Category: 2019

FROM:  PATRICK LUEBBERING, DIRECTOR

SUBJECT:  REFERRAL FOR FINANCIAL EXPLOITATION SECTION OF THE DECEMBER 1973 ELIGIBILITY REQUIREMENTS POLICY UPDATE

MANUAL REVISION #37

1040.030.60

DISCUSSION:

This memorandum introduces revisions to the Referral for Financial Exploitation section of the December 1973 Eligibility Requirements Policy Manual.

The Referral for Financial Exploitation section has been expanded to include policy that will show;

• How the law defines adult abuse,
• Forms of financial exploitation,
• Family Support Division (FSD) reporting requirements, and responsibilities when elderly or adult abuse is suspected, and
• Where to find the FSD legal requirements when release of records in cases of financial exploitation is required.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

PL/vm

FROM:  PATRICK LUEBBERING, DIRECTOR

SUBJECT:  CLARIFICATION ON MAGI PRE-POPULATED ANNUAL RENEWAL FORM TIMEFRAME

MANUAL REVISION #36

1880.005.00

DISCUSSION:

This memorandum provides clarification to the previously released memo, IM-08 January 25, 2019.  Participants are given 30 days to return the review; however, the IM-80 Adverse Action period does not begin until 10 days prior to the last day of the certification period when the IM-1U is not returned.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

PL/al

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
• 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 page in FAMIS Resources 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 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

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

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

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

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

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

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

TWHA Premiums for Single Cases

TWHA Premiums for Couple Cases

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

FROM:  PATRICK LUEBBERING, DIRECTOR

SUBJECT:  2019 UPDATE OF POVERTY INCOME GUIDELINES FOR MAGI MO HEALTHNET PROGRAMS

MANUAL REVISION #34

1805.030.20.20.05

1800.000.00 APPENDIX A

1800.000.00 APPENDIX B

1800.000.00 APPENDIX D

1800.000.00 APPENDIX E

FORM REVISION #12

IM-4PRM

DISCUSSION:

Effective April 1, 2019, the Federal Poverty Level (FPL) income guidelines are increased for:

• MO HealthNet for Kids (MHK);
• Children’s Health Insurance Program (CHIP);
• MO HealthNet for Pregnant Women (MPW);
• Show-Me Healthy Babies Program (SMHB);
• Uninsured Women’s Health Services (UWHS); and
• All Presumptive Eligibility programs
  • Temporary MO HealthNet During Pregnancy (TEMP);
  • Show-Me Health Babies Presumptive Eligibility (SMHB-PE);
  • Presumptive Eligibility for Children (PC); and
  • Presumptive Eligibility for Parents/Caretaker Relatives (MHF-PE)

NOTE: New poverty income guidelines for Presumptive Eligibility programs will be provided to Qualified Entities by Income Maintenance Program and Policy.

Any cases in Annual Renewal status on April 1, 2019 will not receive the FPL update until the renewal is completed.

All other MAGI cases will be adjusted in April 2019 based on the new FPL income guidelines and notices sent.

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 household receiving an IM-80 Adverse Action Notice may request a hearing on the adjustment action within 10 days from the date of the notice.

If a household receiving an IM-80 Adverse Action Notice requests a hearing on the adjustment within 10 days of the notice, the household may request benefits continue at the level before the FPL adjustment until the hearing decision is made. Staff should inform the household that if continued benefits are issued and the agency is determined to be correct, a claim will be established for any overpayment.

PROGRAM DESCRIPTIONS AND OTHER RESOURCES

The Internet pages MHK/MHF/TA Income Chart and Do Your Children Need Health Coverage are updated 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.
• Review this memorandum with appropriate staff.

PL/df                                     

FROM:  PATRICK LUEBBERING, DIRECTOR

SUBJECT:  INDIVIDUALS ACTIVELY RECEIVING SSI/SSDI CAN RECEIVE MO HEALTHNET FOR FAMILIES

MANUAL REVISION #33

1810.020.00

FORMS MANUAL # 11

SSI/SSDI Transition Letter

DISCUSSION:

The purpose of this memorandum is to advise that participants who are actively receiving Supplemental Security Income (SSI) or Social Security Disability Income (SSDI) can receive MO HealthNet for Families (MHF) per guidance from Centers for Medicare and Medicaid Services (CMS). 

The Family MO HealthNet (MAGI) policy manual section 1810.020.00 Eligibility Requirements has been updated to reflect this change.   

For participants currently receiving MHF and SSI or SSDI: send the SSI/SSDI Transition Letter at annual review.  This letter will advise the participant they may be eligible for MO HealthNet for Aged, Blind, and Disabled (MHABD).  If the participant chooses not to complete the MHABD application and all other eligibility factors are met, continue MHF coverage. 

NECESSARY ACTION:

• Start sending participants receiving MHF and SSI or SSDI the SSI/SSDI Transition Letter at annual review.
• Review this memorandum with appropriate staff.

