IM-27 03/26/99 UPDATE OF POVERTY INCOME GUIDELINES
| SUBJECT: |
| UPDATE OF POVERTY INCOME GUIDELINES FOR
MC+ FOR CHILDREN, MC+ FOR PREGNANT WOMEN, NCP AND CP
INCREASE IN FEDERAL POVERTY LEVEL, QMB INCOME STANDARD INCREASE; SLMB INCOME STANDARD INCREASE; TRANSITIONAL MEDICAID; GENERAL RELIEF SUPPORT DETERMINATIONS; AND QDWI INCOME STANDARDS IM MANUAL REVISION #9: CHAPTER I, APPENDIX D; CHAPTER II, SECTION III, PAGES 2A AND 2B - POVERTY LEVEL FOR SUPPORT CAPABILITY DETERMINATIONS; CHAPTER VI, PAGES 73-75 (QDWI) AND PAGES 91-93 (QMB) |
| DISCUSSION: |
| Effective April 1, 1999, the Federal Poverty
Level is increased. This memo updates the poverty income guidelines
for MC+, and Transitional Medicaid. Also increased are the income
standards for the QMB program, the SLMB program, and the QDWI program,
and the support capability determination figures for General Relief.
New poverty figure amounts for TEMP eligibility will be provided to qualified
providers by State Office.
On the weekend of March 27, 1999, the Division of Data Processing will adjust the expense and deficit fields of active MC+ for Children and MC+ for Pregnant Women cases, and the income standard and OASDI amounts (if applicable) for active QMB and SLMB cases. QMB cases were not included in the COLA adjustments in December 1998, 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. MC+ for Children Program and MC+ for Pregnant Women Program For IMU5 transactions entered on or after March 29, 1999, use the new poverty income amounts, effective for April 1999 (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 1999 must be based on the old poverty standards. Also, effective March 28, 1999, IBCA will be updated with the new standards. The IM-30 is revised and will be sent under separate cover. Until it is received, when completing an IM-30 based on the poverty income guidelines:
For this adjustment, we are bypassing edit Error Code 382 - Poverty, Incorrect Expense on the poverty cases. If a case currently has 185% poverty figures (whether correct or in error), the case will be updated with the new 185% 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 must be adjusted and the recipient notified of the change in their level of care. QMB Income Standard Increase Below are the new QMB income standards. Use these standards for all QMB eligibility determinations completed for April or later months. Number of Persons QMB Income Standard 01
$687.00
QMB material in Chapter VI is revised to include the new figures. SLMB Income Standard Increase Below are the new SLMB income standards. Use these standards for all SLMB eligibility determinations completed for April or later months. NOTE: Because SLMB eligibility can include prior quarter determinations, use the previous standards for months prior to April 1, 1999. Number of Persons SLMB Group
1 SLMB Group 2 SLMB Group
3
01
$824.00 $927.00
$1202.00
QMB/SLMB Adjustment For the mass adjustments, Data Processing will match each QMB only or SLMB only individual to BENDEX to determine current OASDI amounts. This amount includes the COLA increase received in January 1999. If the individual matches to BENDEX, the new OASDI amount is entered in Field 13J and the difference between the old OASDI amount and the new OASDI amount is added to the gross and net income fields. The new QMB or SLMB 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. No turnaround IM-5 forms are produced with this 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 close generates a QMB or SLMB automatic open.) Cases not adjusted appear on a listing entitled "QMB/SLMB Cases Needing Review for Adjustment", sent to the counties for review. The listing contains explanatory captions for each case not adjusted. NOTE: Check for SLMB eligibility for QMB cases where a surplus is calculated. Some cases will be adjusted by a percentage method based on information in the IM database if BENDEX information is not available. Any case adjusted by the percentage method will be identified with an asterisk (*) at its caption. In previous adjustments, these cases were not adjusted, with reason "IM NO BENDEX." 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 1.3% increase to the OASDI amount shown in 13J. For these cases, if the amount in 13J is wrong, the adjustment will be wrong. The worker is responsible for correcting 13J and any other affected figures. Because SMI premium information will not be available from BENDEX on percentage-adjusted cases, the program will attempt to identify premium payers and will assume the premium was $45.50 as of December, 1998. Because not every premium is $45.50, 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 caseworkers 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 29, 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:
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 13J 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 13J 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 appear as the result of a computer generated opening (i.e., the QMB/SLMB only case was opened when an MA spenddown case was auto closed, and the MA budget figures remain in Fields 33 through 35.) These are for information only. Correct the budget figures at the next regular handling. Adjust any cases not adjusted by state office as necessary. General Relief and QDWI Manual Updates The General Relief chapter and the QDWI material in Chapter VI are revised to include the new poverty figures. Use the figures in Chapter II for support capability determinations effective for April 1, 1999 and later. Use the updated QDWI expense standards in Chapter VI for eligibility determinations made for April 1, 1999 and later. |
| NECESSARY ACTION: |
Distribution #2 Attachments not available online. |