During the weekend of June 19, 2004, the Division of Data Processing and the
Family Support Division will adjust Vendor cases with allotments based on
changes effective July 1, 2004.
Vendor Adjustments to Allotments and Surpluses
Effective for allotments for July 2004 and later for community spouses, minor
children and eligible dependents, the Minimum Maintenance Standard and the
Shelter Standard are revised in accordance with the new poverty guidelines. In
computing these allotments, use the following amounts:
Minimum Maintenance Standard:
Use the current standards for allotment and surplus computations completed
prior to the mass adjustment. After the adjustment, compute allotments and
surpluses for July 2004 and later using the new standards.
For mass-adjusted cases, State Office will compute the new allotment amounts
and the resulting surplus amounts. State Office will do the complete
adjustment: send adjustment notices to claimants, list the cases for the
counties, and send the updated surplus amounts to the nursing facilities.
Turnaround IM-5 forms will not be generated for this adjustment.
County office staff must complete adjustments on cases listed on report "Cases
Needing Review for Adjustment".
State Office and county office responsibilities in handling this allotment
Calculating new surplus amounts for cases with community spouses or with
minors or eligible dependents:
If the case contains a community spouse, minor or eligible dependent and has an
"N" or a "Y" in Field 13X (Main. Std.), State Office will compute a proposed
new allotment amount using the revised standards. We will then add the
difference between the current and new allotment amounts to Field 33 (Expense)
and compute the new surplus/deficit amount in Field 35 (Deficit/Surplus).
State Office actions as a result of the new surplus amounts:
If the new surplus amount is a decrease in surplus, State Office will adjust
the case. State Office will also send a notice to the claimant (see below for
text of notice).
State Office will include the case on a listing for each county, "Cases
Adjusted," with reason "Surp. Dec." We will also print and mail a separate
listing for each nursing facility.
If either the current or the new amounts for Field 35 is 0.00 or a deficit,
State Office will adjust the case and send a notice to the claimant.
These cases will be included on the "Cases Adjusted" listing with reason "No
Chg." We will print and mail a separate listing for each nursing facility.
If the new surplus amount represents an increase, the case will not be
adjusted. We do not anticipate increases in surplus amounts due to this
adjustment. Any such cases will be noted on the listing, "Cases Needing Review
for Adjustment," with reason "Surp. Inc."
County actions needed on listings:
This listing includes cases in which the surplus decreases or does not change.
It will be sorted by county and load. It is for information only and does not
require action by the caseworker.
If the new surplus amount was determined using $2267.00 as the Total
Maintenance Standard, the "Cases Adjusted" listing will note that a "Y" has
been entered in Field 13X with the caption "Max Std = $2319.00".
If the case was incorrectly coded "Y" in Field 13X, the case will be adjusted.
Field 13X will be changed to "N". The caption will read "Max Std <
"Cases Needing Review For Adjustment."
None of the cases on this listing will have been adjusted by State Office. In
all these situations, compute the new allotments and surpluses based on the
standards contained in this memorandum. Notify the claimant and the facility
or institution via the IM-62.
Cases that have an "H" or "L" in Field 13X (Main. Std.).
The reason "Review 13X" will appear on the listing.
Review Field 13X for these cases:
Use "H" only if a hearing decision set the allotment amount. At this time, no
cases have been determined to need an "H" in Field 13X.
Use "L" only if the institutionalized spouse chooses to make an allotment of
less than the maximum allowable.
Change Field 13X to "N" or "Y" for any case which does not meet either of these
criteria. This will allow State Office to consider the case for automatic
adjustment the next time the standards change.
Cases in which the OASDI amount in Field 13J (OASDI Amt.) is greater than
the amount in Field 13V (Income).
The reason "OASDI > Income" will appear on the listing. Correct Field 13J
or 13V as appropriate. Manually adjust the case.
Cases in which the amount entered in Field 33 (Exp./Eil.) is less than the
current maximum allotment amount.
The reason "Max Allot > Exp" will appear on the listing. If the
institutionalized spouse intends to make the maximum allotment available to the
community spouse, but has insufficient income, add the full amount of the
maximum allotment to the other allowable deductions and show the total in Field
Cases in which there is an increase in the surplus.
The reason "Surp. Inc." will appear on the listing. If this occurs, recompute
the allotment and surplus based on the new standards contained in this
Adjustment notices on computer actions will be computer-generated. There will
be no computer-generated adverse action notices. Letters to nursing facilities
will also be computer generated explaining the changes in the surplus amounts.
The following are samples of the claimant notice and the notice to the nursing
NOTICE TO CLAIMANT:
Dear (case name) (case ID) (date)
Beginning July 1, 2004, the amount of the allotment that may be given to your
spouse and eligible dependents increases.
Because of this increase, the allotment you make to your spouse and eligible
dependents will be $XXX.XX beginning July 1, 2004. Since all your available
income is considered in determining your benefits (13 CSR 40-2.200), the amount
you must pay the nursing home or institution will be $XXX.XX beginning July 1,
We determined the amount you must pay to the nursing home or institution by
assuming that the entire allotment will be given to your spouse and eligible
dependents. If you do not wish to give the full amount of the allotment stated
above to your spouse or eligible dependents, contact your caseworker and an
adjustment will be made.
If your income increases, you may give your spouse and eligible dependents up
to $XXX.XX monthly.
If you believe this decision is not correct, you have the right to request a
hearing within 90 days of the date of this letter.
If you wish to have a hearing, you may advise us by phone, in person or in
writing. We will schedule a hearing for you and notify you of the time of the
hearing. At the hearing, you may present your case or be represented by
someone else including an attorney. You may bring and/or question witnesses.
NOTICE TO NURSING FACILITY OR INSTITUTION
To the Administrator:
Enclosed is a list of patients for whom you receive Nursing Facility (NF),
Mentally Retarded (IMR) or Mental Hospital (MHC) payments from the Division of
Family Services. Beginning July 1, 2004, the amount of the allotment the
patient may make to his/her spouse and eligible dependents is increased. The
increase in the allotment amount will change the amount of surplus paid to your
facility or institution.
The attached listing shows the name and Medicaid number of each patient who is
making an allotment and the old and new surplus amounts. The surplus amount
shown is effective July 1, 2004, unless you receive a notice (IM-62) mailed
from the county office after June 19, 2004, which indicates a different surplus
amount. If you have an NF, IMR, or MHC patient in your facility or institution
who is not on the listing but was approved for vendor care before June 19,
2004, and who is making an allotment, please contact that patient’s caseworker
to find the July 2004 surplus amount.