PL/al                                    

FROM:  PATRICK LUEBBERING, DIRECTOR

SUBJECT:  2019 MAGI COST OF LIVING ADJUSTMENT (COLA) FOR VETERANS ADMINISTRATION AND RAILROAD INCOME  

DISCUSSION:

This memorandum informs staff that Railroad Retirement (RR) and Veterans Administration (VA) participants received a 2.8% Cost of Living Adjustment (COLA) for MAGI programs effective January 2019.

Cases Adjusted

Cases that include MEDES income types of Railroad Retirement and/or VA Benefits were subject to an automatic increase of 2.8% for those income types.  MEDES end dated the previous income and added a new piece of income evidence that reflects the adjusted income amount.

Cases That Did Not Adjust

Some cases did not adjust during this COLA.  These cases will require manual intervention from staff to add the increased income amounts.  As cases are reviewed, check income on each case to determine if current income is entered.  Update and verify income as required using established procedures.

Notices

For case updates made as a result of COLA, MEDES finalized the decision(s) and send out the appropriate notices. The reasons and notices that were sent are as follows:

• Cases with no change were sent the IM-33C.
• Cases that resulted in benefit reduction were sent an IM-80 allowing 10 days for the individual to respond to the proposed case action. The IM-33C was sent after the IM-80 expired.
• Cases that resulted in individuals who no longer qualify were sent an IM-80 PRE allowing 10 days for the individual to respond to the proposed case action. An IM-80PRE and IM-80 were sent, followed by the IM-33C.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

PL/ers

FROM:  PATRICK LUEBBERING, DIRECTOR

SUBJECT:  2019 MAGI COST OF LIVING ADJUSTMENT (COLA) FOR SSA/SSI INCOME                       

DISCUSSION:

Thi memorandum informs staff that Social Security Administration (SSA) and Supplemental Security Income (SSI) participants will receive a 2.8% Cost of Living Adjustment (COLA) for MAGI programs effective April 2019.

Cases Expected to Adjust

Cases that include MEDES income types of Social Security Adult (disability or received off disabled/deceased spouse), Social Security Adult (retirement), Social Security Child (disability or received off disabled/deceased parent), and Supplemental Security Income, will be subject to an automatic increase of 2.8% for those income types.  MEDES will end date the previous income and add a new piece of income evidence that reflects the adjusted income amount.

Cases Not Expected to Adjust

Some cases did not adjust during this COLA.  These cases will require manual intervention from staff to add the increased income amounts.  As cases are reviewed, check income on each case to determine if current income is entered.  Update and verify income as required using established procedures.

Notices

For case updates made as a result of COLA, MEDES will propose and finalize the decision(s) and send out the appropriate notices. The reasons and notices that will be sent are as follows:

• Cases with no change will be sent the IM-33C.
• Cases that result in benefit reduction will be sent an IM-80 allowing 10 days for the individual to respond to the proposed case action. After the IM-80 period expires, the IM-33C will be sent.
• Cases that result in individuals who no longer qualify will be sent an IM-80 PRE allowing 10 days for the individual to respond to the proposed case action. After the IM-80 PRE expires, an IM-80 will be sent allowing an additional 10 days. After the IM-80 expires, the IM-33C will be sent.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

PL/ers

FROM:  PATRICK LUEBBERING, DIRECTOR

SUBJECT:  UPDATED PRESUMPTIVE ELIGIBILITY INCOME GUIDELINES

MANUAL REVISION #32

APPENDIX A (1900.000.00)

DISCUSSION:

The purpose of this memorandum is to update the income guidelines for Presumptive Eligibility due to the increase in the Federal Poverty Level (FPL). These guidelines are effective from April 1, 2019 through March 31, 2020. Appendix A, found in the Presumptive Eligibility Manual has been updated to reflect the new FPL. 

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

PL/df

FROM:  PATRICK LUEBBERING, DIRECTOR

SUBJECT:  INCREASE IN RESOURCE LIMITS FOR QUALIFIED MEDICARE BENEFICIARY (QMB), SPECIFIED MEDICARE BENEFICIARY (SLMB), AND QUALIFYING INDIVIDUALS (QI-1 OR SLMB2) PROGRAMS

MANUAL REVISION #31

0865.010.00
0865.010.15

APPENDIX J

DISCUSSION:

Effective January 1, 2019, the QMB, SLMB, and SLMB2 resource limits increased.  For a single individual, the resource limit increased from $7,560 to $7,730.  For a married couple, the resource limit increased from $11,340 to $11,600.  Resource maximums have been updated in the Family Assistance Management Information System (FAMIS).  There is no change in policy regarding how to determine available resources.

Income Maintenance Manual Sections Eligibility Requirements 0865.010.00 and Resources (QMB) 0865.010.15 have been updated to include the increase in resource limits.  The MO HealthNet Program Description Aged, Blind, and Disabled Chart and MO HealthNet Aged, Blind and Disabled Income Chart have been updated on the Intranet and Internet to show the increased resource limits.

NECESSARY ACTION:

• Review this memorandum with appropriate staff.

PL/vb