MEMORANDUM

2009 Memorandums

IM-#13      03/05/09

DEPARTMENT OF SOCIAL SERVICES
FAMILY SUPPORT DIVISION
P.O. BOX 2320
JEFFERSON CITY, MISSOURI
TO:
ALL COUNTY OFFICES
FROM:
VALERIE J. DAVIS, ACTING DIRECTOR
SUBJECT:
COST OF LIVING ADJUSTMENT (COLA) AND UPDATE OF FEDERAL POVERTY LEVEL (FPL) FOR MO HEALTHNET FOR THE AGED, BLIND, AND DISABLED spend down AND NON spend down, TICKET TO WORK HEALTH ASSURANCE (TWHA) , QUALIFIED MEDICARE BENEFICIARY(QMB), SPECIFIED LOW INCOME MEDICARE BENEFICIARY(SLMB AND SLMB-2) AND QUALIFIED DISABLED WORKING INDIVIDUALS (QDWI) PROGRAMS
MANUAL REVISION #9: 0805.015.45; 0855.005.40.05; 0855.005.45; 0855.005.45.05; 0860.005.15.05; 0865.010.10.10; 0870.010.05

DISCUSSION:

Effective April 1, 2009, the Federal Poverty Level (FPL) standards for the MO HealthNet for the Aged, Blind, and Disabled (MHABD) spend down and non spend down, Ticket to Work Health Assurance (TWHA) Program, QMB, SLMB, and the QDWI program are increased.

On the weekend of March 7, 2009, the Information Technology Services Division (ITSD) will adjust the expense and deficit fields for the following types of active cases: MHABD spend down and non spend down, TWHA, QMB, SLMB, and QDWI cases. The OASDI amounts which were not increased during the COLA adjustment the weekend of December 6, 2008, due to changes implemented from SB 577 (2007) will also be adjusted for active MHABD spend down and non spend down and TWHA cases. OASDI amounts will also be increased for active QMB, SLMB, and QDWI cases based upon annual cost of living adjustments.

LEGACY ADJUSTMENTS

For IMU5 transactions entered on or after March 7, 2009, use the new poverty income amounts and new OASDI amounts based upon annual cost of living adjustments, effective for April 2009. Use the new poverty level 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 2009 must be based on the old poverty standards.

IM-5 forms will not be generated as a result of this adjustment. When using the last IM-5 in the case record for a subsequent action, update Fields 33-35 only if one of these fields is different than the adjusted figures. The adjusted figures will display on the ICAS screen effective March 7, 2009.

MHABD INCOME STANDARD

The MHABD non-spend down income limit for an individual has increased from $737.00 to $768.00 for a single person and $992.00 to $1,033.00 for a couple. The IMU5 system will require the $768.00 figure starting March 9, 2009, for entries in field 33 for single individuals and the $1,033.00 figure for couple MHABD cases. All active spend down cases will be updated on the weekend of March 7, 2009. All spend down cases with income at or below $768.00 for a single person and $1,033.00 for couples 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, 2009. 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 MO HealthNet Division (MHD) will accept the lower amount to begin April coverage. For participants meeting spend down with bills in April, 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. Participants who have a change in the spend down status or amount will be sent the appropriate notice. All notices will be available on MOBIUS on March 9, 2009, under the heading FIMFPLA1A.

MHABD NON-spend down

Effective for April 2009 and later months, the non-spend down income limits for MHABD are:

Single $768.00
Couple $1,033.00

TWHA INCOME STANDARD

Below are the new TWHA income standards. Use these standards for all TWHA eligibility determinations effective for April 2009 and later months.

Number of Persons TWHA Net Income Standard
01 $768.00
02 $1,033.00

Number of Persons TWHA Gross Income Standard
01 $2,708.00
02 $3,643.00

TWHA PREMIUM AMOUNTS

Below are the new TWHA premium amounts effective April 1, 2009.

