IM-14 2024 UPDATE OF POVERTY INCOME GUIDELINES FOR MAGI PROGRAMS

FROM: KIM EVANS, DIRECTOR

SUBJECT: 2024 UPDATE OF POVERTY INCOME GUIDELINES FOR MAGI PROGRAMS

MANUAL REVISION #
1805.030.20.10
APPENDIX A
APPENDIX A (PE)
APPENDIX B
APPENDIX D
APPENDIX E
APPENDIX I

FORM REVISION #
IM-4PRM

 

DISCUSSION:

Effective April 1, 2024, the Federal Poverty Level (FPL) income guidelines increase for all MAGI programs, including Presumptive Eligibility (PE).

MAGI cases were adjusted on March 8, 2024 based on the new FPL income guidelines. Due to the Continuous Eligibility requirement during the Transition Period, cases that have not had an Annual Renewal in the last 12 months will not have coverage closed or reduced to a lower level of care.
Note: Changes in circumstance or applications processed prior to April 1, 2024 will need to be authorized before the FPL change can be viewed.

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;
  • go from CHIP75 to CHIP74; or
  • go from CHIP74 to CHIP73.

The refund process will take approximately 8 weeks to complete.

MAGI MANUAL REVISION, PROGRAM DESCRIPTIONS, AND OTHER RESOURCES

MAGI Manual section 1805.030.20.10 Income Excluded Under MAGI has been updated to reflect an increase in the tax filer threshold for a child for earned income to $13,850 and unearned income to $1,250 based on the 2023 IRS Publication 501.

PRESUMPTIVE ELIGIBILITY

PE Manual Appendix A income standards are updated. These standards are effective from April 1, 2024 through March 31, 2025.

 

NECESSARY ACTION:

  • Use the new FPL income guidelines beginning April 1, 2024
  • Review this memorandum with appropriate staff.

 

 

 

KE/rc

IM-12 INCREASE IN AVERAGE PRIVATE PAY NURSING RATE FOR TRANSFER OF PROPERTY PENALTIES

FROM: KIM EVANS, DIRECTOR

SUBJECT: INCREASE IN AVERAGE PRIVATE PAY NURSING RATE FOR TRANSFER OF PROPERTY PENALTIES

MANUAL REVISION #
APPENDIX J
APPENDIX N

 

DISCUSSION:

The average private pay nursing care rate increased to $7,536 per month effective April 1, 2024. For applications taken on or after April 1, 2024, use $7,536 to determine the number of months of ineligibility for vendor level services.

Appendix J of the MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual lists the current average private pay nursing care rate.

Appendix N of the December 1973 Eligibility Requirements Manual lists the historical values for average private pay nursing care rates.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

 

 

KE/cj

IM-11 NON-MAGI FEDERAL POVERTY LEVEL ADJUSTMENT

FROM: KIM EVANS, DIRECTOR

SUBJECT: NON-MAGI FEDERAL POVERTY LEVEL ADJUSTMENT

MANUAL REVISION #
Appendix J
Appendix K

 

DISCUSSION:

Effective April 1, 2024, the Federal Poverty Level (FPL) income guidelines increase for the following programs:

  • MO HealthNet Non-Spend Down (MHNS)
  • MO HealthNet Spend Down (MHSD)
  • Ticket to Work Health Assurance (TWHA)
  • Qualified Medicare Beneficiary (QMB)
  • Specified Low Income Medicare Beneficiary (SLMB and SLMB2)
  • Qualified Disabled Working Individuals (QDWI)
  • MO HealthNet for Disabled Children (MHDC)
  • Blind Pension (BP)

The weekend of March 9, 2024, programs with income eligibility based on the federal poverty level will be adjusted in the eligibility system.

Note: All MO HealthNet cases will be adjusted based on the new FPL income guidelines. However, due to the continuous enrollment condition, participants will not have coverage reduced to a lower level of care or cases closed until after their annual renewal is completed.

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.

Program Descriptions
Appendix K in the Non-MAGI Policy Manual is updated to include the change in FPL income limits.

Income Standards
Appendix J in the Non-MAGI policy Manual is updated with the updated FPL income limits.

All FPL income guidelines are effective from April 1, 2024 through March 31, 2025. These standards may be referenced as needed for historical purposes.

