SUBJECT:
UPDATE OF POVERTY INCOME GUIDELINES FOR THE MC+ PROGRAM FOR CHILDREN AND PREGNANT WOMEN, TRANSITIONAL MEDICAL ASSISTANCE, MEDICAL ASSISTANCE, QMB, SLMB, QI-1 AND QDWI
IM MANUAL REVISION #5: SECTIONS 0805.015.45, 0860.005.15.05, 0865.010.10.10 & 0870.010.05; SECTION 0900.000.00, APPENDIX D 
DISCUSSION:
Effective April 1, 2006, the Federal Poverty Level (FPL) is increased. This memo updates the poverty income guidelines for MC+ and Transitional Medical Assistance (TMA) in third reporting period. Also increased are the income standards for the Medical Assistance, QMB, SLMB, and the QDWI program. New poverty figure amounts for TEMP eligibility will be provided to qualified providers by State Office.
On the weekend of March 18, 2006, the Information Technology Systems Division (ITSD) will adjust the expense and deficit fields for the following types of active cases: MC+ for children, MC+ for pregnant women, TMA in third reporting period, Medical Assistance, QMB and SLMB cases. The OASDI amounts (if applicable) will also be adjusted for active Medical Assistance, QMB and SLMB cases. QMB cases were not included in the COLA adjustments in December 2005, due to federal legislation requiring that OASDI COLA increases not be considered on QMB budgets until the effective date of the new Federal Poverty guidelines. This federal legislation is also applicable to SLMB cases. The OASDI amounts for QMB and SLMB cases are increased based on cost of living with this adjustment.
Medical Assistance, TMA in Third Reporting Period, MC+ for Children and Pregnant Women Program
For IMU5 transactions entered on or after March 20, 2006, use the new poverty income amounts, effective for April 2006 (attached). Use the new amounts even if eligibility was established for March or earlier months based on the old amounts. This is necessary to prevent edits. Eligibility for months prior to April 2006 must be based on the old poverty standards. Also, effective March 20, 2006, IBCA will be updated with the new standards.
The IM-30 is being revised. A memorandum will be issued when the revision is available.
- For March 2006 and prior months, use the old poverty figures in effect during those months; and
- For April 2006 and later, use the amounts on the attached page.
No IM-5 forms will be generated from this adjustment. When using the last IM-5 in the case record for a subsequent action, update Fields 33-35 only if one of these fields is different than the adjusted figures. The adjusted figures will appear on the ICAS screen effective March 20, 2006.
For this adjustment, we are bypassing edit Error Code 382 - Poverty, Incorrect Expense on the poverty cases. If a case currently has poverty figures (whether correct or in error), the case will be updated with the new poverty figures. After the adjustments are made the edit will be reactivated. Some children may have a change in LOC because of the increase in FPL. These cases will be adjusted and the recipient notified of the change in their level of care.
Medical Assistance Income Standard
The Medicaid non-spenddown income limit for an individual has increased from $678.00 to $695.00 for a single person and $909.00 to $935.00 for a couple. The IMU5 system will require the $695.00 figure starting March 20, 2006, for entries in field 33 for single individual and the $935.00 figure for couple MA cases. All active spenddown cases will be updated on the weekend of March 18, 2006. All spenddown cases with income at or below $695.00 for a single person and $935.00 for a couple, will be converted to non-spenddown. For cases that remain spenddown the new amount will be printed on the invoices that are scheduled to be mailed on April 1, 2006. For cases with a decrease in the spenddown amount, the April invoice will be adjusted on the MPNI screen. New invoices for April will not be sent, but DMS will accept the lower amount to begin April coverage. For clients meeting spenddown with bills in April, the worker is to use the adjusted amount. For active cases with an increase in spenddown, the increase is effective for May coverage, as April invoices have already been sent.
Recipients who have a change in the spenddown status or amount will be sent the appropriate attached notice.
