Family & Children's Medicaid Change Notices

A. Applications

B. Ongoing Cases

C. Transitional Medicaid

A. Remove MA-3255, NC Health Choice, pages 13 – 14 & Attachment 1.

B. Insert attached MA-3255, NC Health Choice, pages 13 - 14 & Attachment 1, effective 4/1/2002.

C. Remove MA-3305, MAF, MIC, HSF Budgeting, Attachment – Income Charts.

D. Insert attached MA-3305, MAF, MIC, HSF Budgeting, Attachment – Income Charts, effective 4/1/2002.

E. Remove MA-3310, MPW Budgeting, pages 1 and 2.

F. Insert attached MA-3310, MPW Budgeting, pages 1 and 2, effective 4/1/2002.

CHANGE NOTICE FOR MANUAL NO 16-02, Poverty Level Income Limits

DATE: FEBRUARY 22, 2002

Manual: Families & Children Medicaid

Change No.: 16-02

To: County Directors of Social Services

Effective: April 1, 2002

I. CONTENT OF CHANGE

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 and to provide implementation instructions for pending applications, new applications, and ongoing cases.

II. EFFECTIVE DATE

Income limits for MPW, MIC, NC Health Choice for Children and Transitional Medicaid are increased effective April 1, 2002, to reflect the increase in the federal poverty level. EIS edits were updated effective Tuesday, February 26, 2002. You may now enter the new income limits. Cases keyed with a Medicaid effective date of 4/01/02 or later require use of the new income limits in EIS.

III. IMPLEMENTATION

A. Applications

1. MPW Applications That Are Pending On or Taken On or After April 1, 2002

a. Determine eligibility prior to 4/1/02 using the income limits in effect prior to 4/1/02. If income does not exceed the income limits and all other eligibility requirements are met, approve the application. Authorize from the first month of eligibility through the end of the post-partum period. Refer to MA-3310, MPW Budgeting.

b. If ineligible for months prior to 4/1/02 due to excess income, determine eligibility effective 4/1/02 using the new income limits.

If eligible using the new income limits and all other eligibility factors are met, approve the application and authorize effective 4/1/02. Authorize through the end of the 60 day post-partum period. Refer to MA-3310, MPW Budgeting. Evaluate months prior to 4/1/02 for other Medicaid.

c. If ineligible using the new income limits, evaluate for medically needy coverage.

2. Applications for MIC-N and NC Health Choice for Children Pending on April 1, 2002

Always evaluate for eligibility under any other aid/program category (including MAF-M) prior to evaluating for NC Health Choice for Children.

a. Determine eligibility prior to 4/1/02 using the income limits in effect prior to 4/1/02. If the Medicaid effective date is prior to 4/1 and the income does not exceed the income limit and all other eligibility requirements are met, approve the application with the income limit prior to 4/1/02. The 12-month certification/ authorization begins with the first month of eligibility.

b. If ineligible using the income limits in effect prior to 4/1/02, determine eligibility using the income limit that is effective 4/1/02.

(1) If eligible:

(a) Authorize the case effective 4/1/02 through the end of the 12-month period. The certification would be 4/1/2002 through 3/31/2003.

(b) Evaluate the case for medically needy coverage for months prior to 4/1/02.

Note: Use the new income limits in EIS if the Medicaid effective date is 4/01/02 or later.

(2) If ineligible:

(a) For MIC-N applications using income limits effective 4/1/02, evaluate as NC Health Choice or MAF medically needy.

(b) For NCHC applications deny the case due to excess income. Evaluate for MAF medically needy.

4. Applications for MIC-N or NC Health Choice for Children Taken on or After April 1, 2002

a. Determine eligibility for MIC-N for months in the retroactive period that are prior to 4/1/02 using the income limits in effect prior to 4/1/02. Use the income limits effective 4/1/02 for retroactive months April or later.

b. Determine ongoing eligibility for MIC-N or NC Health Choice for Children using the income limits that are effective 4/1/02.

c. If eligible for MIC/NCHC authorize beginning the first month of eligibility through the end of the 12-month period. Refer to MA-3425, Certification and Authorization, for MIC authorizations.