MHABD income standards

Assistance Group Size Non-Spend Down OAA/PTD (85% FPL) Non-Spend Down AB (100% FPL)
1 $1067 $1255
2 $1448 $1704

 

QDWI income standards

Assistance Group Size QDWI (200% of FPL)
1 $2510
2 $3407

 

Medicare Savings Programs income standards

Assistance Group Size QMB (100% FPL) SLMB1 (120% FPL)  SLMB2 (135% FPL) 
1 $1255 $1506 $1695
2 $1704 $2044 $2300
3 $2152 $2582 $2905

 

Blind Pension sighted spouse monthly income maximum

Sighted Spouse (500% FPL)  $8517

 

TWHA Income Standards and Premiums

Percent of FPL Type of Case Monthly Income Premium Amount
Less than 100% FPL Single $1255.00 or less non premium
  Couple $1704.00 or less non premium
100% FPL up to but not including 150% FPL Single $1255.01-1822.99 $42
  Couple $1704.01-2554.99 $56
150% FPL up to but not including 200% Single $1883.00-2509.99 $62
  Couple $2555.00-3406.99 $85
200% FPL up to but not including 250% FPL Single $2510.00-3137.99 $104
  Couple $3407.00-4258.99 $141
250% FPL up to 300% FPL Single $3138.00-3765.00 $156
  Couple $429.00-5110.00 $211

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.
  • Begin using the new FPL income guidelines for eligibility determinations effective April 2024 and ongoing.
  • Follow the staff user guides in FAMIS Resources to resolve conflicting actions related to FPL.
  • Review this memorandum with appropriate staff.

KE/st

IM-04 REVISION TO MO HEALTHNET (MHN) POLICY ALLOWING ACTIVE PARTICIPANTS TO MOVE FROM ONE MHN PROGRAM TO ANOTHER

FROM: KIM EVANS, DIRECTOR

SUBJECT: REVISION TO MO HEALTHNET (MHN) POLICY ALLOWING ACTIVE PARTICIPANTS TO MOVE FROM ONE MHN PROGRAM TO ANOTHER

MANUAL REVISION #
0840.010.00
0840.015.05
1890.000.00
1890.010.00
1890.010.10
1890.010.20

 

DISCUSSION:

MHN policy is updated with requirements for active participants moving from one program to another when a change in circumstance occurs, or upon request from the participant.

An active MHN participant does NOT require a new application to move from one program to another, as long as they remain in the same household. All actions should be completed ex parte (which means without contacting the participant), if possible.

Note: This policy does NOT change the existing policy for an active participant or applicant who is requesting a cash benefit. See 0804.025.00 MO HealthNet Application Concurrent With MHABD Cash Programs.

Policy updates shown below should be reviewed by all staff:

Non-MAGI Policy Manual

MAGI Policy Manual

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

 

 

KE/cj

IM-02 2024 AFFORDABLE INSURANCE QUOTES UPDATED ON FAMILY MO HEALTHNET (MAGI) APPENDIX G

FROM: KIM EVANS, DIRECTOR

SUBJECT: 2024 AFFORDABLE INSURANCE QUOTES UPDATED ON FAMILY MO HEALTHNET (MAGI) APPENDIX G

MANUAL REVISION #
APPENDIX G

 

DISCUSSION:

The CHIP Affordability Test Calculator, Appendix G, has been updated with 2024 insurance quotes from the Federally Facilitated Marketplace (FFM). Affordable insurance determinations for Children’s Health Insurance Program (CHIP) premium children must still be completed.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.
  • Begin using the updated CHIP Calculator (MAGI Appendix G) January 1, 2024.

 

 

 

KE/bl

IM-106 POLICY UPDATES FOR THE TICKET TO WORK HEALTH ASSURANCE (TWHA) PROGRAM

FROM: KIM EVANS, DIRECTOR

SUBJECT: POLICY UPDATES FOR THE TICKET TO WORK HEALTH ASSURANCE (TWHA) PROGRAM

MANUAL REVISION #

0855.000.00 0855.005.45
0855.005.00 0855.005.45.05
0855.005.35 0855.010.05 Obsolete
0855.005.40 0855.020.00
0855.005.40.01 Appendix K
0855.005.40.05 Obsolete  
0855.005.40.10 Obsolete       

 

DISCUSSION:

Senate Bill 106 requires changes to Missouri’s TWHA program. Missouri’s State Plan Amendment (SPA) for these changes was approved by the Centers for Medicare and Medicaid Services (CMS) on December 20, 2023. The following policy changes to the TWHA program are effective on January 1, 2024:

  • Changes to the asset limit calculations to exclude the value of all retirement accounts,
  • Modified the income calculations by broadening the definition to now consider the income of disabled participants up to 250% FPL, and
  • Changes to the earned income that is disregarded for the non-TWHA Spouse.

