| TO: | ALL COUNTY OFFICES |
| FROM: | JANEL R. LUCK, DIRECTOR |
| SUBJECT: | COST OF LIVING ADJUSTMENT (COLA) AND UPDATE OF FEDERAL POVERTY LEVEL (FPL) FOR MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED SPENDDOWN AND NON SPENDDOWN, TICKET TO WORK HEALTH ASSURANCE PROGRAM, QMB, SLMB, QI-1 AND QDWI PROGRAMS |
, DISCUSSION:
Effective April 1, 2008, the Federal Poverty Level (FPL) standards for the MO HealthNet for the Aged, Blind, and Disabled (MHABD) spenddown and non spenddown, Ticket to Work Health Assurance (TWHA) Program, QMB, SLMB, and the QDWI program are increased.
On the weekend of March 8, 2008, the Information Technology Services Division (ITSD) will adjust the expense and deficit fields for the following types of active cases: MHABD spenddown and non spenddown, TWHA, QMB, SLMB, and QDWI cases. The OASDI amounts which were not increased during the COLA adjustment the weekend of December 8, 2007, due to changes implemented from SB 577 (2007) will also be adjusted for active MHABD spenddown and non spenddown and TWHA cases. OASDI amounts will also be increased for active QMB, SLMB, and QDWI cases based upon annual cost of living adjustments.
LEGACY ADJUSTMENTS
For IMU5 transactions entered on or after March 10, 2008, use the new poverty income amounts and new OASDI amounts based upon annual cost of living adjustments, effective for April 2008. Use the new poverty level 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 2008 must be based on the old poverty standards.
- For March 2008 and prior months, use the old poverty figures in effect during those months and OASDI amounts received prior to the annual cost of living adjustment; and
- For April 2008 and later, use the new poverty level and OASDI amount received following the annual cost of living adjustment.
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 10, 2008.
MHABD INCOME STANDARD
The MHABD non-spenddown income limit for an individual has increased from $724.00 to $737.00 for a single person and $970.00 to $992.00 for a couple. The IMU5 system will require the $737.00 figure starting March 10, 2008, for entries in field 33 for single individuals and the $992.00 figure for couple MHABD cases. All active spenddown cases will be updated on the weekend of March 8, 2008. All spenddown cases with income at or below $737.00 for a single person and $992.00 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, 2008. 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 MO HealthNet Division (MHD) will accept the lower amount to begin April coverage. For participants 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. Participants who have a change in the spenddown status or amount will be sent the appropriate notice. All notices will be available on MOBIUS on March 10, 2008, under the heading FIMFPLA1A.
MHABD NON-SPENDDOWN
Effective for April 2008 and later months, the non-spenddown income limits for MHABD are:
| Single | $737.00 |
| Couple | $992.00 |
TWHA INCOME STANDARD
Below are the new TWHA income standards. Use these standards for all TWHA eligibility determinations effective for April 2008 and later months.
| Number of Persons | TWHA Net Income Standard |
|---|---|
| 01 | $737.00 |
| 02 | $992.00 |
| Number of Persons | TWHA Gross Income Standard |
|---|---|
| 01 | $2,600.00 |
| 02 | $3,500.00 |
TWHA PREMIUM AMOUNTS
Below are the new TWHA premium amounts effective April 1, 2008.
