Enter a new administrative MAABD and approve as MAABD effective April 1, 2011. Authorization for Q classification always begins the month following the month of disposition.
3. If the case’s countable income prior to April 1, 2011 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 April 1, 2011. The certification from date must equal the first day of the month of application.
D. Applications Dated April 1, 2011 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, 2011.
IV. Implementation instructions for ongoing Mqb-b & e cases
For April 1, 2011 or later, countable monthly income will have to be compared to the new income limits. An NCXPTR report, titled “Poverty Potential Eligibility for Program Review,” will be prepared which will compare countable income to the new poverty level for the aid program category and Medicaid classification.
An Administrative Letter will be issued within the next few days with instructions on how to work the report.
V. INSTRUCTIONS FOR MAINTENANCE OF THE MANUAL
A. Remove: MA- 400, Introduction to Medicaid, Figure 1.
Insert: MA-400, Introduction to Medicaid, Figure 1 effective 04/01/11.
B. Remove: MA-2110, Passalong, pages 3-8 and attachment 3.
Insert: MA-2110, Passalong, pages 3-8 and attachment 3 effective 04/01/11.
C. Remove: MA-2260, Financial Eligibility Requirements/PLA, pages 14-15.
Insert: MA-2260, Financial Eligibility Requirements/PLA, pages 14-16 effective 04/01/11.
D. Remove: MA-2311, LIS Processing and Case Maintenance, pages 7-8 and Figure 1.
Insert: MA-2311, LIS Processing and Case Maintenance, pages 7-8 and Figure 1 effective 04/01/11.
If you have any questions, please contact your Medicaid Program Representative.
Craigan L. Gray, MD, MBA, JD,
Director
(This material was researched and written by William Appel, Policy Consultant, Medicaid Eligibility Unit.)