The MO HealthNet (MHN) policy sections and appendix listed above are updated to reflect changes made to the TWHA program.

The IM-4 TWHA Brochure is available to assist staff in explaining the purpose of the TWHA program to participants and provide an understanding of TWHA coverage.

Processing information to be used until system updates are complete will be released in an upcoming email memorandum.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

 

 

KE/mm

IM-105 MO HEALTHNET (MHN) POLICY CHANGES TO EXTEND POSTPARTUM COVERAGE TO 12 MONTHS

FROM: KIM EVANS, DIRECTOR

SUBJECT: MO HEALTHNET (MHN) POLICY CHANGES TO EXTEND POSTPARTUM COVERAGE TO 12 MONTHS

0810.045.00 1850.040.20.10
0810.045.05 1850.040.30 obsolete
1850.000.00 1850.040.40 obsolete
1850.010.00 1850.040.40.10 obsolete
1850.020.00 1850.040.40.30 obsolete
1850.030.00 1850.050.00
1850.040.10 1855.030.15
1850.040.20 1890.000.00
APPENDIX I  

 

FORM REVISION #

IM-32MAGI

 

DISCUSSION:

Senate Bills 45 and 106, signed by Governor Parson on July 7, 2023 extend postpartum coverage to 12 months for women who have active Medicaid (including prior quarter) or Children’s Health Insurance Programs (CHIP) coverage when their pregnancy ends. The manual sections listed above are updated to reflect these changes. The changes included in this memorandum were effective July 7, 2023. Missouri’s State Plan Amendment (SPA) to implement these changes was approved by the Centers for Medicare and Medicaid Services (CMS) on November 14, 2023.

Note: This change to postpartum coverage does not apply to state funded programs such as Blind Pension (BP), Emergency MHN for Ineligible Aliens (EMCIA), Show-Me Healthy Babies (SMHB) individuals denied MO HealthNet for Pregnant Women (MPW) coverage due to an ineligible immigration status, and Uninsured Women’s Health Services (UWHS).

The following Family MO HealthNet (MAGI) manual sections are now obsolete:

  • 1850.040.30 Coverage When Application Is Made After the Birth
  • 1805.040.40 Extended Women’s Health Services
  • 1850.040.40.10 Eligibility for Other MO HealthNet Programs
  • 1850.040.40.30 Notification of Ineligibility for Extension Due to Insurance

The following sections have been added to the MO HealthNet for the Aged, Blind, and Disabled (MHABD) Manual:

Appendix I and the IM-32MAGI have been updated to reflect a 12 month postpartum period.

Non-Pregnancy Levels of Care

Individuals receiving coverage under a non-pregnancy MHN level of care will not be moved to a pregnancy level of care unless they request that Family Support Division (FSD) do so.

Postpartum coverage for these individuals is granted within the MHN program they were on the date their pregnancy ended.

  • Non-MAGI Spend Down and Ticket to Work Health Assurance (TWHA) – A pregnant individual under these programs will have continuous coverage from the first day they meet their Spend Down or pay their premium while pregnant through the end of the 12 month postpartum period.
  • CHIP children – If it is not reported that a CHIP child is pregnant until after the pregnancy ends, the child will continue to be covered on the CHIP level of care they had on the date the pregnancy ended through their 12 month postpartum period. Pregnant and postpartum CHIP individuals are not required to pay a premium. However, if it is reported that a CHIP child is pregnant, they will be transitioned to MPW or SMHB for the remainder of their pregnancy through the end of the 12 month postpartum period.

NOTE: CHIP/SMHB individuals in their postpartum period who request to be moved to Title XIX level of coverage will not be able to regain eligibility under postpartum.

