Sections

What's New

• Obsoleting Medicaid Autism Waiver

• Clarifying when an Adult Expansion ESI recipient can transition to Utah's Premium Partnership (UPP)

• Adding if the case was approved in error or due to fraud as additional closure reasons.

• Added approved halfway houses to complete the 43A.
• Corrected name of Wasatch Mental Health to Wasatch Behavioral Health.  

• Clarifying when a new TAM form is needed at review.
• Added TAM agencies to complete the 43A.
• Added TAM agency to complete the 42A.

• Clarifying that an applicant may qualify for TAM.

• Updating Utility Allowances for Long Term Care.  

• Adding Special Notice to meeting a spenddown or MWI premium during the emergency period.  
• Clarifying what to do when a household member on Medicaid leaves the home during the emergency period.

Sections

What's New

• Obsoleting PCN Policy.

• Adjusting the question numbers under the Chronically Homeless verification column for the updated 42A.

• Added Tax rule changes and  how to determine the MAGI income for a household.

• Clarifying who can get Adult Expansion with ESI Premium Reimbursement.  
• Clarifying LPR children that turn 19 can be approved for any emergency program coverage group.  
• Clarifying Former Foster Care individuals turning 26 will be approved for Adult Expansion Medicaid.    

• Added Crossover Recovery Center to complete 42A all questions.
• Added Salt Lake County Criminal Justice Services to complete 42A and 43A all questions.
• Added University Neuropsychiatric Institute (UNI) - all locations to complete 43A all questions.

• Added the following IMD's with a Licensed SUD Treatment Program

  • Lifeline For Youth- 2/1/19

  • Skull Valley Health Clinic- 1/4/20

  • Steps Recovery Center- 10/1/19

  • Liberty Addiction Recovery Centers- 12/5/19

  • Crossover Recovery Center (Switchpoint)- 2/28/20

  • Tranquility Home (Weber County Substance Abuse)- 3/12/19

  • Stepping Stones (Weber County Substance Abuse)- 3/12/19

  • Weber Recovery Center- 5/5/20

• Adding information on telephonic signatures and new form 114COVID form

Deleting Sections:

386-4 NCW Retroactive Coverage, 386-6 Closure or Denial of Waiver Cases, 386-7 Reviews

• Adding the new 1915(c) Community Transitions Waiver

• Clarifying that the network deductible is $4000 or less per person.

• Adding adult group to those that are eligible for nursing home benefits.

• Clarifying that expedited SNAP issuance does not qualify for cooperating with the SNAP employment and training requirement.
• Adding more information on self employment and working 30 hours a week participation exemption.

• Those with renal failure in need of dialysis treatment can remain open for emergency services.

• Clarifying the Minimum Essential Coverage age requirement.

• Clarifying Medicaid Cancer program does not have medical support enforcement requirement.

• How to complete SMDO determinations while someone is incarcerated.

• Updated Spousal Needs Allowance figures.

• Added The Other Side Academy (TOSA) to complete 43A question 4.
• Added The Ogden Police Department to complete 42A all questions.

• Clarifying QDRO information in MAGI income sections

• Clarifying when to consider pregnant woman retroactive coverage.

• Clarifying that citizenship exemptions need to be documented in the case file.

• Adding COVID-19 uninsured testing coverage group.
• Adding Temporary COVID-19 Verification Changes.
• Adding applications received from testing sites for the COVID-19 uninsured testing coverage group.

New and Modified Sections:

