Obsolete 0114 - What's New 2013

107-2  Verification

111-1  When Confidential Information May Be Released

115  Safeguards of Income Match Data

115-1  Special Safeguards for IRS Income Match Records

115-2  Who May Have Access to Income Match Records

115-3  Special Safeguards for IRS Income Match Records (obsolete)

221-3  Who Does Not Have to Provide a Social Security Number

731  Verification

731-1  What Must Be Verified

731-3  What is Acceptable Verification

731-4  Verification and SSI Recipients

731-7  Verification of SSA Benefits

751-1  Sources of IEVS Data

751-2  Special Rules for Income Matches Required When Clients Apply

751-3  What to Do With Match Reports

751-5  What to Do When There is No Response to a Request

Workers will verify items such as citizenship, identity and tax information electronically through the Federal Data Services Hub, and through other available electronic match services.  

Workers will only request verification from the customer if the information is not available via the Hub, through other electronic means or the customer statement and the electronic information received is not reasonably compatible.

Information from the Hub and other income match systems must be safeguarded.

Customer’s attestation may be accepted to verify many factors of eligibility.   Customer statement must be accepted for verification of pregnancy.

Information in section 115-1 ‘Verifying Income Match Records’ has been moved to section 751-3.

Section 115-3 is obsolete and the information moved to section 115-1.  Section 115-1 has also been renamed to ‘Special Safeguards for IRS Income Match Records’

A SSN is not required for a child until after they turn 1 year of age if they are eligible under the ‘Deemed Newborn’ policy.

An individual does not have to provide a SSN if it is based upon well-established religious objections.

No further income verification is required if the income data is either:

Reasonably compatible or;

The income data and customer statement are different, but both are either below the income limit or both are above the income limit

A worker cannot reduce, deny or close benefits until a worker has requested the household to explain or verify the discrepancies.

107-7 Cooperate with Quality Control Reviews

Language for case closure due to not cooperating with a quality control review has been removed.

A medical case cannot be closed due to not cooperating with a QC review.

125 Fair Hearings

Applicants and recipients should file fair hearings with the agency that took the action on their case that they are disputing.

105 Rights of Applicants and Recipients

107-1 Completion of an Application

703 Application

703-1 What is an Application

703-2 Date of Application

703-3 Who can Apply

703-4 What to do with an Application

703-5 Eligibility Decisions

Applicants may now apply for Medicaid through the Federally Facilitated Marketplace (FFM).  The date of application for an application received from the FFM is the date the application was received by the FFM.  The 30 day processing period begins on the day DWS receives the electronic case from the FFM.  Workers will determine eligibility for MAGI based Medicaid programs before looking at non-MAGI or medically needy programs.

If Medicaid is denied or closed, workers will make appropriate referrals to the FFM.  When making referrals to the FFM, workers will send the denial or closure reason and the electronic case.

Timeframes for applications received by fax during non-business hours has been clarified.

Information from section 703-6 regarding requesting an assessment of assets was moved to 703-2.

107-4 Report Changes

815 Changes

815-1 Change of Address

Clients on MAGI based Medicaid programs do not need to report asset changes.

Applicants and recipients receiving MAGI based Medicaid programs have additional reporting requirements.  They must report changes in:

Tax filing status

Number of claimed dependents

Earnings of a child

Student status of a child

When a client reports a change in address, provide the client with voter registration information.

The worker may accept client statement for all change reports except for claims of citizenship and immigration status.  The worker must determine if the client’s statement is reasonably compatible with electronic information available.

The worker may begin a new 12 month certification period if all eligibility criteria have been verified after a client’s change report.

If a change causes a client to be ineligible for medical assistance, workers will make a referral to the Federally Facilitated Marketplace for Advanced Premium Tax Credit eligibility.

205  Citizenship and Alien Status Requirements

205-4  Sponsored Aliens

205-5  Deeming and Household Size

205-6  Emergency Medicaid

Workers will verify items such as citizenship, identity, and alien status through electronic data sources.  Workers will only request verification from the customer if the information is not available through an electronic data source or there is a discrepancy.

