| TO: | ALL COUNTY OFFICES |
| FROM: | JANEL R. LUCK, DIRECTOR |
| SUBJECT: | MO HEALTHNET |
DISCUSSION:
Today Governor Matt Blunt signed Senate Bill 577 passed by the Missouri 94th General Assembly in May 2007. The bill replaces and re-names the Missouri Medicaid program with the MO HealthNet program. The new program includes several eligibility changes Family Support Division (FSD) will implement in the coming months. This memorandum briefly introduces the eligibility changes to let staff know what to expect. Unless noted below, these changes are all either authorized or effective August 28, 2007.
TICKET TO WORK
Senate Bill 577 authorizes the Ticket to Work Health Assurance Program, which replaces Medical Assistance for Workers with Disabilities (MA-WD) that was discontinued by Senate Bill 539 in 2005. Although similar to MA-WD, this program has some significant differences. The Ticket to Work Health Assurance Program will have a gross income maximum of 250% of the federal poverty level, but the net income test will be the same as the current Medical Assistance income tests for the permanently and totally disabled (PTD). The earned income of the worker with a disability is disregarded when determining eligibility on net income. In determining net income, a standard deduction for impairment-related employment expenses equal to one half of the disabled worker's earned income is allowed. In addition, $50 of Social Security Disability Insurance (SSDI) income is disregarded, and a minimum of $75 is deducted for optical/dental insurance premiums. Other deductions are the same as for Medical Assistance. Another key difference in this program and MA-WD is that FSD must document that Medicare and Social Security taxes are withheld from the disabled worker's earned income to qualify.
DRUG COURT MAF EXTENSION
Senate Bill 577 authorizes a 60 day extension of Medicaid eligibility to a Medical Assistance for Families parent who loses eligibility due to removal of his or her children from the home when the parent participates in drug court. This change is subject to approval by the Centers for Medicare and Medicaid Services (CMS).
SHELTERED WORKSHOP
This change, authorized by Senate Bill 577, excludes sheltered workshop income for the Medical Assistance program. A mass adjustment is planned to implement this change for all Medical Assistance cases that have sheltered workshop income budgeted.
COLA INCREASES
Senate Bill 577 authorizes changing when Social Security Administration (SSA) cost-of-living (COLA) increases are made for Medicaid cases. Currently a mass adjustment is done in December to show January COLA increases. This legislation authorizes FSD to disregard the Social Security COLA increases for Medicaid until the federal poverty level adjustments take effect in April.
ANNUITIES
Senate Bill 577 made a change for annuities to exclude the stream of income from an annuity as an available resource for Medicaid if the annuity is:
- Actuarially sound as measured against the SSA Life Expectancy Tables;
- Provides equal or nearly equal payments for the duration of the annuity and excludes balloon-style final payments;
- Names the State of Missouri as secondary or contingent beneficiary to ensure payment of Medicaid expenditures made for the individual if the individual predeceases the duration of the annuity; and
- Names the Medicaid claimant as the primary beneficiary.
PERSONAL CARE CONTRACTS
This change, authorized by Senate Bill 577, sets out in State statute when a personal care contract is considered fair and valuable consideration in exchange for other assets. This change is expected to reduce personal care contracts as a way to shelter assets for vendor Medicaid applicants and recipients.
MC+ FOR CHILDREN
Senate Bill 577 authorizes DSS to follow all Federal Medicaid requirements when providing healthcare coverage to CHIP children in families with income up to 150% of the federal poverty level guidelines. Missouri's current program has requirements that are more restrictive than Medicaid normally allows due to a federal waiver. This change would allow prior quarter coverage and eliminate the six month penalty for dropping insurance for this group of eligible children.
AFFORDABILITY TESTS
Senate Bill 577 lowers the affordability tests for families with income above 150% of the federal poverty level with access to insurance for their children. In addition, health insurance plans that do not cover an eligible child's pre-existing condition shall not be considered affordable insurance, and if a child has exceeded the annual coverage limits for all health care services, the child is not considered insured and does not have access to affordable health insurance.
UNINSURED WOMEN'S HEALTH PROGRAM
Senate Bill 577 authorizes Medicaid coverage for uninsured women who are at least 18 years old with a net family income of at or below 185% of the federal poverty level. This program, similar to Extended Women's Health Services, covers family planning services and sexually transmitted disease testing and treatment only. This change is subject to approval by the Centers for Medicare and Medicaid Services (CMS).
LONG TERM CARE PARTNERSHIP PROGRAM
Senate Bill 577 authorizes DSS to partner with the Department of Insurance to provide an incentive for individuals to purchase long-term care insurance. The incentive is an asset disregard if the individual applies for Medicaid and has a qualified long-term care insurance policy.
INDEPENDENT FOSTER CARE ADOLESCENTS
Senate Bill 577 extends Medicaid for independent foster care adolescents up to age 21 without regard to income or assets. Although this change will be implemented by Children's Division, FSD staff should refer children who lose eligibility for FSD Medicaid programs to Children's Division if FSD staff knows the child was a foster child on his or her 18th birthday and may qualify for this coverage. This change is effective July 1, 2007.
NECESSARY ACTION:
- Review this memorandum with all appropriate staff.
- Consider these upcoming policy changes as you plan your work.
- Implement changes only after notification policy changes are made.