| TO: | ALL COUNTY OFFICES |
| FROM: | JANEL R. LUCK, DIRECTOR |
| SUBJECT: | UPDATE OF POVERTY INCOME GUIDELINES FOR THE MEDICAL ASSISTANCE FOR FAMILIES, MC+ PROGRAM FOR CHILDREN AND PREGNANT WOMEN, TRANSITIONAL MEDICAL ASSISTANCE, MEDICAL ASSISTANCE, QMB, SLMB, QI-1 AND QDWI IM MANUAL REVISION #8: SECTIONS 0210.005.30, 0805.015.45, 0860.005.15.05, 0865.010.10.10 & 0870.010.05; SECTION 0900.000.00, APPENDIX D |
, DISCUSSION:
Effective April 1, 2007, the Federal Poverty Level (FPL) is increased. The poverty income guidelines for TA, MAF, MC+, MPW, Newborn and Transitional Medical Assistance (TMA) in the third quarterly reporting period are updated. 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 24, 2007, FAMIS and the Information Technology Services Division (ITSD) will adjust the expense and deficit fields for the following types of active cases: Medical Assistance for Families, MC+ for Children, MC+ for Pregnant Women, Newborn, TMA in the third quarterly 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 2006, 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.
LEGACY ADJUSTMENTS
For IMU5 transactions entered on or after March 26, 2007, use the new poverty income amounts, effective for April 2007 (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 2007 must be based on the old poverty standards. Also, effective March 26, 2007, IBCA will be updated with the new standards.
The IM-30 is being revised to reflect the new FPL figures. A memorandum will be issued when the revision is available.
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For March 2007 and prior months, use the old poverty figures in effect during those months; and
- For April 2007 and later, use the amounts on the attached page.
IM-5 forms will not be generated as a result of 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. If the case has not been updated since the IMU5 individual screen was revised, the case will not pass edits without updating those fields. The adjusted figures will display on the ICAS screen effective March 26, 2007.
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.
FAMIS ADJUSTMENTS
The adjustments begin Saturday, March 24; FAMIS will be unavailable until the adjustments are completed. If the adjustments are not completed by the morning of March 26, 2007, staff will be notified. FAMIS will adjust active MAF and MC+ cases, based on the new FPL figures. Notices will be sent on all actions that do not result in a NOCH. NOCH action notices will not be sent for the Poverty Level Adjustment. FAMIS cases that are in the controlled flow, conversion status in the controlled flow or on the MCL will not be adjusted. Those cases will have the new figures applied when the case is taken through the flow or fully converted to FAMIS. Process conversion cases as soon as possible so the cases can be updated with the new FPL figures timely.
For FAMIS actions taken on or after March 26, 2007, FAMIS will use the new poverty amounts effective for April 2007. For actions effective March 2007 and earlier, FAMIS will apply the previous poverty figures. The EU Action Log (FM40) displays the action taken by the system and the benefit amount for the month. To view information for the MAF and MC+ adjustments, select the action and press F17=INQAUTH. The Action Authorization (FM4N) screen displays. Press F16=BUDSUM. The Medicaid Category Summary screen displays. To view specific budget information, select the individual and press F6=DETAILS or F14=ITERATIONS to view budget and assistance grouping information for the selected individual.
If changes were entered prior to the mass adjustment and a new eligibility determination was not completed, the mass adjustment will create a new eligibility determination. This may result in the actions being set to RTA (ready to authorize) status. The alert, “OUTSTANDING ELIGIBILITY DETERMINATION” will be generated for these cases and must be resolved.
CONFLICT OF ACTIONS
FAMIS will adjust the FPL figures on EUs with pending adverse actions at the time of the mass adjustment. If an adverse action is pending on another change at this time a conflict of actions occurs. These conflicting actions must be resolved so the system can properly take action on the case. When there are conflicting actions, the worker receives the alert “OUTSTANDING ELIGIBILITY DETERMINATION.” The conflict must be resolved by the Eligibility Specialist. To resolve the conflict:
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Access the Action Resolution screen (FM50 or ACTRES) and void the adverse action resulting from the mass adjustment. Refer to the user guide “Changing an Adverse Action Status” for instructions.
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After voiding the adverse action, access the Eligibility Determination Resolution screen (FM3Y or EDRES) and run a new eligibility determination.
- Authorize the new adverse action.
PREMIUM REFUNDS
Premiums paid for April coverage will be refunded to the client if the FPL causes the case to become eligible as a non-premium case. Spenddown cases which are now eligible as a non-spenddown case or lower spenddown as of April 1, 2007, will have either a total or partial payment refunded. The refund process will take approximately 8 weeks to complete.
MEDICAL ASSISTANCE INCOME STANDARD
The Medicaid non-spenddown income limit for an individual has increased from $695.00 to $724.00 for a single person and $935.00 to $970.00 for a couple. The IMU5 system will require the $724.00 figure starting March 26, 2007, for entries in field 33 for single individuals and the $970.00 figure for couple MA cases. All active spenddown cases will be updated on the weekend of March 24 2007. All spenddown cases with income at or below $724.00 for a single person and $970.00 for couples 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, 2007. 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, 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.
MEDICAL ASSISTANCE NON-SPENDDOWN
Effective for April 2007 and later months, the non-spenddown income limits for MA are:
| Single | $724.00 |
| Couple | $970.00 |
QMB INCOME STANDARD
Below are the new QMB income standards. Use these standards for all QMB eligibility determinations effective for April 2007 and later months.
Number of Persons |
QMB Income Standard |
01 |
$851.00 |
02 |
$1141.00 |
03 |
$1431.00 |
SLMB INCOME STANDARD
Below are the new SLMB income standards. Use these standards for all SLMB eligibility determinations effective for April and later months.
NOTE: Because SLMB eligibility can include prior quarter determinations, use the previous standards for months prior to April 2007.
Number of Persons |
SLMB Group 1 Income Standard |
SLMB Group 2(QI-1) Income Standard |
01 |
$1021.00 |
$1149.00 |
02 |
$1369.00 |
$1541.00 |
03 |
$1717.00 |
$1932.00 |
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 2007. ITSD will adjust cases matching BENDEX by entering the new OASDI amount in Field 14M and adding the difference between the old OASDI amount and the new OASDI amount 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.
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 closing generates a QMB or SLMB automatic open.) The report titled, “QMB/SLMB Cases Needing Review for Adjustment” will be generated in Mobius to provide a listing of cases not adjusted. Check for SLMB eligibility for QMB cases where a surplus is calculated.
When BENDEX information is not available, cases will be adjusted by percentage based on information in the IM database. Cases adjusted by the percentage method will be identified with an asterisk (*).
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 3.3% increase to the OASDI amount shown in 14M. For these cases, if the amount in 14M is wrong, the adjustment will be wrong. The worker is responsible for correcting 14M and any other affected figures. As a result of SMI premium information not being available from BENDEX on percentage-adjusted cases, the program will attempt to identify premium payers and will assume the premium was $93.50 as of December 2006. Because not every premium is $93.50, 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 Eligibility Specialists 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 26, 2007, 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 14M 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 14M 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 display as the result of a computer generated opening (i.e., the QMB/SLMB only case was opened when a MA spenddown case was auto closed, and the MA budget figures remain in Fields 33 through 35.) These cases display for your information only. Correct the budget figures at the next regular handling.
NECESSARY ACTION:
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Review this memorandum with appropriate staff.
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Begin using the new poverty level figures effective for April 2007 and later. Use the new figures for IMU5 transactions entered on or after March 26, 2007.
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Resolve conflicting actions in a timely manner.
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Review cases on listing “QMB/SLMB Cases Needing Review for Adjustment” and take necessary action by May 31, 2007.