MEMORANDUM
2005 Memorandums
IM-46      05/13/05

SUBJECT:

DECREASE IN MEDICAL ASSISTANCE FOR FAMILIES (MAF) INCOME STANDARD
Family Healthcare Manual Revision 15, Sections 0905.005.00, 0905.012.00, 0905.012.20, 0905.012.25, 0905.012.35, 0905.012.50, 0905.012.55, 0905.012.55.05, 0905.012.55.10, 0905.012.55.15, 0920.010.35, 0925.010.25, 0925.010.25.05 & Appendix D pdf logo (Section 0900.000.00)

DISCUSSION:

Missouri House Bill 11 decreased the income standard for Medical Assistance for Families (MAF) from 75% of the federal poverty level (FPL) to the July 16, 1996 AFDC income standards effective July 1, 2005. Lowering the MAF income limit to the July 16, 1996 AFDC limit requires the first $50 of child support to be disregarded.

NOTE: The July 16, 1996 AFDC income standards are the same as the current Temporary Assistance income standards and are referred to as the TA (Temporary Assistance) income limits in the rest of this memo. It is important to note that while these income standards/limits are the same at this time, there are two differences in the income disregards between MAF and TA. The two-thirds disregard of earned income does not apply to MAF. The first $50 of child support received is disregarded for MAF, but is not for TA, MC+ for Children or MC+ Pregnant Women.

On June 25, 2005, all active MAF cases with net income above the TA income limits that meet the following criteria will be changed to Transitional Medical Assistance (TMA) effective July 1, 2005:

Active MAF cases with net income above the July 16, 1996 AFDC income standards that do not meet the TMA requirements above will be converted by the system to MC+ for Children on June 25, 2005. 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, 2005. Parents under age 19 and children on these cases will be converted from loc “T” to loc “Q” effective July 1, 2005.

On May 20, 2005 advance notices of the change ( copies attached below ) will be mailed to all the families (who were active on May 13, 2005) 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. For case actions after May 13, 2005, refer to the section labeled “Action on MAF Cases Prior to June 25, 2005.”

County offices will receive a report of all cases notified of the loss of MAF eligibility.

INCOME LIMITS:

Effective with budgets for July 2005, MAF eligibility determinations will be done using the TA income standards:

IBCA will be programmed to reflect the TA income limits for MAF budgets prepared for July 2005 forward. Continue to enter “MAF” in the POVERTY Field on the IBCA when completing a MAF budget. This will prevent the two-thirds disregard from being allowed on MAF.

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 TA income limit. 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 the ex-parte review indicates that it is child support income that is making the MAF case ineligible, determine continued eligibility using the $50 child support disregard and different assistance grouping, if applicable.

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 by June 25, 2005 to show net income of less than the TA income limit 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 established by House Bill 11.” 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 May 31, 2005 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 informs the recipient of the date and time a hearing will be held, if requested. The hearings are scheduled for June 1 through June 22, 2005. This will allow the Hearing Unit to make this decision prior to June 30, 2005.

If a hearing is requested by May 31, 2005, 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 the TA income limit 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 25, 2005:

Until the conversion takes place, staff should continue to process MAF cases based on eligibility at 75% of the federal poverty level (FPL). However, for new approvals and budget adjustments completed after May 13, 2005, staff must determine if the family’s net income exceeds the TA income limit. If it does, the worker must notify the family that the parents’ eligibility will end on June 30, 2005 and include the appropriate attached Notification of Change in MAF Income Limit and the July 16, 1996 AFDC income standard 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% FPL and the TA income limit. 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 the TA income limit, 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% FPL and the TA income limit. 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 the TA income limit 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 BEGINNING JUNE 27, 2005:

Effective June 27, 2005, IMU5 will no longer allow approvals for MAF cases with income above the TA income limit. Eligibility under the previous guidelines may exist for months prior to July 1, 2005. If eligibility prior to July, 2005 is established for a MAF parent with income below 75% FPL but above the TA income limit, approve the case by entering income of less than the TA income limit. 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, 2005 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, 2005, and eligible for TMA beginning July 1, 2005, due to the reduction of the income limit.

EFFECT ON MPW & MACC CASES:

The July 16, 1996 AFDC income standards (TA income limits) 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.

NECESSARY ACTION:

LH

The Family Healthcare Manual sections are being revised. Staff will be notified when revisions are available.

ATTACHMENTS:

(all are pdf pdf logo)

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