TWHA Premium Charts for Single Cases

Type of Case Percent of FPL Monthly Income Premium Amount
Single = 100% FPL $903.00 or less Non-premium case
Single >100% FPL but < 150% FPL $903.01-$1353.99 $36
Single = 150% FPL but < 200% FPL $1354.00-$1804.99 $54
Single = 200% FPL but < 250% FPL $1805.00-$2256.99 $90
Single = 250% FPL but = 300% FPL $2,257.00- $2,708.00 $135

TWHA Premium Charts for Couple Cases

Type of Case Percent of FPL Monthly Income Premium Amount
Couple = 100% FPL $1215.00 or less Non-premium case
Couple >100% FPL but < 150% FPL $1215.01-$1821.99 $49
Couple = 150% FPL but < 200% FPL $1822.00- $2428.99 $73
Couple = 200% FPL but < 250% FPL $2429.00- $3035.99 $121
Couple = 250% FPL but = 300% FPL $3036.00- $3643.00 $182

All active TWHA cases will be updated on the weekend of March 7, 2009. All TWHA cases with income at or below $903.00 for a single person and $1215.00 for couples will be converted to TWHA non premium coverage. For cases that remain premium, the new amount will be printed on the invoices that are scheduled to be mailed on April 1, 2009. For cases with a decrease in the premium amount, the April invoice will be adjusted on the MPNI screen. New invoices for April will not be sent, but MO HealthNet Division (MHD) will accept the lower amount to begin April coverage. For active cases with an increase in premium, the increase is effective for May coverage, as April invoices have already been sent. Participants who have a change in the premium status or amount will be sent the appropriate notice. All notices will be available on MOBIUS on March 9, 2009, under the heading FIMFPLA1A.

QDWI INCOME STANDARD

Below are the new QDWI income standards. Use these standards for all QDWI eligibility determinations effective for April 2009 and later months.

Number of Persons QDWI Income Standard
01 $1805.00
02 $2429.00

QMB INCOME STANDARD

Below are the new QMB income standards. Use these standards for all QMB eligibility determinations effective for April 2009 and later months.

Number of Persons QMB Income Standard
01 $903.00
02 $1215.00
03 $1526.00

SLMB INCOME STANDARD

Below are the new SLMB income standards. Use these standards for all SLMB eligibility determinations effective for April and later months.

NOTE: Because SLMB eligibility can include prior quarter determinations, use the previous standards for months prior to April 2009.

Number of Persons SLMB Group 1 Income Standard SLMB Group 2(QI-1) Income Standard
01 $1083.00 $1219.00
02 $1457.00 $1640.00
03 $1831.00 $2060.00

HEARINGS ON COMPUTER ADJUSTED CASES

The adverse action notices generated by the mass adjustment will be dated March 9, 2009. The participant has until March 19, 2009, to request a hearing and have benefits restored to pre-adjustment levels.

If the participant requests a hearing on or before March 19, 2009, complete an IMU5 transaction to cancel the computer adjustment (i.e., cancel-close a closed case, etc.) and follow usual hearing procedures. Immediately print a copy of the computer generated Adverse Action Notice (IM-80), available on MOBIUS.

If the participant does not request a hearing on or before March 19, 2009, no further case action is necessary.

COUNTY OFFICE RESPONSIBILITY

Using the listing "QMB/SLMB Cases Needing Review for Adjustment", which will be available on MOBIUS under the heading FIMFPLA2A, 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.

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 14M 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 14M 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 display as the result of a computer generated opening (i.e., the QMB/SLMB only case was opened when a MHABD spend down case was auto closed, and the MHABD budget figures remain in Fields 33 through 35.) These cases display for your information only. Correct the budget figures at the next regular handling.

Using the listing "MHABD Cases Needing Adj- No OASDI", which will be available on MOBIUS under the heading, FIMFPLA2D, review listed cases as follows:

NO OASDI- These cases have no OASDI amount in Field 14M of IMU5 but have OASDI amount appearing on the BENDEX tape file. Review for accuracy of information in the IM database and make necessary corrections.

NECESSARY ACTION:

ER

ATTACHMENTS:



2009 Memorandums