Prior Quarter

Individuals who apply for coverage after their pregnancy ends and are found eligible for prior quarter coverage, including the date the pregnancy ended, will be eligible for 12 months of postpartum coverage.

Extended Women’s Health Services (EWHS)

The EWHS program is discontinued with the implementation of 12 month postpartum. The UWHS program remains in place.

Annual Renewals

Annual renewals are not to be completed until the end of the 12 month postpartum period. An ex parte renewal will be attempted prior to sending a pre-populated renewal form to the participant.

System Updates

Updates are in progress in both eligibility systems to systematically grant 12 months of postpartum coverage. Review MEDES Resources, key word “Mitigation” for the manual process to follow on MAGI levels of care. The Non-MAGI manual process will be released in an email memorandum.

 

NECESSARY ACTION:

  • Review MEDES Resources, key word “Mitigation” for the MAGI manual process to follow until system updates can be completed.
  • Review this memorandum with appropriate staff.

 

 

 

KE/rc

IM-104 CONTINUOUS ELIGIBILITY FOR CHILDREN

FROM: KIM EVANS, DIRECTOR

SUBJECT: CONTINUOUS ELIGIBILITY FOR CHILDREN

 

DISCUSSION:

Effective January 1, 2024, Missouri is implementing Continuous Eligibility for Children (CEC) as directed in the Consolidated Appropriations Act, 2023. CEC allows continuous eligibility for 12 months for children ages 18 and under.

Eligibility may only be terminated prior to the end of the 12 month period if the child meets one of the following criteria:

  • Turns 19,
  • Ceases to be a resident of the State of Missouri,
  • The child or child’s representative requests a voluntary termination of eligibility,
  • The child dies, or
  • Eligibility is erroneously granted at the most recent determination, redetermination, or renewal due to agency error or fraud, abuse, or perjury attributed to the child or child’s representative.

Policy updates will be released once the Centers for Medicare and Medicaid Services (CMS) has approved Missouri’s State Plan Amendment.

Note: Additional information on processing procedures is forthcoming.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

 

 

KE/vh

IM-100 2024 FAMILY MO HEALTHNET (MAGI) COST OF LIVING ADJUSTMENT (COLA) FOR VETERANS ADMINISTRATION (VA) AND RAILROAD (RR) INCOME

FROM: KIM EVANS, DIRECTOR

SUBJECT: 2024 FAMILY MO HEALTHNET (MAGI) COST OF LIVING ADJUSTMENT (COLA) FOR VETERANS ADMINISTRATION (VA) AND RAILROAD (RR) INCOME

 

 

DISCUSSION:

Effective January 2024 VA and RR participants will receive a 3.2% COLA. System updates will be made the weekend of December 16, 2023.

Note: Annual renewals resumed for all MO HealthNet (MHN) programs on April 1, 2023. An annual renewal must be completed before a determination of ineligibility or lesser coverage can be made. The eligibility system will not reduce or end MHN coverage due to the COLA changes until an annual renewal has been completed for the case.

Cases Adjusted

Cases that include income types VA and/or RR benefits in the eligibility system are subject to an automatic increase of 3.2% for those income types. The eligibility system will end date the previous income and add a new piece of income evidence that reflects the adjusted income amount.

Note: Actions to reduce benefits will not be taken until an annual renewal has been completed.

Cases That Did Not Adjust

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

Notices

For case updates made as a result of COLA, the eligibility system will finalize the decision(s) and send out the appropriate notices.

Note: Adverse Action notices will not be issued until an annual renewal has been completed.

 

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.

 

 

KE/vh

IM-99 JANUARY 2024 COLA ADJUSTMENT OF SSA/SSI/VA/RR INCOME FOR ALL INCOME MAINTENANCE PROGRAMS EXCEPT MAGI MO HEALTHNET

FROM: KIM EVANS, DIRECTOR

SUBJECT: JANUARY 2024 COLA ADJUSTMENT OF SSA/SSI/VA/RR INCOME FOR ALL INCOME MAINTENANCE PROGRAMS EXCEPT MAGI MO HEALTHNET

MANUAL REVISION #
APPENDIX B
APPENDIX D
APPENDIX E
APPENDIX J
APPENDIX K

 

DISCUSSION:

In January 2024, all Social Security Administration (SSA), Supplemental Security Income (SSI), Veterans Administration (VA), and Railroad Retirement (RR) participants will receive an 3.2% Cost of Living Adjustment (COLA).

