MEMORANDUM

DISCUSSION:

Effective April 1, 2009, the Federal Poverty Level (FPL) increases and the Cost of Living Adjustment (COLA) for participants receiving Social Security Administration (SSA) and Supplemental Security Income (SSI) are updated for the Family Healthcare Programs. Memorandum IM-10 dated January 28, 2008, announced that Senate Bill 577 (2007) amended Section 208.153 RSMo to authorize the disregard of annual Social Security Cost of Living Adjustment (COLA) increases for the Family Healthcare programs until the next Federal Poverty Level (FPL) adjustment. COLA income increases for participants receiving Veterans Administration (VA) and Railroad Retirement (RR) continue to be adjusted yearly in January.

The poverty income guidelines for MO HealthNet for Families, Kids, Pregnant Women, Newborn, and Transitional MO HealthNet (TMH) in the third quarterly reporting period are updated. New poverty figure amounts for Temporary MO HealthNet for Pregnant Women (TEMP) eligibility will be provided to qualified providers by State Office.

On the weekend of March 7, 2009, FAMIS will do the following adjustments for the month of April 2009 for Family Healthcare programs noted above:

• Budget the SSA and SSI COLA increases that were effective January 2009; and
  
• Increase the “Max Allowed” fields (Expense fields) on the “Medicaid Budget Summary” screens by the appropriate FPL amount based on program and family size.

FAMIS ADJUSTMENTS

The adjustments begin Saturday, March 7; FAMIS will be unavailable until the adjustments are completed. If the adjustments are not completed by the morning of March 9, staff will be notified. FAMIS will adjust active Family Healthcare cases, based on the new FPL figures and the SSI/SSA COLA increases effective January 2009. If there is no outstanding verification or other outstanding issues at the time the adjustment is completed, the system will authorize the action(s).

Notices will be sent on all actions except actions that result in no change (NOCH action in FAMIS).   FAMIS cases that are in the controlled flow will not be adjusted.  Those cases will have the new figures applied when the case is taken through the flow.

For FAMIS actions taken on or after March 7, 2009, FAMIS will use the new poverty amounts effective for April 2009 and SSI/SSA COLA increases. For actions effective March 2009 and earlier, FAMIS will apply the previous poverty figures and pre-COLA amounts for SSI and SSA.

The EU Action Log (EULOG or FM40) displays the action taken by the system and the benefit amount for the month. To view information for the Family Healthcare adjustments, select the action and press F17=INQAUTH. The Action Authorization (FM4N) screen displays. Press F16=BUDSUM. The Medicaid Category Summary (FM4H) 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.

CONFLICT OF ACTIONS

FAMIS will adjust the FPL and COLA 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 eligibility specialist receives two alerts “OUTSTANDING ELIGIBILITY DETERMINATION” and “ADVERSE ACTION NEEDS RESOLVING”. The conflict must be resolved by the Eligibility Specialist. To resolve the conflict:

• Access the Action Resolution (FM50 or ACTRES) screen and determine which pending adverse action period is most appropriate to void. For example, if there is an earlier pending adverse action to close the case based upon ineligibility then the eligibility specialist would choose to void the adverse action generated from the system adjustment. Refer to the user guide “Changing an Adverse Action Status” for instructions.
• After voiding the adverse action, access the Eligibility Determination Resolution screen (FM3Y or EDRES) and run a new eligibility determination.
  
• Authorize the adverse action.

PREMIUM REFUNDS

Premiums paid for April coverage will be refunded to the participant if the FPL and COLA adjustments cause the case to become eligible as a non-premium case. The refund process will take approximately 8 weeks to complete.

REQUEST FOR HEARING/CONTINUED BENEFITS

The FA-410 Adverse Action Notice is dated March 9, 2009. Any EU receiving an FA-410 Adverse Action Notice may request a hearing on the mass adjustment action within 10 days from the date of the notice.

The FA-450 Action Notice generated by the mass adjustment is dated March 9, 2009, unless an FA-410 notice was sent. Any EU receiving an FA-450 Action Notice may request a hearing on the mass adjustment action within 90 days from March 9, 2009.

If the EU receiving an FA-410 Adverse Action Notice requests a hearing on the Family Healthcare adjustment by March 19, 2009, the EU may request benefits continue at the level before the mass adjustment until the hearing decision is made. County staff should inform the EU that if continued benefits are issued and the agency is determined to be correct, a claim will be established for the overpayment.

To continue the Family Healthcare benefits at a higher level of care for EUs who received an FA-410 Adverse Action Notice pending the hearing decision, update the action status to HOLD (HOL) on the Action Resolution (FM50) screen. Refer to Changing an Adverse Action Status user guide for instructions.

NECESSARY ACTION:

• Begin using the new poverty level figures effective for April 2009 and later.
• Begin using the COLA increased amounts for SSI and SSA for April 2009 and later.
• Resolve conflicting actions.
• Review this memorandum with appropriate staff.

ER