IM-049 – UPDATE OF POVERTY INCOME GUIDELINES FOR MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED PROGRAMS

Department of Social Services
Family Support Division
PO Box 2320
Jefferson City, Missouri

TO:  ALL FAMILY SUPPORT OFFICES

FROM:  PATRICK LUEBBERING, DIRECTOR

SUBJECT:  UPDATE OF POVERTY INCOME GUIDELINES FOR MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED PROGRAMS

 MANUAL REVISION #35

0805.015.45
0855.005.40.05
0855.005.45
0860.005.15.05
0860.005.15.10
0865.010.10.10
0865.010.10.25
0870.010.05
Appendix J, Adult Standards Chart
Appendix K, MO HealthNet Aged, Blind, and Disabled Program Descriptions
Appendix L, Aged, Blind, Disabled Income Chart
Appendix M, Medicare Cost Savings Program

 

DISCUSSION:

Effective April 1, 2019, the Federal Poverty Level (FPL) income guidelines increase for the following programs: MO HealthNet for the Aged, Blind and Disabled (MHABD) Spend Down and Non-Spend Down, Ticket to Work Health Assurance (TWHA), Qualified Medicare Beneficiary (QMB), Specified Low Income Medicare Beneficiary (SLMB and SLMB-2), Qualified Disabled Working Individuals (QDWI), MO HealthNet for Disabled Children (MHDC) and Gateway to Better Health programs (GTBH).  The Blind Pension (BP) spousal support income maximum has also increased with the FPL.    

On the weekend of March 09, 2018, MO HealthNet for the Aged, Blind and Disabled programs in FAMIS with income eligibility based on the federal poverty level will be adjusted. This memorandum includes information on:

 

PREMIUM REFUNDS

Premiums paid for April coverage will be refunded to the participant if the FPL causes the case to become eligible as a non-premium case. The refund process will take approximately 8 weeks to complete.

 

REQUEST FOR HEARING/CONTINUED BENEFITS

Any participant receiving an FA-420 MO HealthNet Adverse Action Notice may request a hearing on the mass adjustment action.   

If a participant receiving an FA-420 requests a hearing on the adjustment within ten days from the date of the notice, the participant may request benefits be continued at the level received before the FPL adjustment, until the hearing decision is made. Staff should inform the participant if continued benefits are issued and the agency is determined to be correct, a claim will be established for any overpayment.

Refer to the “FPL user guide” for eligibility system processes to allow continued MO HealthNet benefits at the same level of care prior to the FPL adjustment when a hearing decision is pending.  The “FPL user guide” will also provide information regarding specific cases in FAMIS the FPL mass adjustment is unable to systematically adjust. 

 

INCOME CHARTS

Income Charts are no longer being updated in each Manual Section, but instead will be updated in the Appendices.  For historical purposes, the income standards listed below will be included in the FPL memo:

MHABD OAA/PTD Income standards effective April 01, 2019 through March 31, 2020

Assistance Group Size

Non-Spend Down Income Standard

1

$885.00

2

$1198.00

 

MHABD AB Income standards effective April 01, 2019 through March 31, 2020

Assistance Group Size

Non-Spend Down Income Standard

1

$1041.00

2

$1410.00

 

Blind Pension sighted spouse income maximum effective April 01, 2019 through March 31, 2020

Sighted Spouse

$7046.00

 

QDWI income standards effective April 01, 2019 through March 31, 2020 

Assistance Group Size

QDWI Income Standard

1

$2.082.00

2

$2,818.00

 

QMB income standards effective April 01, 2019 through March 31, 2020

Assistance Group Size

QMB Income Standard

1

$1,041.00

2

$1,409.00

3

$1,778.00

 

SLMB1 income standards effective April 01, 2019 through March 31, 2020

Assistance Group Size

SLMB1 Income Standard

1

$1,249.00

2

$1,691.00

3

$2,133.00

 

SLMB2 income standards effective April 01, 2019 through March 31, 2020

Assistance Group Size

SLMB2 Income Standard

1

$1,406.00

2

$1,903.00

3

$2,400.00

 

TWHA Premiums for Single Cases

Type of Case

Percent of FPL

Monthly Income

Premium Amount

Single

≤ 100% FPL

$1,041.00 or less

non premium

Single

>100% FPL but < 150% FPL

$1,1041.01 – $1,560.99

$42

Single

≥ 150% FPL but < 200% FPL

$1,561.00 – $2,081.99

$62

Single

≥ 200% FPL but < 250% FPL

$2,082.00 -$2,601.99

$104

Single

≥ 250% FPL but ≤ 300% FPL

$2,602.00 – $3,123.00

$156

 

TWHA Premiums for Couple Cases

Type of Case

Percent FPL

Monthly Income

Premium Amount

Couple

≤ 100% FPL

$1,409.00 or less

non premium

Couple

>100% FPL but < 150% FPL

$1,409.01 -$2,113.99

$56

Couple

≥ 150% FPL but < 200% FPL

$2,114.00 -$2,817.99

$85

Couple

≥ 200% FPL but < 250% FPL

$2,818.00 -$3,522.99

$141

Couple

≥ 250% FPL but ≤ 300% FPL

$3,523.00 – $4,228.00

$211

 

PROGRAM DESCRIPTIONS AND OTHER RESOURCES

The MO HealthNet for the Aged, Blind, and Disabled (MHABD) Standards Chart, MO HealthNet Aged, Blind, and Disabled Program Descriptions, the MO HealthNet Aged, Blind, Disabled Income Chart, and the Medicare Cost Savings Programs (QMB and SLMB) internet pages are updated in Appendices J, K, L, and M in the Medical Assistance for the Aged, Blind, and Disabled Manual to include the change in FPL income limits.

 

NECESSARY ACTION:

  • Begin using the new federal poverty level income guidelines effective for April 2019 and later.
  • Follow the FPL FAMIS Guide to resolve conflicting actions.
  • Review this memorandum with appropriate staff.

 

PL/vm