The weekend of December 9, 2023, a mass adjustment will be completed in the eligibility system for Child Care (CC), Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance (TA), and Non-MAGI MO HealthNet cases. Income increases for SSA, SSI, VA, and/or RR and other adjustments will be completed. Medicare Premium amounts and federal eligibility standards will also be updated.

Note: The 2024 COLA will have the following effect on SNAP cases:

  • Increase in SNAP benefit reductions for January 2024.
  • Increase in SNAP closures for December 2023.

SSI Increases

SSI TABLE 2023 AMOUNT 2024 AMOUNT INCREASE
SSI Individual maximum (in own household) $914 $943 $29
SSI Couple maximum (in own household) $1371 $1415 $44
SSI Individual in household of another $609 $629 $20
SSI Couple in household of another $914 $943 $29
SSI Essential person/own home $458 $472 $14

 

Non-MAGI Standards Adjustments

NON-MAGI STANDARDS 2023 AMOUNT 2024 AMOUNT
Maximum Allotment of Community Spouse $3,716 $3,854
Minimum Maintenance Standard for Allotments $2,289 $2,465
Maximum Allocation to a child $457 $472
Maximum Allotment to a child $763 $821
Minimum Spousal Share $29,724 $30,828
Maximum Spousal Share $148,620 $154,140
Maximum Home Equity $688,000 $713,000
HCB Maximum $1,598 $1,649
SAB Standard $987 $1,019

 

Supplementary Medical Insurance (SMI) Premium Adjustment

The standard SMI, commonly known as Medicare Part B, premium will increase for 2024 to $174.70. Premiums for Medicare participants who pay less than the standard premium amount will not have an increase of more than the amount of the increase in Social Security benefit the individual received.

Additional Non-MAGI Program Increases

Resource Limits for Medicare Savings Programs (QMB/SLMB/QI-1)
For a single individual, the resource limit increases to $9,430 for a married couple, the resource limit increases to $14,130. There is no change in policy regarding how to determine available resources.

Minimum and Maximum Spousal Share
The 2024 minimum spousal share is $30,828. The new maximum spousal share is $154,140. Both amounts become effective for any assessment completed on or after January 1, 2024.

Substantial Gainful Activity (SGA)
The SGA monthly amounts increase and are as follows:

  • $2,590 for statutorily blind individuals
  • $1,550 for non-blind individuals

 

Appendices Updates

The following appendices were updated to show the new amounts:

  • MO HealthNet for Aged, Blind, and Disabled Manual
    • Appendix B – Maintenance Standards for Allotments
    • Appendix E – HCB Income Maximums
    • Appendix J – Eligibility Standards for Non-MAGI Programs
    • Appendix K – MO HealthNet eligibility for Non-MAGI Programs
  • December 1973 Eligibility Requirements Manual
    • Appendix D – Substantial Gainful Activity

 

Adjustments by Program and Mass Adjustment Process

All programs will be adjusted according to program. Review FAMIS Resources for further information about the mass adjustment process.
Senate Bill 577 (2007) authorized the disregard for Social Security COLA increases for certain MO HealthNet (MHN) programs with income eligibility based on federal poverty level (FPL) until the next FPL adjustment in April. All SSA, SSI, VA, and RR income sources will be updated with the new income amount and verification code “CO” for COLA adjustment.

Note: For budget months prior to January 2024, do not use the “CO” – COLA verification code.

Note: Actions to reduce MHN benefits will take effect after an annual renewal is completed during the transition/unwinding period.

 

Reports with Actions Needed

Reports with action needed will be distributed to the appropriate teams. Follow the instructions in FAMIS Resources on how to process each type of report.

 

Request for Hearing/Continued Benefits

When a fair hearing is requested, follow current fair hearing request procedures.

 

NECESSARY ACTION:

  • Review this memorandum with appropriate staff.
  • Search “COLA” or “Adjustment” in FAMIS Resources for processing guidance.
  • State Office will provide the SSA/SSI/VA/RR Needing Review report to designated staff.
  • Allow MHN Policy for “CO” income verification to disregard SSA and SSI COLA Adjustments until the Federal Poverty Level (FPL) Adjustment in April.

 

 

 

KE/cj