Time frames to submit proof of citizenship and identity have been changed from 30 to 90 days.

A child’s citizenship and identity are verified and no additional verification is required, at any time, if the child is/was eligible for Medicaid as a deemed newborn (Child 0-1 Medicaid) or the child’s mother was open for CHIP on or after July 1, 2006 at the time of the child’s birth in a state that provides deemed newborn coverage.

Authenticating of original documents is no longer required.  Originals or copies of the originals are acceptable.  

A procedure has been written outlining the steps workers will now complete in verifying alien status.

Income from an alien’s sponsor does not count towards MAGI-based groups or Emergency Medicaid programs.  Non-MAGI-based groups still follow sponsor deeming policy.

Unborn(s) are now counted in the household size for Pregnant Woman Emergency Medicaid.

Sections 202-5 because the changes to the MAGI household section will address this.

207  Utah Residence

207-1  Determining Residency

207-2  Who is Capable of Expressing Intent

207-3  Determining Residency for Individuals Age 21 and Over

207-4  Determining Residency for Individuals Under Age 21

207-5  Factors Indicating No Intent to Reside in Utah

207-6  Moving From State to State

Policy has been updated separating individuals age 21 and over and those individuals under age 21, and how to determine the residency for these different groups based upon their current living arrangement such as residing in an institution and foster care.

A resident of a household has been separated into MAGI-based and non-MAGI-based groups.

229  Relationships

229-2  Establishing Parental Relationship

229-5  When Unrelated Adults Live in the Home

Policy has been updated to clarify that the household composition for a MAGI-based group is based on the tax filing status, even though relationships are still relevant, they may not always determine who to include in the household.

Policy has been separated into MAGI-based and non-MAGI-based groups.

215-2 Who is a “Resident” of a Household?

For MAGI-based programs, a person may be absent from the household and still count as a household member if the tax filer still expects to claim the person as a dependent on their tax return.  For MAGI-based non-filer households, a person would have to live in the household or be temporarily absent to be included in the household size.

223  Application for Other Possible Benefits

223-2  Applying for Part B Medicare

223-4  VA Benefits

Having to apply for other benefits in regards to MAGI and non-MAGI households has been updated and clarified.  Individuals only have to apply for benefits that will count as income, and for Medicare Part B if potentially eligible.

For MAGI based groups, VA benefits do not count, so an individual eligible on a MAGI group does not have to apply for VA benefits.

224 Strikers

Eligibility for MAGI or non-MAGI medical groups is not affected by a household member being on strike.

225-3  Changing and Updating TPL Information

227  Medical Support Enforcement

227-1  Cooperation Requirements

227-2  Refusal to Cooperate with Medical Support Enforcement Requirements

227-3  Good Cause

227-4  Procedures for Processing Good Cause Determination

227-6  Sanctions for Non-Cooperation

Medical support enforcement requirements have been updated and clarified for the new MAGI-based and non-MAGI-based groups.  Applicants only have to state an intent to cooperate to become eligible.  After eligibility is established, recipients must then take other steps to cooperate.

MAGI-based households have 30 days to complete the review and update TPL information.

303-6 When SSI or SSDI Benefits are Denied or Stopped

Updated to include information explaining that workers will transfer a client’s electronic account to the Federally Facilitated Marketplace (FFM) when Medicaid benefits end.

340 Modified Adjusted Gross Income (MAGI) Methodology.

340-1 MAGI General Rules

340-2 Non-Financial Rules for MAGI

Modified Adjusted Gross Income (MAGI) refers to a methodology of determining if an individual is eligible for medical assistance.  This methodology follows federal tax rules for determining a household size, whose income counts and the amount of that income, and the coverage group for each individual.  There are some exceptions to the tax rules and we will follow non-tax-filer rules for the exceptions.  There is no asset test with the MAGI methodology.   It is used for the following eligibility groups:

Parent/Caretaker Relative

Pregnant Woman

Children under age 19

Non-title IV-E Foster Children

Individuals Infected with Tuberculosis

341    The MAGI Household

341-1 Tax Filer’s MAGI Household

341-2 Non-Tax Filer’s MAGI Household

The first step to determine eligibility for MAGI-based coverage groups is to build the MAGI household for each applicant or recipient.  The household composition rules follow federal tax rules, and in some cases, relationship rules.

