MEMORANDUM
2004 Memorandums
IM-70     07/29/04
SUBJECT:

INCREASE IN THE MEDICAL ASSISTANCE INCOME LIMIT

MANUAL REVISION #18:
0800.005.00
0805.015.45

DISCUSSION:

The Medical Assistance non-spend down income limit is raised to 100% of the Federal Poverty Limit (FPL) retroactive to July 1, 2004. This is in accordance with RSMo.Section 208.151.1(25). For an individual the income limit is increased from $699.00 to $776.00. For a married couple the income limit is increased from $937.00 to $1041.00. On the weekend of July 31, 2004, the Information Systems Technology Division will adjust the expense and deficit fields for Medical Assistance cases.

MA NON-spend down INCOME LIMITS
        Single       Couple
April 2004 through June 2004   $699.00 (90% FPL)   $937.00 (90% FPL)
July 2004 and later months   $776.00 (100% FPL)   $1041.00 (100% FPL)

IMU5 Changes and Notification

All active Medical Assistance spend down and non-spend down cases will be updated on the weekend of July 31, 2004. Cases that are currently spend down with income at or below the 100% FPL will be converted to non-spend down. They will receive a letter (sample attached #1) informing them of the change. It will be mailed the first week of August 2004. All cases with income above 100% FPL will have a reduced spend down amount. A notice (sample attached #2) will be included with the August invoice for September’s spend down informing them of this action and their hearing rights. The reduced spend down amount will be shown on the MPNI screen for July and August with (POV ADJ) above “Notice Type” on Tuesday, August 3, 2004. The caseworker will need to use the adjusted spend down amount in field 35 on the ICAS if putting in bills on August 2, 2004. Division of Medical Services (DMS) will not have the reduced figures in MPNI until August 3, 2004. The September MPNI will show the new spend down amount.

When entering any IMU5 transaction prior to the mass adjustment use the current income limit of $699.00 for single and $937.00 for a married couple. When entering an IMU5 transaction on both active cases and new approvals after the adjustment, enter 100% FPL for the appropriate type of case in the expense field 33. On new approvals with eligibility begin dates prior to July 1, 2004, DMS will send invoices for June and prior months based on the 90% FPL limit. On the approval letter (IM-32SPND) for cases eligible for months prior to July the caseworker will need to inform the client of the change in spend down amount or change to non-spend down.

Reduction of Previously Invoiced spend down Amounts

For clients who have already paid in their July and/or August spend down a refund will be issued automatically by DMS. No action by the client or caseworker is required. Clients may call 1-877-888-2811 if they have questions. The refunds will be made in four to six weeks.

For clients who remain spend down and have met their July spend down with bills, the county will receive a listing. Upon receipt of the listing the caseworker must review the case record using the reduced spend down amount for July to determine the date the spend down was met and the remaining client liability for that date. Use the MSPU screen to manually adjust the spend down. This needs to be completed immediately after receiving the listing. The county will need to send a revised IM-29SPDN to notify the client of the change. The system generated notice instructs the client to talk with their provider(s) after receiving the revised IM-29SPDN about the possibility of billing Medicaid for services used to meet spend down prior to the adjustment.

The system generated notice for clients going from spend down to non-spend down instructs those who met spend down with bills to talk with their provider about billing Medicaid for services used to meet spend down prior to the adjustment. No further action is required for the caseworker on these cases.

If there are questions regarding billing Medicaid for expenses previously used to meet spend down the client must call Recipient Services at 1-800-392-2161. The provider may call Provider Relations at 1-800-392-0938.

 
NECESSARY ACTION:
  • Review this memorandum with appropriate staff.
  • Begin using the new Medical Assistance non-spend down limits as outlined in the memorandum.
  • Review the cases that met July spend down with incurred expenses upon receipt of the listing.
DS
ATTACHMENTS: