IM-218 12/13/01 INCREASE IN MEDICAL ASSISTANCE FOR FAMILIES (MAF) INCOME STANDARD
|INCREASE IN MEDICAL ASSISTANCE FOR FAMILIES
(MAF) INCOME STANDARD
FAMILY HEALTHCARE MANUAL REV: # 55
SECTIONS 0905.005.00, 0905.010.45, 0905.010.45.10, 0905.010.45.20, 0905.010.45.25, 0905.010.45.35, 0905.010.45.50, 0920.000.00, 0920.010.35, 0920.025.00, 0920.030.00, 0920.030.05, and 0925.010.25
|Effective January 1, 2002, the income
standard for Medical Assistance for Families (MAF) will increase to 100%
of the federal poverty level (FPL) and some budgeting procedures change.
This change eliminates the Custodial Parent program, as those parents will
now qualify for MAF, which provides less restrictive coverage. This
change also allows insured parents and other caretakers with income below
100% of FPL to qualify.
All current custodial parent cases will be converted by the system to MAF on December 15, 2001.
CHANGES IN MAF BUDGETING PROCEDURES EFFECTIVE JANUARY 2002:
Effective with budgets for January 2002, determine MAF eligibility using the following income standards:
The wage earner on a MAF case with the highest earnings will receive a standard work exemption of $206. The remaining wage earner will receive the current $90 standard work exemption. This $206 deduction applies to both MAF and MC+ 100% FPL eligibility budgets. The $90 standard work expense deduction applies to all other applicable budgeting, such as deeming income, etc. IBCA has been revised to reflect these changes.
Effective January 1, 2002, the $50 child support and two-thirds earned income disregard no longer apply when determining MAF eligibility.
When determining deemed income, whether minor parent or stepparent, the full need standard used remains the 1996 AFDC (current Temporary Assistance) standard.
If deemed stepparent income causes ineligibility
for MAF, complete a new MAF budget including the income and needs of the
stepparent. If the family is still ineligible, evaluate the child's
eligibility for MAF excluding the stepparent income and needs. A
parent, with a spouse in the home, is ineligible for MAF unless the spouse
is included in the assistance group or their income deemed.
Step #1: Assistance group consists of Mrs. A. and her two children. Deemed stepparent income of $1217 (Gross minus $90 standard work expense, MAF full need standard for one person of $393, and $300 in child support paid) and $200 child support income exceeds $1220 MAF income limit for three persons.
Step #2: Assistance group consists of Mrs. A, her two children and stepparent. Mr. A's income of $2000 minus $206 standard work expense and child support income of $200 exceeds the eligibility income limit of $1471 for a four person assistance group..
Step #3: Since Mrs. A. is ineligible for MAF using both budget procedures, complete an MAF budget excluding the step-parent's income and needs. Only the children are eligible for healthcare coverage. Mother will be shown as an included (Z loc) on the IMU5.
Example 2: Mrs. B. applies for MAF for herself and one child by a previous marriage. She is employed earning $1300 and receives no child support for the child. Her current spouse is unemployed and has no unearned income.
Step #1: Assistance group consists of Mrs.
B. and her child. Since spouse has no income, there is no deemed
stepparent income and when budgeting Mrs. B's earnings of $1300 minus $206
work expense standard, they are ineligible as the adjusted income of $1094
exceeds the eligibility amount of $968 for two persons.
During the weekend of December 15, 2001 Data Processing will convert active individuals on C7 cases with both a level of care (loc) "R" and "Q" to MAF with a loc "T". Individuals with loc "R" will be sent a written notification (copy attached) of the change in their healthcare coverage. There is no change in the healthcare package for children going from "Q" loc to a "T" loc.
DP will also identify C7 cases with net income below 100% FPL with "Q" and "Z" levels of care to convert to MAF. The children's loc will change to "T" but there is no change in their healthcare benefits. A notice (copy attached) will be sent to those "Z" loc parents or caretakers explaining they no longer have to be uninsured to qualify. If interested in having their eligibility determined they are to contact their caseworker. These eligibility determinations should be completed within 30 days of request.
When the conversion is complete there will be MAF only cases on sequence numbers C1-6 and C7-8. The converted cases will continue with a C7 or 8 sequence number, while previously approved MAF cases will have a C1-6. Until further system work is completed all new MAF approvals must be entered as a sequence number C1-6. On any MAF only case, the 100% FPL figure must be entered in the field 33 (expense) of IMU5 on any further action, whether the action is new approval or change to an existing case.
Effective December 15, 2001, loc "R" will no longer be a valid loc. Eligibility under the new guidelines cannot begin prior to January 1, 2002. If eligibility prior to January 1, 2002 is established under the Custodial Parent program, it will be necessary to contact State Office for entry. Call Donna Schubert at 573-751-3569 or email SCHUEHM.
EXAMPLE: Applied for MC+ on December 5, 2001. Determine eligibility for MC+ based on guidelines in effect for December and again on the new MAF income guidelines. The income for December is above the current Temporary Assistance guidelines but below 100% FPL and uninsured. Approve parent for MAF effective January 1, 2002 and contact state office for entry of Custodial Parent coverage for December 5, 2001 through December 31, 2001.
For MAF only approvals entered after December 15, 2001, it will be necessary to enter the number of persons in the assistance group in Field 29 of the IMU5. The system will begin accepting "S" (sanction) and "Z" (included) individuals on the IMU5 for a MAF approval. These individuals should be included in the number entered in Field 29.
Currently Temporary Assistance/MAF combination cases that lose eligibility due to employment, increased earnings or loss of disregards were moved to TMA if eligible because the income limits for Temporary Assistance and MAF were the same. Effective with January 1, 2002, eligibility for MAF must be explored using the new income guidelines prior to determining eligibility for TMA.
There is no change in determining TMA eligibility when the family loses eligibility for MAF.
EFFECT ON MPW & MACC CASES:
The MAF income standards replace the Temporary Assistance standards previously used to establish MPW eligibility for level of care "H". The $206 standard work expense applies to MPW cases based on MAF standards, but does not apply to those based on 185% FPL. Section 0925.010.25 NEED (MPW) has been revised to reflect these changes.
Use the new MAF need criteria to determine eligibility for MACC (K cases) where applicable.
MC+ FOR CHILDREN AND CUSTODIAL PARENTS (MC+):
As stated above, the MC+ for custodial parents program ends on December 31, 2001. The standard work exemption (SWE) for MC+ for children under the 100% FPL income is increased to $206 for the wage earner with the highest earnings. The SWE remains $90 for the other wage earners on 100% of FPL cases and all wage earners on the MC+ cases using the 133% and 185% of FPL income limits.
Most children in families with net income below 100% of FPL will now qualify for MAF. A child in the home of a parent, NPCR or legal guardian can receive coverage under MAF even the caretaker is ineligible or chooses not receive coverage. If a child is not living with an eligible caretaker, eligibility should be determined under the MC+ program with a Q loc.
Section 0920.000.00 and Section 0920.030.00 have been revised to remove references to custodial parents. Section 0920.025 through 0920.025.30.05 are now obsolete and should be removed from the Family Healthcare Manual. Section 0920.010.35 has been revised to reflect the change in the standard work expenses for 100% budgets.