The MAGI household is determined based on whether the applicant or recipient expects to file a federal tax return or not, and whether the person can be claimed as a dependent by another tax filer.

The MAGI household of a spouse of a tax filer is determined based on whether they file a joint return, and if filing separately who the spouse can claim as dependents.

The MAGI household size for children of the applicant or recipient depends on whether the children are claimed as dependents by a tax filer, who is claiming them, and who they live with.

The MAGI household of other dependents of a tax filer is based on the relationships of the people those dependents live with.

The MAGI household for individuals who will neither file a tax return nor be claimed as a dependent by another tax filer will be determined based on the relationships of the people living in the household.

342    MAGI-Based Income Requirements

342-1 Income for MAGI-Based Programs

342-2 Income that does not count for MAGI-Based   Programs

342-3 Whose Income Counts for the MAGI Household?

342-4 Calculating Income for MAGI-Based Programs

347    MAGI Based Medicaid for Children

Income rules to determine eligibility for MAGI-based Medicaid groups will follow federal tax rules with a few Medicaid specific differences.  MAGI-based income is a method of calculating a “modified adjusted gross income” amount based on federal tax rules, and certain “add-backs” and exclusions specific to Medicaid for each individual who is applying for or renewing eligibility for Medicaid.

The countable income for an individual is the sum of the MAGI-based income of every person included in the individual’s household if that person’s income is required to be counted.

MAGI-based income is the adjusted gross income of an individual, plus any untaxed portion of Social Security benefits, tax-free interest income, and foreign earned income even if it was not taxable.  Adjusted gross income under tax rules allows certain deductions from the individual’s gross income.

The worker will calculate a monthly MAGI-based income best estimate that will account for reasonably expected income fluctuations or changes that will occur during the certification period.

343  4 Month Extended and 12 Month Transitional Medicaid

343-1  4 Month Extended Medicaid

343-2  12-Month Transitional Medicaid

343-3  Good Cause For No Earnings-12 Month Transitional Medicaid

343-5  Changes During the 12-Month Period

343-6  Reopening a 12 Month Transitional Case

343-7  Medical Support Enforcement and Third Party Liability (removed)

Medicaid provides extended Medicaid coverage for families when a parent or caretaker relative has received MAGI-based Parent/Caretaker Relative coverage and loses that coverage due to certain changes.

4 Month Extended Medicaid

A parent or caretaker relative and the dependent children living with the parent or caretaker relative can receive 4 months of extended Medicaid when there is an increase in income from support payments or earnings.  

A two parent household can receive 4 months of extended coverage when deprivation is lost due to an increase in hours of employment.

12 Month Transitional

Eligible households can receive up to twelve months of Medicaid after the parent or caretaker relative loses eligibility for MAGI-based Parent/Caretaker Relative coverage.

12 month transitional takes precedence over 4 Month Extended Medicaid if is continued in 2014.

Section 343-7 was removed.

345 MAGI-based Parent/Caretaker Relative (former 340)

345-1 Age of a Dependent Child (former 340-1)

345-2 Deprivation of Support (former 340-2)

345-3 Caretaker Relative for MAGI-based program (former 340-3)

There is a new Medicaid coverage group titled Parent/Caretaker Relatives.  A caretaker relative and their spouse can be included in coverage.  Eligibility Requirements include.

U.S. citizen or qualified Alien

Utah residency

Eligible, dependent child in the household

The child must be deprived of parental support

Relationship to the dependent child must be verified by self-attestation

Household income must be below the MAGI standard.