300 Medicaid Programs, 303 Medicaid for People Who are Aged, Blind or Disabled, 314 Medicaid Work Incentive Program (MWI), 405-4 Earned Income Exclusions, 411-12 Household Size and Income for Long Term Care, 427 Deeming Income for Aged, Blind , Disabled Medicaid and Medicare Cost Sharing Programs, 427-1 When to Deem Income, 427-2 Deeming Income from a Spouse, 427-3 Deeming Income from a Parent, 427-4 Deeming Rules Chart, 427-5 Parental Deeming Worksheet, 427-6 Spouse Deeming Worksheet, 431-1 Health Insurance Premiums, 431-1.1 Medically Needy Programs and Health Insurance Premiums, 431-1.2 MWI and Health Insurance Premiums, 431-1.3 Long Term Care and Health Insurance Premiums, 435 Budgeting Income, 435-1 Definitions, 435-2 Determine a Best Estimate of Income, 435-3 Retroactive Period Income, 443 Determining Countable Income for Aged, Blind and Disabled People, 443-1 Comparing Income to FPL, 443-2 100% FPL Group or Spenddown Program for the Aged, Blind or Disabled, 443-3 Disregard of RSDI COLA’s, 460 Payments to Receive Medicaid, 460-1 Programs without Payments, 460-2 Payment Notification, 460-3 Time Limit, Late Payments, 460-4 Changes in Payments, Refunds, Fair Hearings, 461 Spenddown Medicaid, 461-1 Benefits of Spenddown, 461-2 Methods of Meeting a Spenddown, 461-3 Cash Spenddown, 461-4 Spenddown for Multiple Family Members, 461-5 Meeting Spenddown with Bills, 461-6 Medical Necessity, 461-7 TPL and Medical Expenses, 461-8 Applying Medical Expenses, 461-9 Spenddown Summary Chart, 462 Meeting MWI Premiums, 462-1 MWI Income and Premium Tests, 462-2 Payment of a MWI Premium, 463 Payments for Long Term Care, 463-1 Determine Total Income and Cost of Care Contribution, 463-2 Waiver Recipients with a Spenddown, 463-3 Long Term Care and Medical Bills, 731-3 Client Statement Verification, Table VII-A Medicaid Work Incentive Income and Premium Tests.

Removed Sections:

302  (combined in 303), 314-7 (moved to 462), 409-1  (moved to 431-1), 409-9  (moved to 463-3), 412-413-2 (moved to 427), 414 through 414-2 (moved to 463), 415 all sections (these have been rewritten and renumbered into 460 through 463-3), 416 all sections (these have been rewritten and renumbered into 443 through 443-3), 445 all sections (these have been combined into 435-3), 477 (moved to 411-12), 485-4 (moved to 462), 487 (moved to 411-12)

• Re-organizing policy and updating the information regarding spenddown and ABD/LTC income sections.

• Removing form 354 as an alternative means of verifying a medically frail condition.

• Removing the reference to Substance use disorder (SUD) residential treatment subgroup from the Needing Treatment group.

• Adding new CMS guidance on Medically Needy and MWI coverage groups.
• Adding new guidance on Refugee Medical.

• Maintain enrollment of all Medicaid eligible recipients who were eligible on March 18, 2020, or who become eligible for coverage that includes March 18, 2020 until the end of the emergency.

• Federal law exempts COVID-19 recovery rebates checks as income and as a resource for 12 months after the month of receipt.

• Papilion Integrated Recovery Center has been added to Tables XVII to complete all questions 43A.

• Updating IRS figures for qualifying child and qualifying relative tax dependents.

• A child in DCFS custody who is placed on a trial visit with a parent in an approved IMD/SUD facility will no longer be considered as a dependent child for PCR.

• PMV is not countable income for 1619a and 1619b.

• Applications received while someone is incarcerated will be suspended, not denied.  This is regardless of the release date.

• Clarified that an overpayment due to excess resources will be the lesser of the claims paid or the highest amount resources exceeded the limit at any time during such period.
• Also, that if an individual qualifies for any other Medicaid during such period, then there is no overpayment.

• The federal government released its updated poverty limits

• Steps Recovery Centers has been added to Tables XVII to complete the 43A and the 44A.
• University Neuropsychiatric Institute of Park City (UNI-PC) has been added to Tables XVII to complete the 43A.
• Weigand Homeless Resource Center has been added to Tables XVII to complete the 42A.

• Clarified TAM recipients are not eligible for Emergency Medicaid.
• New sub-groups were added to the TAM coverage groups.
• Individuals eligible for or receiving Medicare are not eligible for TAM.

• Adult Expansion income limit is increasing to 133% of FPL.
• 348-1 has been obsoleted, as the Adult group no longer has open enrollment requirements.
• Adults with children receiving Adult Expansion will have to have 'Minimum Essential Coverage' for the child under age 19.
• Recipients of Adult Expansion will be required to participate in community engagement activities unless they meet and exemption or good cause criteria.
• Adult Expansion recipients who have access to employer sponsored health insurance will be required to enroll in that insurance unless they meet an exemption.
• Adult Expansion recipients with children who are determined 'Medically Frail' will receive a traditional benefit package.
• UPP annual deductible is increasing to $4,000 per person.

• The Part D Low Income Subsidy Premium Allowance was removed from Table II because this figure is only applicable to 8 plans in Utah. 
• Table were updated with the yealry COLA figures for 2020.