IM-65 06/04/02 DECREASE IN MEDICAL ASSISTANCE FOR FAMILIES (MAF) INCOME STANDARD
|DECREASE IN MEDICAL ASSISTANCE FOR FAMILIES
(MAF) INCOME STANDARD
FAMILY HEALTHCARE MANUAL REV: #20
SECTIONS: 0905.005.00,0905.010.45, 0905.010.45.20, 0905.010.45.25, 0905.010.45.35, 0920.010.35, 0925.010.25, and 0925.010.25.05
MANUAL REVISION #17:CHAPTER I, APPENDIX D (attachment below)
|Missouri House Bill 1111 decreased the
income standard for Medical Assistance for Families (MAF) to 77% of the
federal poverty level (FPL) effective July 1, 2002. In addition,
the standard work expense reverts back to $90 for all wage earners on MAF
and MC+ cases.
All current MAF cases with net income above 77% FPL will be converted by the system to MC+ for children on June 29, 2002. All parents, age 19 and over, on those cases will be converted from level of care (loc) "T" to loc "Z" and their MC+ Healthcare coverage will end June 30, 2002. Parents under age 19 and children on the cases will be converted from loc "T" to loc "Q".
On June 10, 2002, advance notice of the change (copy attached below) will be mailed to all families with a parent losing eligibility. The notice informs the family of the change in the MAF income limit and that based on the information in their case record the parents are no longer eligible for MC+ healthcare coverage. It also informs the parent(s) that they may remain eligible if they are blind, disabled, pregnant, or if there has been a change in income. A report of these cases will be sent to the county office. Ex-parte and hearing procedures must be followed as addressed later in this memorandum.
Effective with budgets for July 2002, determine MAF eligibility using the following income standards:
EX-PARTE REVIEW PROCEDURES:
When the report of cases with parents losing eligibility is received the caseworker must complete an ex-parte review. If there is a corresponding Food Stamp case with total income less than the gross income on the MAF case, the report will list the Food Stamp record's income. These cases must be reviewed to determine if the families net income for MAF is below 77% FPL. Also, all parents who are showing Social Security benefits in IMU5 will have the SSA amount listed. If SSA benefits are listed review the record to determine if the benefit indicates the parent is disabled.
If eligibility is not established in the ex-parte review but the individual responds to the Advance Notice indicating a change in income or other possible eligibility, the MAF eligibility for that particular individual must remain open pending a determination of eligibility based on the report. To accomplish this, IMU5 must be updated to show income of less than 77% FPL in field 34. This action will prevent the system from ending the parent(s)' eligibility on June 30th. If the report indicates potential eligibility for another category, register the appropriate (MA, MC+ for Pregnant Women) application in IAPP.
If determined ineligible based on reported pregnancy, disability, blindness or change in income, send an IM-80 specifying the reason eligibility for MC+/Medicaid does not exists. Address the reason for the denial of the new category as well as the reason for loss of eligibility for MAF. The reason for MAF ineligibility is, " your family's net income of $______ exceeds the MAF income limit of 77% of the federal poverty level established by House Bill 1111". The IM-80 will also serve as the rejection notice and provide appeal rights. Close the active MAF case once the IM-80 expires.
If the family remains eligible for MAF, enter the correct income in IMU5. If eligibility exists under another category, switch the individual to the appropriate category (an application is not needed). If discontinuing eligibility under MAF and approving in another category, process both transactions on the same day in order to prevent any disruption in healthcare coverage.
Families have a right to appeal the parent(s') loss of MAF eligibility. The advance notice gives them until June 20, 2002, to request a hearing. The caseworker must screen hearing requests to determine if the change in state law is the sole reason for the request, however the Hearing Unit will make the final decision on this issue. The Advance Notice will inform the recipient of the date and time a hearing will be held, if requested. The hearings will be scheduled for 8:00 AM on June 21, 24, 25, 26 or 27. This will allow the Hearing Unit to make this decision prior to June 29th. The listing of cases notified will contain the hearing date.
If a hearing is requested by June 20th, staff must determine if the request is due to the change in state law or for another reason. For example, if the recipient agrees with the income, allowable deductions and household composition used to determine their eligibility that indicates they are only in disagreement with the change in state law. If the recipient disagrees with how net income was calculated the reason for the hearing is for something other than the change in state law. Staff must clearly indicate on the Application for State Hearing (IM-87) form whether the reason for the hearing is the change in state law or something else. The IM-87 must be faxed to the Hearing Unit on the date the request is made to ensure that hearings on these cases are held as soon as possible. The original IM-87 must still be mailed to the Hearing Unit.
If the reason for the hearing request is for a reason other than the change in state law, benefits must continue pending the outcome of the hearing. Normal hearing procedures will apply to these requests. Advise the claimant to disregard the hearing date shown on the advance notice because they will be notified by the Hearing Unit of a new hearing date. To prevent the system from closing the parent, update the IMU5 to show income of less than 77% FPL in field 34.
If the reason for the hearing request is solely due to the change in state law, no action needs to be entered in IMU5.
ACTION ON MAF CASES PRIOR TO JULY 1, 2002:
Until the conversion takes place, staff should continue to process MAF cases based on eligibility at 100% FPL. However, for new approvals and budget adjustments completed after June 7, 2002, staff must determine if the family's net income exceeds 77% FPL. If it does, the worker must notify the family that the parents' eligibility will end on June 30, 2002 and include the attached Notification of Change in MAF Income Limit (see below for attachment) with the letter to the family.
ACTION ON MAF CASES AFTER JULY 1, 2002:
Effective July 1, 2002, IMU5 will no longer allow approvals of MAF cases with income above 77% FPL. Eligibility under the old guidelines may exist for months prior to July 1, 2002. If eligibility prior to July 1, 2002 is established for a MAF parent with income below 100% FPL but above 77% FPL, approve the case by entering income of less than 77%. The next day enter the correct income, close the parents (change from loc "T" to "Z") and change the children to loc "Q". The notice to the family must state that the parents are only eligible through June 30, 2002 due to the reduction of the income limit.
EFFECT ON MPW & MACC CASES:
The 77% FPL MAF income standards are to be used to establish MPW eligibility for level of care "H". The $90 standard work expense applies to all MPW cases.
Use the new MAF need criteria to determine eligibility for MACC (K cases) where applicable.
Advance Notice of the Change (pdf)
Attachment to Advance Notice (77% FPL table) (pdf)
Chapter I, Appendix D (pdf)
Notification of Change in MAF Income Limit (pdf)