2005 Memorandums
IM-85      08/05/05




This memorandum addresses changes discussed in Memorandum IM-69, dated June 27, 2005 and actions required for cases processed after August 6, 2005. Memorandum IM-69 addressed the reduction in the monthly income limit from $798.00 to $678.00 for individuals and from $1,070.00 to $909.00 for married couples as required by Senate Bill 539 and House Bill 11 (2005). The new income limits are effective September 1, 2005.

On August 6, 2005, all active Medical Assistance (OAA and PTD) cases identified as having net income over these new amounts will be adjusted. All MA (OAA/PTD) non-spenddown and spenddown cases will be adjusted by reducing the expense amount in Field 33 of IMU5 to 85% of the FPL, which will increase the surplus amount in Field 35. Non-spenddown cases with income above 85% of the federal poverty level (FPL) identified by the Department of Health and Senior Services (DHSS) as receiving in-home services will not be converted to spenddown.

For cases changing from non-spenddown, level of care (loc) “T” with sanction reason “T”, to spenddown the sanction reason will be changed to “S” with a Medicaid begin date of September 1, 2005. On the MXIX and IXIX screens the non-spenddown (loc/reason T/T) coverage segment will show an end date of August 31, 2005, the spenddown (loc/reason T/S) segment will show a begin date of September 1, 2005. On August 8, 2005, notices (sample attached) will be sent to these claimant(s) notifying them of the change in their benefit eligibility. On August 9, 2005, DMS will mail a spenddown invoice for September to these claimants.

Cases that were spenddown prior to the reduction in the non-spenddown limit were sent a notice (sample attached) of the increase in their spenddown amount on August 1, 2005. Division of Medical Services adjusted the spenddown amount on the August 2, 2005 invoices for September and the MPNI screen by adding $120 for single individuals and $161 for married couples to the amount of spenddown shown in the IMU5 system.

No turnaround IM-5's are produced for this adjustment.


A match with the Department of Health and Senior Services (DHSS) identified MA non-spenddown clients with income above 85% of the FPL who are eligible for Medicaid based on receipt of Home and Community Based (HCB) services. Single cases and couple cases where the payee is the only person on Medicaid will be transferred to HCB during the mass adjustment on August 6, 2005. The level of care and reason will be changed to T/H. Claimants eligible for Medicaid based on eligibility for HCB will be notified of the decision not to move them to spenddown (sample attached). A printout will be sent to the county on each case converted to HCB. The printout takes the place of the IM 54A, Home and Community Based Referral, and must be filed in the record as verification that this claimant met DHSS eligibility requirements. A listing of couple cases identified in the DHSS match that could not have a determination of eligibility made without a case review will be sent to the counties. Upon receipt of this list, counties are to review the record to determine if one or both individuals can be transferred to HCB. The county will need to send appropriate notification to the claimants and enter any changes on IMU5.


Memorandum IM-69 dated June 27, 2005 explained that the system will require the new expense amounts for all MA (OAA/PTD) cases beginning August 8, 2005. If the claimant's income is over the new income limit, the case will be a spenddown and will generate an initial invoice for the month of approval. The transition approval letter that is attached to Memo IM-69 is to be used for all MA spenddown approvals that include eligibility for August 2005 and prior months.

Spenddown applications and prior quarter coverage for periods prior to September 2005 will be based on 100% of the FPL figures. County staff are not responsible for adjusting the figures to reflect 100% of the FPL for these cases. DMS will subtract $120.00 for single and $161.00 for couple cases from the September spenddown amount (field 35) for eligibility for months prior to September 2005. For cases that would be non-spenddown for those months, DMS will give them “Transitional” lock-in coverage that will not require them to meet a spenddown for those months. For the transitional lock-in coverage, the MSPI screen will show SPND under “PGM”, TRANS under “METHOD” and zeros under “LIAB AMT”. The MPNI screen will not have any information on it for those months. MXIX and IXIX will show the LOC T and the reason S.



Notice (08/08/05)
Notice (08/01/05, single)
Notice (08/01/05, couple)
HCB Notice

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