IM-70 06/14/02 EXTENDED
TRANSITIONAL MEDICAL ASSISTANCE (ETMA) CHANGES
FAMILY HEALTHCARE REVISION #21
SECTIONS: 0910.00.00, 0910.005.00, 0910.030.05, 0910.055.00, 0910.055.20, 0910.055.35
|EXTENDED TRANSITIONAL MEDICAL ASSISTANCE
FAMILY HEALTHCARE REVISION #21
SECTIONS: 0910.000.00, 0910.005.00, 0910.030.05, 0910.055.00, 0910.055.20, 0910.055.35
|Missouri House Bill 1111 shortened Extended
Transitional Medical Assistance (ETMA) eligibility from 24 months to 12
months of coverage effective July 1, 2002. Additionally, the income
limit to qualify for ETMA was reduced from 300% of the federal poverty
level (FPL) to 100%.
We have identified the following ETMA recipients who will be affected:
An advance notice of change (copies attached as pdf) will be mailed on June 17th and 18th to:
#1: ETMA recipients who have received for 12 months or more.
Group #1 and #2 letters will be mailed on the 17th and the cases closed by the system on June 29, 2002. MC+ Healthcare coverage will end June 30, 2002. The advance notice of change informs the recipients they may remain eligible if they are blind, disabled, pregnant or have had a change in income. If the recipient responds to the Advance Notice indicating other possible eligibility, register the appropriate (MA, MC+ for Pregnant Women) application in IAPP or explore MAF eligibility. The ETMA eligibility for that particular individual must remain open pending a determination of eligibility based on the report. If eligibility for MA, MPW, or MAF has not been established by June 25th, send an e-mail to the IM Program and Policy unit (F051XIX). The e-mail should state that the ETMA recipient listed has a determination pending for another eligibility category and needs to remain open for ETMA.
Persons in Group #3 are being mailed an advance notice on June 18, 2002 advising them of their shortened period of eligibility. This notice also informs the recipient they may remain eligible if they are blind, disabled, pregnant or have had a change in income. If the recipient responds to the Advance Notice indicating other possible eligibility, register the appropriate (MA, MC+ for Pregnant Women) application in IAPP or explore MAF eligibility.
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 exist. Address the reason for the denial of the new category as well as the reason for loss of eligibility for ETMA. The reason for ETMA ineligibility is, " your family's net income of $______ exceeds the ETMA income limit of 100% of the federal poverty level established by House Bill 1111 (13CSR 70-4.090)" or "you have exhausted the 12 month time limit allowed to receive ETMA as established by House Bill 1111 (13CSR 70-4.090)". The IM-80 will also serve as the rejection notice and provide appeal rights. Close the active ETMA case once the IM-80 expires.
If eligibility exists under another category, switch the individual to the appropriate category (an application is not needed). If discontinuing eligibility under ETMA 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 ETMA eligibility. The advance notice gives them until June 27, 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 28. This will allow the Hearing Unit to make a decision prior to June 29th.
If a hearing is requested by June 27th, 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, send an e-mail to the IM Program and Policy unit (F051XIX). The e-mail should state that the ETMA recipient listed has requested a hearing for a reason other than the change in State law and give the recipient's stated reason.
Individuals notified of the proposed shortening of their ETMA eligibility period have until June 28, 2002 to request a hearing. Follow normal hearing procedures for these.
CASES WITH INCOME BELOW 77%
We have identified a number of ETMA cases active over 12 months, that have net income equal to or less than 77% of FPL on the C7 case that includes their children. A listing of these cases is being sent to each county for review since the income information indicates the parents are MAF eligible. If there is MAF eligibility, move the parent(s) to MAF and close the ETMA.
If it is determined the family's net income is in excess of 77% of the federal poverty level, complete an ex-parte review to determine if there is possible eligibility elsewhere. If no eligibility is found send an IM-80PRE to notify the parent(s) of ineligibility for ETMA. The reason for ETMA ineligibility is, "House Bill 1111 shortened the time allowed for eligibility under the ETMA program to 12 months and our records indicate you have received 12 or more months (13CSR 70-4.090)." Follow normal pre-closing review and closing procedures.
ETMA SYSTEM CHANGES:
At the end of the 12 month TMA period, the system will check for insured status and net income when determining whether the recipients qualify for ETMA. Because the conversion to ETMA is done by the system, it is now necessary to have the most recent income information in the system at the time of conversion from TMA. All TMA cases that are determined eligible for the final two months of TMA based on the third quarterly report must also have a 100% of FPL budget completed. The income and deductions on this budget will be the same as what is shown on a MAF budget. The 100% FPL budget will be done only on TMA cases that have earned income minus childcare expense below 185% of FPL.
Effective July 1, 2002, IMU5 will require entry of a new 100% FPL budget when a "4" is entered in field 38a. An online edit will be put into place to insure that when the third quarterly report is coded as received on the IMU5, that new budget information is entered. The information on the 100% FPL budget will be used to determine if the case should be converted to ETMA.
Effective with July 2002, the system will calculate 12 months of ETMA eligibility and begin reviewing for income eligibility. The ex-parte letters have been revised to reflect these changes.