TWHA Premium Charts for Single Cases
| Type of Case | Percent of FPL | Monthly Income | Premium Amount |
|---|---|---|---|
| Single | ≤ 100% FPL | $867.00 or less | Non-premium case |
| Single | >100% FPL but < 150% FPL | $867.01-$1299.99 | $34 |
| Single | ≥ 150% FPL but < 200% FPL | $1300.00-$1733.99 | $52 |
| Single | ≥ 200% FPL but < 250% FPL | $1734.00-$2166.99 | $86 |
| Single | ≥ 250% FPL but ≤ 300% FPL | $2,167.00- $2,600.00 | $130 |
TWHA Premium Charts for Couple Cases
| Type of Case | Percent of FPL | Monthly Income | Premium Amount |
|---|---|---|---|
| Couple | ≤ 100% FPL | $1167.00 or less | Non-premium case |
| Couple | >100% FPL but < 150% FPL | $1167.01-$1749.99 | $46 |
| Couple | ≥ 150% FPL but < 200% FPL | $1750.00- $2333.99 | $70 |
| Couple | ≥ 200% FPL but < 250% FPL | $2334.00- $2916.99 | $116 |
| Couple | ≥ 250% FPL but ≤ 300% FPL | $2,917.00- $3500.00 | $175 |
All active TWHA cases will be updated on the weekend of March 8, 2008. All TWHA cases with income at or below $867.00 for a single person and $1167.00 for couples will be converted to TWHA non premium coverage. For cases that remain premium, the new amount will be printed on the invoices that are scheduled to be mailed on April 1, 2008. For cases with a decrease in the premium amount, the April invoice will be adjusted on the MPNI screen. New invoices for April will not be sent, but MO HealthNet Division (MHD) will accept the lower amount to begin April coverage. For active cases with an increase in premium, the increase is effective for May coverage, as April invoices have already been sent. Participants who have a change in the premium status or amount will be sent the appropriate notice. All notices will be available on MOBIUS on March 10, 2008, under the heading FIMFPLA1A. The TWHA Budget Worksheet has been updated with the new FPL standards.
QDWI INCOME STANDARD
Below are the new QDWI income standards. Use these standards for all QDWI eligibility determinations effective for April 2008 and later months.
| Number of Persons | QDWI Income Standard |
|---|---|
| 01 | $1734.00 |
| 02 | $2334.00 |
QMB INCOME STANDARD
Below are the new QMB income standards. Use these standards for all QMB eligibility determinations effective for April 2008 and later months.
| Number of Persons | QMB Income Standard |
|---|---|
| 01 | $867.00 |
| 02 | $1167.00 |
| 03 | $1467.00 |
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 2008.
| Number of Persons | SLMB Group 1 Income Standard | SLMB Group 2(QI-1) Income Standard |
|---|---|---|
| 01 | $1040.00 | $1170.00 |
| 02 | $1400.00 | $1575.00 |
| 03 | $1760.00 | $1980.00 |
HEARINGS ON COMPUTER ADJUSTED CASES
The adverse action notices generated by the mass adjustment will be dated March 10, 2008. The participant has until March 20, 2008, to request a hearing and have benefits restored to pre-adjustment levels.
If the participant requests a hearing on or before March 20, 2008, complete an IMU5 transaction to cancel the computer adjustment (i.e., cancel-close a closed case, etc.) and follow usual hearing procedures. Immediately print a copy of the computer generated Adverse Action Notice (IM-80), available on MOBIUS.
If the participant does not request a hearing on or before March 20, 2008, no further case action is necessary.
COUNTY OFFICE RESPONSIBILITY
Using the listing “QMB/SLMB Cases Needing Review for Adjustment”, which will be available on MOBIUS under the heading FIMFPLA2A, 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 MHABD spenddown case was auto closed, and the MHABD budget figures remain in Fields 33 through 35.) These cases display for your information only. Correct the budget figures at the next regular handling.
Using the listing “MHABD Cases Needing Adj- No OASDI”, which will be available on MOBIUS under the heading, FIMFPLA2D, review listed cases as follows:
NO OASDI- These cases have no OASDI amount in Field 14M of IMU5 but have OASDI amount appearing on the BENDEX tape file. Review for accuracy of information in the IM database and make necessary corrections.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
- Begin using the new poverty level figures effective for April 2008 and later. Use the new figures for IMU5 transactions entered on or after March 10, 2008.
- Review cases on listing “QMB/SLMB Cases Needing Review for Adjustment” and MHABD Cases Needing Adj- No OASDI” report and take necessary action by May 31, 2008.
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