| TO: | ALL COUNTY OFFICES |
| FROM: | JANEL R. LUCK, DIRECTOR |
| SUBJECT: | INCOME EXCLUSION FOR MEDICAL ASSISTANCE FOR INDIVIDUALS ELIGIBLE FOR CERTIFIED EXTENDED EMPLOYMENT AT A SHELTERED WORKSHOP
|
DISCUSSION:
Senate Bill 577, passed by the General Assembly in May 2007, includes an exclusion of any income earned by individuals eligible for certified extended employment at a sheltered workshop when determining eligibility for Medical Assistance (MA) effective August 28, 2007. The exclusion applies to income earned at both a sheltered workshop and a different employer when the individual is certified for extended employment at a sheltered workshop. Section 0805.015.10 Income Exclusions of the Medical Assistance manual and Section 0110.050.00 Eligibility for Certified Extended Employment at a Sheltered Workshop in the Verification Requirements manual are revised and added to reflect this change. This memorandum introduces new policy and announces a mass adjustment of Medical Assistance cases with sheltered workshop income on July 29, 2007.
Continue to budget income earned by individuals eligible for certified extended employment at a sheltered workshop when determining eligibility for Medical Assistance for approvals and adjustments completed before the mass adjustment on July 29, 2007. Exclude income earned by individuals eligible for certified extended employment at a sheltered workshop when completing budgets for September 2007 after July 29, 2007. Continue to enter sheltered workshop income in Field 14P of the IMU5 system.
EXCLUSION OF INCOME EARNED BY INDIVIDUALS ELIGIBLE FOR CERTIFIED EXTENDED EMPLOYMENT AT A SHELTERED WORKSHOP
Effective July 30, 2007, for budgets completed for Medical Assistance for September 2007 and later, exclude any income earned by individuals who:
- work at a sheltered workshop; or
- are certified by Department of Elementary and Secondary Education (DESE) as eligible for extended employment at a sheltered workshop.
This income exclusion applies to the income a Medical Assistance applicant or recipient may have from working at a sheltered workshop, working at a sheltered workshop and another employer at the same time, or working for an employer when the Medical Assistance recipient has been certified by DESE as eligible for extended employment at a sheltered workshop, but the applicant/recipient is working for an employer other than a sheltered workshop. This may include individuals who previously worked at a sheltered workshop and are now working for another employer.
Verification that the individual meets the criteria for this income exclusion must be obtained. Accept any of the following as verification:
- pay stubs from the sheltered workshop;
- a letter from DESE or the sheltered workshop stating the individual is employed by the sheltered workshop or is eligible for extended employment at a sheltered workshop;
- a DESE form certifying eligibility for extended employment at a sheltered workshop; or
- pay stubs or other documentation that shows the individual previously worked at a sheltered workshop.
EXAMPLE: Ms. Smith works at a sheltered workshop. Her earned income from the sheltered workshop is excluded as income for Medical Assistance.
EXAMPLE: Mr. Jones works part-time at a sheltered workshop and part-time for a local fast food restaurant. His earned income from the sheltered workshop and the fast food restaurant is excluded as income for Medical Assistance.
EXAMPLE: Ms. Roberts works for the City and is certified by DESE as eligible for extended employment at a sheltered workshop. Ms. Roberts provides her eligibility specialist a copy of her DESE certification form. Because she is certified as eligible for extended employment at a sheltered workshop, her earned income from the City is excluded for Medical Assistance.
EXAMPLE: Mr. Perry used to work at a sheltered workshop, but now he works for a local fast food restaurant. His past employment at a sheltered workshop is accepted as verification that he is eligible for extended employment at a sheltered workshop. Mr. Perry’s earned income from employment at the fast food restaurant is excluded for Medical Assistance.
If there is any question as to whether or not the individual is eligible for extended employment at a sheltered workshop, send a policy clearance to IM Program and Policy through supervisory channels.
MASS ADJUSTMENTS IN LEGACY
On July 29, 2007, the Information Technology Services Division and the Family Support Division will adjust all cases with sheltered workshop income shown in Field 14P in the IMU5 system for the month of September 2007.
State Office will complete the adjustment as follows:
- The adjustment will identify the net amount of sheltered workshop income budgeted, and update the Net Income and DEF/SURP fields.
- For cases changing from spenddown to nonspenddown, the sanction reason will be changed from “S” to “T” with a Medicaid begin date of September 1, 2007. The MXIX and IXIX screens will show an end date of August 31, 2007, for the spenddown (loc/reason T/S) coverage segment, and the nonspenddown (loc/reason T/T) segment will show a begin date of September 1, 2007.
- On July 30, 2007, the attached notice will be sent to Medical Assistance recipients with sheltered workshop income notifying them of the change in their benefit eligibility.
- On August 1, 2007, Division of Medical Services (DMS) will mail claimants remaining a spenddown an invoice for September showing the reduced spenddown.
The following reports will be generated to MOBIUS and will be available after the mass adjustment:
- FIM3172301 “Cases Adjusted” - this listing will display cases adjusted during the mass adjustment; it is for informational purposes only.
- FIM3172302 “Cases Not Adjusted” – this listing will display cases with sheltered workshop income in Field 14P in IMU5 that were not adjusted during the mass adjustment. Take immediate action to review and adjust these cases as necessary.
No turnaround IMU5 will be produced for this adjustment.
NECESSARY ACTION:
- Beginning with budgets completed for September 2007, exclude any income earned by individuals eligible for certified extended employment at a sheltered workshop.
- Send any questions regarding eligibility for certified extended employment at a sheltered workshop to IM Program and Policy.
- Continue to enter sheltered workshop Income in Field 14P of the IMU5.
- Review cases on the “Cases Adjusted” and “Cases Not Adjusted” reports and take immediate action to review and adjust cases not adjusted during the mass adjustment.
- Review this memorandum with all appropriate staff.
DS/SD
Attachment