5. Applications for MAF-M pending on April 1, 2002

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 4/1/02 using the new income limits. Evaluate individuals under age 19 for MIC-N and NC Health Choice. Evaluate pregnant women for MPW.

a. For MAF applicants under age 19 eligible for MIC-N effective 4/1/02:

(1) Enter an administrative DSS-8124 to create a new application. The application date is the date of the original MAF application.

(2) Enter a certification period of 4/1/2002 through 3/31/2003.

(3) Authorize effective 4/1/2002.

b. For MAF applicants under age 19 eligible for NC Health Choice effective 4/1/02:

(1) Enter an administrative DSS-8124 to create a new application. The application date is the date of the original MAF application.

(2) Do not delete the child(ren) from the pending MAF application. The children remain on the MAF application until they are determined ineligible for MAF or are approved for NCHC.

c. For MAF applicants now eligible for MPW:

(1) Enter an administrative DSS-8124 to create an MPW application. The application date is the same date as the MAF application.

(2) Authorize the MPW case effective 4/1/2002, provided all eligibility requirements are met.

(3) Certify through the end of the 60-day post-partum period. (See MA-3240, Pregnant Woman Coverage.)

d. Continue to process the MAF application for months prior to 4/1/02.

(1) Recompute the deductible for months prior to 4/1/02 if all individuals on the MAF application are eligible effective 4/1/02 under MIC or MPW. Approve an open/shut MAF case for any months prior to 4/1/02 for which eligibility is determined. If ineligible for MAF for the months prior to 4/1/02, deny the application following policy in MA-3215, Processing Situations.

(2) Recompute the deductible for case members who remain in MAF only if an individual who had his own income is deleted from the MAF application and moved to a MIC-N or MPW application.

(a) At the point MAF is approved, delete the individuals eligible as MIC-N or MPW from the MAF application. The individual termination date is the date of application for individuals who have no eligibility under MAF.

(b) For individuals who have eligibility under MAF prior to 4/1/02, the individual termination date is 3/31/2002 since MIC-N or MPW is authorized 4/1/2002.

B. Ongoing Cases

1. MAF Cases

Apply these changes at the next redetermination or change in situation to determine eligibility for MIC-N, NC Health Choice for Children, or MPW if the case is ineligible for MAF or has a deductible.

2. MIC-N Cases

Apply these changes at the next redetermination or, if the certification period began prior to 4/1/02, the next change in situation. See MA-3305, MAF, MIC, HSF Budgeting, for instructions regarding changes that affect the MIC.

3. NC Health Choice for Children Cases

Apply these changes at the next reenrollment.

C. Transitional Medicaid

Use the new 185% of poverty limit for Transitional Medicaid for months beginning April 1, 2002.

IV. MAINTENANCE OF THE MANUAL

A. Remove MA-3255, NC Health Choice, pages 13 – 14 & Attachment 1.

B. Insert attached MA-3255, NC Health Choice, pages 13 - 14 & Attachment 1, effective 4/1/2002.

C. Remove MA-3305, MAF, MIC, HSF Budgeting, Attachment – Income Charts.

D. Insert attached MA-3305, MAF, MIC, HSF Budgeting, Attachment – Income Charts, effective 4/1/2002.

E. Remove MA-3310, MPW Budgeting, pages 1 and 2.

F. Insert attached MA-3310, MPW Budgeting, pages 1 and 2, effective 4/1/2002.

If you have any questions, please contact your Medicaid Program Representative.

Nina M. Yeager

Director

[This material was researched and written by Denise Rogers, Policy Consultant, Medicaid Eligibility Unit.]

MA-3255

MA-3255, Attachment 1 - NC Health Choice Income Limits

MA-3305, Family and Children's Income Limits

MA-3310