Effective April 1, 2006 the non-spenddown income limits for MA are:
Single $695.00
Couple $935.00
QMB Income Standard Increase
Below are the new QMB income standards. Use these standards for all QMB eligibility determinations completed for April or later months.
| Number of Persons | QMB Income Standard |
|---|---|
01 |
$817.00 |
02 |
$1100.00 |
03 |
$1384.00 |
SLMB Income Standard Increase
Below are the new SLMB income standards. Use these standards for all SLMB eligibility determinations completed for April or later months. NOTE: Because SLMB eligibility can include prior quarter determinations, use the previous standards for months prior to April 1, 2006.
| Number of Persons | SLMB Group 1 Income Standard | SLMB Group 2(QI-1) Income Standard |
|---|---|---|
01 |
$980.00 |
$1103.00 |
02 |
$1320.00 |
$1485.00 |
03 |
$1660.00 |
$1868.00 |
QMB, SLMB and OASDI Adjustment
For the mass adjustments, ITSD will match each individual to BENDEX to determine current OASDI amounts. This amount includes the COLA increase received in January 2006. If the individual matches to BENDEX, the new OASDI amount is entered in Field 13J and the difference between the old OASDI amount and the new OASDI amount is added to the gross and net income fields. The new standard for household size is entered in the expense field and a deficit or surplus is calculated. Adjusted cases appear on ICAS with the new budget figures on the first working day after the mass adjustment. No turnaround IM-5 forms are produced with this adjustment.
On the day of the mass adjustment, if the figure in Field 33 (Expense) is not a previous QMB, SLMB, or MA expense figure the case will not be adjusted. Additionally, if the new Field 35 is calculated to be a surplus, the case will not be adjusted. (MA expense figures correctly appear when an MA spenddown automatic close generates a QMB or SLMB automatic open.) Cases not adjusted appear on a listing entitled “QMB/SLMB Cases Needing Review for Adjustment”. The listing contains explanatory captions for each case not adjusted.
NOTE: Check for SLMB eligibility for QMB cases where a surplus is calculated.THESE NOTICES ARE ONLY AVAILABLE ON MOBIUS.
Some cases will be adjusted by a percentage method based on information in the IM database if BENDEX information is not available. Any case adjusted by the percentage method will be identified with an asterisk (*) at its caption. In previous adjustments, these cases were not adjusted, with reason “IM NO BENDEX.”
If a case does not appear on BENDEX but shows OASDI on the IM database, the case may be adjusted. Other cases will be adjusted by applying the 4.1% increase to the OASDI amount shown in 13J. For these cases, if the amount in 13J is wrong, the adjustment will be wrong. The worker is responsible for correcting 13J and any other affected figures. Because SMI premium information will not be available from BENDEX on percentage-adjusted cases, the program will attempt to identify premium payers and will assume the premium was $88.50 as of December 2005. Because not every premium is $88.50, a small portion of percentage-adjusted cases may be wrong due to this assumption. Therefore, each percentage-adjusted case is marked on the listings with an asterisk (*) to help caseworkers identify them in case of incorrect adjustments.
After the adjustment, IMU5 will accept only the new QMB or SLMB standard expense figures. Therefore, effective March 20, enter QMB or SLMB IM-5/IMU5 transactions using the new figures.
County Office Responsibility
Using the listing “QMB/SLMB Cases Needing Review for Adjustment”, review listed cases as follows:
QMB SURP - These cases have a surplus calculated in Field 35. Review for continuing eligibility, including eligibility under the SLMB program.
SLMB SURP - These cases have a surplus calculated in Field 35. Review for continuing eligibility.
IM NO BNDX - These cases have an OASDI amount in Field 13J of IMU5 but no OASDI amount appearing on the BENDEX tape file.
Review for accuracy of information in the IM database and make necessary corrections.
IM > BNDX - These cases have an OASDI amount in Field 13J of IMU5 that is greater than the amount appearing on the BENDEX tape file. Review for accuracy of information in the IM database and make necessary corrections.
INCOR EXP - These cases appear as the result of a computer generated opening (i.e., the QMB/SLMB only case was opened when an MA spenddown case was auto closed, and the MA budget figures remain in Fields 33 through 35.) These are for information only. Correct the budget figures at the next regular handling.
Adjust any cases not adjusted by state office as necessary.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
- Begin using the new poverty level figures for MC+ for children and pregnant women, Transitional Medical Assistance in third reporting period, Medical Assistance, QMB, SLMB, QI-1, and QDWI effective for April 1, 2006 and later. Use the new figures for IMU5 transactions entered on or after March 20, 2006.
- Review cases on listing “QMB/SLMB Cases Needing Review for Adjustment” and take necessary action by May 31, 2006.
- File the revised manual pages.
GLS
Attachments:
Spenddown Decrease
MC+ Premium
NEMT
Spenddown to Non-Spenddown