| SUBJECT: |
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DECREASE IN MEDICAL ASSISTANCE FOR FAMILIES (MAF) INCOME STANDARD
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| DISCUSSION: |
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Missouri House Bill 1011 decreased the income standard for Medical Assistance for Families (MAF) from 77% to 75% of the federal poverty level (FPL) effective July 1, 2004. On June 26, 2004, all active MAF cases with net income above 75% FPL that meet the following criteria will be changed to Transitional Medical Assistance (TMA) effective July 1, 2004:
Active MAF cases with net income above 75% FPL that do not meet the TMA requirements above will be converted by the system to MC+ for Children on June 26, 2004. All parents, age 19 and over, on these cases will be converted from level of care (loc) “T” to loc “Z” and their MC+ healthcare coverage will end June 30, 2004. Parents under age 19 and children on these cases will be converted from loc “T” to loc “Q” effective July 1, 2004. On June 7, 2004 advance notices of the change ( copies attached below ) will be mailed to all the families affected by the reduction in the MAF income limit. The notice informs the families of the change in the MAF income limit and the proposed changes in eligibility. The notice to parents that do not qualify for TMA informs them that they may remain eligible for healthcare coverage (Medicaid) if they are blind, disabled, pregnant, or if there has been a change in income. Ex-parte and hearing procedures must be followed as addressed later in this memorandum. County offices will receive a report of all cases notified of the loss of MAF eligibility. INCOME LIMITS : Effective with budgets for July 2004, MAF eligibility determinations will be done using the following income standards:
IBCA has been programmed to reflect 75% FPL for budgets prepared for July 2004 forward. Effective with June 7, 2004 MAF budgets completed on IBCA, must have “MAF” entered in the POVERTY Field instead of the federal poverty level percent number. IBCA will automatically calculate the correct federal poverty level for the effective month entered. EX-PARTE REVIEW PROCEDURES (NOT ELIGIBLE FOR TMA) When the report of cases with parents losing MAF eligibility, not eligible for TMA, 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 recorded on the MAF case, the report will list the Food Stamp record’s income. These cases must be reviewed to determine if the family’s net income for MAF is below 75% FPL. Also, 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 determinations of eligibility based on the report. To accomplish this, IMU5 must be updated by June 25, 2004 to show net income of less than 75% FPL in field 34. This action will prevent the system from ending the parent’s’ eligibility on June 30 th. 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 75% of the federal poverty level established by House Bill 1011”. The IM-80 will also serve as the rejection notice and provide appeal rights. Close the MAF case once the IM-80 expires if no hearing is requested. 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 (a signed application is not necessary). 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. Keep in mind that MAF eligibility is date specific. HEARING PROCEDURES: Families have a right to appeal the parent(s’) loss of MAF eligibility. The advance notice gives them until June 17, 2004 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 June 17 through June 24, 2004. This will allow the Hearing Unit to make this decision prior to June 26, 2004. If a hearing is requested by June 17, 2004, 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, this 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(s), update the IMU5 to show income of less than 75% 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 JUNE 26, 2004: Until the conversion takes place, staff should continue to process MAF cases based on eligibility at 77% FPL. However, for new approvals and budget adjustments completed after June 5, 2004, staff must determine if the family’s net income exceeds 75% FPL. If it does, the worker must notify the family that the parents’ eligibility will end on June 30, 2004 and include the appropriate attached Notification of Change in MAF Income Limit and the 75% FPL table ( see below for attachments ) with the letter to the family. Notification of Change #1 is for new approvals eligible for TMA. Notification of Change #2 is for new approvals ineligible for TMA. Examples: Jane Smith is approved for MAF in June, with income between 75% and 77% FPL. Ms Smith has earned income and is also eligible for MAF in the prior quarter. She will not remain eligible for MAF as her income is over 75%, but qualifies for TMA as she has earned income and has received MAF three out of the last six months. Send Ms Smith the Notification of Change #1. John Doe is approved for MAF in June, with income between 75% and 77% FPL. Mr. Doe is receiving Unemployment Compensation and is also eligible for MAF prior quarter. Mr. Doe will not remain eligible for MAF as his income is over 75%, and the family does not qualify for TMA as he has no earned income. Send Mr. Doe the Notification of Change #2. ACTION ON MAF CASES AFTER JUNE 26, 2004: Effective June 28, 2004, IMU5 will no longer allow approvals for MAF cases with income above 75% FPL. Eligibility under the previous guidelines may exist for months prior to July 1, 2004. If eligibility prior to July, 2004 is established for a MAF parent with income below 77% FPL but above 75% FPL, approve the case by entering income of less than 75% FPL. Review the case history to determine if TMA criteria are met (family has earned income and also received MAF three out of the last six months). If the family does not meet TMA criteria, 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 the parents are only eligible through June 30, 2004 due to the reduction of the income limit. If the family does meet TMA criteria, the next day enter TMA eligibility into the IMU5 system. The notice to the family must state the parents are eligible for MAF through June 30, 2004, and eligible for TMA beginning July 1, 2004, due to the reduction of the income limit. EFFECT ON MPW & MACC CASES: The 75% FPL MAF income standards are to be used to establish MPW eligibility for level of care “H”. Use the new MAF need criteria to determine eligibility for MACC (K cases) where applicable.
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| NECESSARY ACTION: |
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| Attachments: |
(all are pdf  )
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