Adult Medicaid Change Notices
CHANGE NOTICE FOR MANUAL No. 10-06, POVERTY iNCOME lIMITS
DATE: FEBRUARY 20, 2006
Manual: Aged, Blind, and Disabled Medicaid
Change No: 10-06, Poverty Level Income Limits
To: County Directors of Social Services
Effective: April 1, 2006
I. CONTENT OF 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.
Income limits for the Low Income Subsidy are now included in the MA-2260 Income Table.
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, 2006, to reflect the increase in the federal poverty level. The income limits were updated in EIS effective Friday, February 24, 2006. You can now enter the new income limits.
Use the new income limits to determine eligibility beginning April 2006. Use the 2005 income limits to determine eligibility for months prior to April 2006.
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 2005 COLA effective April 1, 2006. Continue to disregard the COLA for January, February and March 2006.
iII. Implementation instructions for pending applications
A. Pending MAABD PLA Applications Dated Prior to April 1, 2006
1. For the months prior to April 2006, use the income limits and countable income for those months. For months April 2006 and later, use the income limits effective April 1, 2006 and the countable income effective for those months.
For MAABD-N cases, the 2005 RSDI COLA was disregarded through March 2006. Begin counting the COLA increase in April 2006.
2. If the budget unit’s countable income is within the MAABD-N limit for months in the certification period prior to April 2006 and for months April 2006 and later, approve the application effective the first month of eligibility through the end of the certification period. Enter the April 1, 2006, income limits and countable income.
3. If the budget unit’s countable income prior to 04/01/06 exceeded the MAABD-N income limit, but effective 04/01/06 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 04/01/06. When the deductible is met, authorize the case as medically needy from the date the deductible is met through 3/31/06.
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 04/01/06. 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 4/01/06 exceeded the MAABD-N income limit and it still exceeds the increased N limit, evaluate the case for medically needy. Use the 4/01/06 income limits and the current COLA amount for any certification period that includes 4/01/06 or later, regardless of the begin date. It if 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, 2006
If countable income is above the MAABD-N income limit prior to 4/01/06 but is within the limit effective 4/01/06, and all other MAABD-N criteria are met, classify the case as N effective 4/01/06. For all months prior to 4/01/06, classify as medically needy if all other factors are met.
C. Pending MQB Applications Dated Prior to April 1, 2006
1. If the classification effective 4/01/06 is different than that prior to 4/01/06, and all other criteria are met, approve effective 4/01/06 in the new classification. Enter the income limit effective 4/01/06 in EIS. The certification from date must equal the first day of the month of application. Authorize months prior to 4/01/06 on the DB/PML screen. This means that due to the increased income limit an MQB-E case is now MQB-B or an MQB-B case is now MQB-Q.
2. If the applicant is eligible for MQB prior to 4/01/06 and eligible for MAABD effective 4/01/06:
a. Approve the MQB as open/shut for the months prior to 4/01/06. 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 4/01/06. Enter in EIS the income limit effective 4/01/06. The certification from date must equal the first day of the month of application.
EXAMPLE: Applicant applies for Medicaid on March 1, 2006. His countable income is $815. The application is processed on March 15, 2006. You determine he is eligible for MAABD-Q effective April 1, 2006, based on the new income limits and he is eligible for MQB-B for March. Approve the MQB-B application open/shut for March 2006. Enter a new administrative MAABD and approve as MAABD effective 4/01/06. Authorization for Q classification always begins the month following the month of disposition.
3. If the case’s countable income prior to 04/01/06 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 04/01/06. The certification from date must equal the first day of the month of application.
D. Applications Dated 04/01/06 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, 2006.
IV. IMPLEMENTATION INSTRUCTIONS FOR ONGOING ADULT MEDICAID (Maabd-n, f,g,h,q & b, mqb-q, b & e cases)
A. For 4/01/06 or later, apply the new income limits and 2006 RSDI amounts to establish eligibility for the ongoing certification period.
A report will display on NCXPTR. The title of the report is Poverty Potential Eligibility 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 Limit for their current aid program/category. The Minimum Income 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 an OLV 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 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 Q) has a deductible, he must be transferred to MQB-Q. 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 04/01/06, apply the current income limits and 2006 RSDI amounts to establish eligibility for ongoing certification period.
If the budget unit’s countable income is within the MAABD-N income limit prior to04/01/06 and all other criteria are met, approve effective the first month of eligibility.
Use the 04/01/06 income limits and the current COLA amount for any certification period that includes 04/01/06 or later, regardless of the begin date. Please note that to enter the case in EIS, when months April 2006 or later are covered, you must enter the income limits effective 04/01/06.
EXAMPLE: You are completing a February 2006 review. The total countable income is $780.00, due to disregard of the RSDI COLA. You determine he is eligible for MAABD for March 2006 using the 2005 income limits. For April 2006 and later, you must include the RSDI COLA as countable income. Therefore, the new total countable income is $812.00. You determine he remains eligible for MAABD effective April 1, 2006, based on the new income limits. The new certification period is March 2006 – August 2006. To enter April 2006 and later months into EIS, you must enter the income limits effective 04/01/06.
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.
D. Insert attached MA-2260, Financial Eligibility Requirements/PLA, pages 14-15 effective 04/01/06.
If you have questions, please contact your Medicaid Program Representative.
(This material was researched and written by Trenita Dawkins, Policy Consultant, Medicaid Eligibility Unit)
