Department of Social Services
Family Support Division
PO Box 2320
Jefferson City, Missouri
TO: ALL FAMILY SUPPORT OFFICES
FROM: KIM EVANS, DIRECTOR
SUBJECT: UPDATE OF POVERTY INCOME GUIDELINES FOR MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED (MHABD) PROGRAMS
MANUAL REVISION #09 – 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, 2020, 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 07, 2020, 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
- REQUEST FOR HEARING/CONTINUED BENEFITS
- INCOME CHARTS AND PROGRAM DESCRIPTIONS
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 “FAMIS Changes Due to the Federal Poverty Level Adjustments” 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 “FAMIS Changes Due to the Federal Poverty Level Adjustments” 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, 2020 through March 31, 2021
|
Assistance Group Size |
Non-Spend Down Income Standard |
|
1 |
$904.00 |
|
2 |
$1222.00 |
MHABD AB Income standards effective April 01, 2020 through March 31, 2021
|
Assistance Group Size |
Non-Spend Down Income Standard |
|
1 |
$1064.00 |
|
2 |
$1437.00 |
Blind Pension sighted spouse income maximum effective April 01, 2020 through March 31, 2021
|
Sighted Spouse |
$7184.00 |
QDWI income standards effective April 01, 2020 through March 31, 2021
|
Assistance Group Size |
QDWI Income Standard |
|
1 |
$2.127.00 |
|
2 |
$2,874.00 |
QMB income standards effective April 01, 2020 through March 31, 2021
|
Assistance Group Size |
QMB Income Standard |
||
|
1 |
$1,064.00 |
||
|
2 |
$1,437.00 |
||
|
3 |
$1,810.00 |
SLMB1 income standards effective April 01, 2020 through March 31, 2021
|
Assistance Group Size |
SLMB1 Income Standard |
|
1 |
$1,276.00 |
|
2 |
$1,724.00 |
|
3 |
$2,172.00 |
SLMB2 income standards effective April 01, 2020 through March 31, 2021
|
Assistance Group Size |
SLMB2 Income Standard |
|
1 |
$1,436.00 |
|
2 |
$1,940.00 |
|
3 |
$2,444.00 |
TWHA Premiums for Single Cases
|
Type of Case |
Percent of FPL |
Monthly Income |
Premium Amount |
|
Single |
≤ 100% FPL |
$1,064.00 or less |
non premium |
|
Single |
>100% FPL but < 150% FPL |
$1,1064.01 – $1,594.99 |
$43 |
|
Single |
≥ 150% FPL but < 200% FPL |
$1,595.00 – $2,126.99 |
$64 |
|
Single |
≥ 200% FPL but < 250% FPL |
$2,127.00 -$2,658.99 |
$106 |
|
Single |
≥ 250% FPL but ≤ 300% FPL |
$2,659.00 – $3,190.00 |
$160 |
TWHA Premiums for Couple Cases
|
Type of Case |
Percent FPL |
Monthly Income |
Premium Amount |
|
Couple |
≤ 100% FPL |
$1,437.00 or less |
non premium |
|
Couple |
>100% FPL but < 150% FPL |
$1,437.01 -$2,154.99 |
$57 |
|
Couple |
≥ 150% FPL but < 200% FPL |
$2,155.00 -$2,873.99 |
$86 |
|
Couple |
≥ 200% FPL but < 250% FPL |
$2,874.00 -$3,591.99 |
$144 |
|
Couple |
≥ 250% FPL but ≤ 300% FPL |
$3,592.00 – $4,310.00 |
$216 |
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 2020 and later.
- Follow the FPL FAMIS Guide to resolve conflicting actions.
- Review this memorandum with appropriate staff.
KE/vm