UPDATE OF POVERTY INCOME GUIDELINES FOR THE MC+ PROGRAM FOR CHILDREN
AND PREGNANT WOMEN; MAF, TRANSITIONAL MEDICAL ASSISTANCE, MEDICAL ASSISTANCE,
MA-WD, QMB, SLMB, QI-1, GENERAL RELIEF SUPPORT DETERMINATIONS, AND QDWI
IM MANUAL REVISION # 6: SECTIONS 0805.015.45, 0855.000.00, 0860.000.00 & 0865.000.00; SECTION 0900.000.00, 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)
Effective April 1, 2004, the Federal Poverty Level (FPL) is increased.
This memo updates the poverty income guidelines for MC+, MAF and Transitional
Medical Assistance. Also increased are the income standards for the
Medical Assistance, MA-WD, QMB, SLMB, 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.
MA-WD premium amounts are based on a percentage of mid-point of each income range and therefore are adjusted effective April 1st each year. This year there is no change in the premium amount for persons with income between 151 and 175% of the FPL. There is an increase for MA-WD recipients in the other premium ranges.
On the weekend of March 20, 2004, the Information Systems Technology Division will adjust the expense and deficit fields for the following types of active cases: MC+ for children, MC+ for pregnant women, MAF, Medical Assistance, MA-WD, QMB and SLMB cases. The OASDI amounts (if applicable) will also be adjusted for active Medical Assistance, MA-WD, QMB and SLMB cases. QMB cases were not included in the COLA adjustments in December 2003, 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. Missouri applies this same rule to the MA-WD program.
Medical Assistance, MA-WD, MAF, MC+ for Children and Pregnant Women Program
For IMU5 transactions entered on or after March 22, 2004, use the new poverty income amounts, effective for April 2004 ( 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 2004 must be based on the old poverty standards. Also, effective March 22, 2004, IBCA will be updated with the new standards.
The IM-30 is being revised. A memorandum will be issued when the revision is available.
For this adjustment, we are bypassing edit Error Code 382 - Poverty, Incorrect Expense on the poverty cases. If a case currently has poverty figures (whether correct or in error), the case will be updated with the new 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 will be adjusted and the recipient notified of the change in their level of care.
Medical Assistance Income Standard
The Medicaid non-spend down income limit for an individual has increased from $674.00 to $699.00 for a single person and $909.00 to $937.00 for a couple. The IMU5 system will require the $699.00 figure starting March 22, 2004, for entries in field 33 for single individual and the $937.00 figure for couple MA cases. All active spend down cases will be updated on the weekend of March 20, 2004. All spend down cases with income at or below $699.00 for a single person and $937.00 for a couple, will be converted to non-spend down. For cases that remain spend down the new amount will be printed on the invoices that are scheduled to be mailed on April 1, 2004. For cases with a decrease in the spend down amount, the April invoice will be adjusted on the MPNI screen. New invoices for April will not be sent, but DMS will accept the lower amount to begin April coverage. For clients meeting spend down with bills in April, the worker is to use the adjusted amount. For active cases with an increase in spend down, the increase is effective for May coverage, as April invoices have already been sent.
Recipients who have a change in the spend down status or amount will be sent the appropriate attached notice.
Effective April 1, 2004 the non-spend down income limits for MA are:
MA-WD Gross Income Limit
Below are the new MA-WD income limits. Use these amounts for all
MA-WD eligibility determinations completed for April and ongoing months.
All active premium cases with income at or below $1164.00 will be converted to non-premium effective April 1, 2004 and will be sent the attached notice. For cases that remain premium the new amount will be printed on the invoices that are scheduled to be mailed on April 1, 2004.
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.
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, 2004.
QMB, SLMB and MA-WD OASDI Adjustment
For the mass adjustments, Data Processing will match each individual to BENDEX to determine current OASDI amounts. This amount includes the COLA increase received in January 2004. 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 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, MA or MA-WD 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 spend down automatic close generates a QMB or SLMB automatic open.) Cases not adjusted appear on a listing entitled "QMB/SLMB Cases Needing Review for Adjustment" or “MA-WD 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 2.1% 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 $66.60 as of December 2003. Because not every premium is $66.60, 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, SLMB or MA-WD standard expense figures. Therefore, effective March 22, enter QMB, SLMB or MA-WD 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:
QMB SURP - These cases have a surplus calculated in Field 35. Review for continuing eligibility, including eligibility under the SLMB program.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, 2004 and
Use the updated QDWI expense standards in Chapter VI for eligibility
made for April 1, 2004 and later.
Poverty Income Guide (Section 0900.000.00 Appendix D)
Chapter II Revision
Chapter VI Revision