345-2 Deprivation of Support  (renumbered from 340-2, and modified)

Deprivation of Support is a requirement for a parent or caretaker relative to qualify for the Parent/Caretaker Relative group or the Family Medically Needy group.  Sections of this policy were updated to include:

For joint custody situations, a child must not spend three or more nights per week with the absent parent.

If a convicted and sentenced parent lives at home under court control, the parent may be considered in the household size only for MAGI based Medicaid programs.  This parent may not receive Parent/Caretaker Relative Medicaid.

If a parent or caretaker relative is on paid leave, he is considered to be unemployed or working less than 100 hours if the combination of paid leave hours and paid work hours equal or exceed 100 hours.  Any paid hours count as employed hours.

A parent or caretaker relative is not required to have good cause for refusing work, quitting work, or reducing hours of employment.

347 Child Medicaid (MAGI rules)   (renumbered from 350)

There are changes to the Child Medicaid program due to ACA.

There is no duty of support requirement.

There is no deprivation requirement.

There is no asset test.

Income follows the MAGI-based income rules and must be below the MAGI equivalent

If a child is not eligible under the MAGI group, consider medically needy coverage.

349 Pregnant Woman (MAGI rules)

There are changes to the Pregnant Woman Medicaid program due to ACA.

Workers may take client statement of pregnancy.

There is no duty of support requirement.

There is no asset test.

Income must be below the MAGI equivalent income limit.

The household size includes all unborn children.

Eligibility may begin in the application month or the retro period.  Eligibility may continue through the end of the 60 day post-partum period.

350 Family Medically Needy

350-1 Age of child  (info from old 340-1)

350-2 Deprivation of Support (info from old 340-2)

350-3 Parents and Caretaker Relatives for Medically Needy programs

350-4 Household size for family medically needy (former 340-4)

350-5 Whose income and assets to count (former 340-5)

350-6 Family Medically Needy Eligibility for child living with non-parent caretaker relative (former 340-7)

351 Medically Needy Family (former 344)

These sections have been moved and renumbered to cover just the eligibility criteria for medically needy family groups.  

Determine eligibility for Medically Needy Family Medicaid for households that don’t qualify for Parent/Caretaker Relative, Family-4 Month Extended or Family-12 Month Transitional because of income.

The asset limit still applies for medically needy.

Deprivation of support is required for Parent/Caretaker Relative Medicaid eligibility.

Consider on-going eligibility for other insurance affordability programs, including Child Medicaid, CHIP, PCN, or a referral to the Federally Facilitated Marketplace (FFM) for an Advanced Premium Tax Credit (APTC).

352 Medically Needy Pregnant Woman Medicaid

352-1 Income Eligibility for Medically Needy Pregnant Woman Medicaid

352-2 Medically Needy Pregnant Woman Medicaid Asset Rules

352-3 Medically Needy Pregnant Woman Medicaid Period of Eligibility

Sections 361, 361-1, and 361-2 were renumbered 352, 352-1, and 352-3 respectively.  

This program is for pregnant women who have failed the MAGI-based Pregnant Woman group.

If a client receiving Medically Needy Pregnant Woman Medicaid in the application month or the retroactive period wants coverage for the 60-day post-partum period, the spenddown must be met.  If the income has decreased, the spenddown amount may be lower.  The spenddown can’t be more than the amount determined in the first Pregnant Woman Medically Needy month.

353 Medically Needy Child

353-1 Medically Needy Child Income and Asset Eligibility (former 353-2)

353-1 Medically Needy Child  Age Requirements (removed section)

The old Section 353-1 was removed.  Content from section 353-2 was moved to 353-1 and so is renumbered.

354 Foster Care Medicaid

354-4 Foster Care Independent Living

Foster Care Independent Living policy has been updated to reflect that individuals may be eligible from age 18 through the month in which they turn 21.

356 Medicaid Presumptive Eligibility for Children

356-1 Presumptive Medicaid Eligibility for the Baby Your Baby Program

356-2 Medicaid Presumptive Eligibility Determined by Qualified Hospitals.

Hospitals that express interest and enter into a formal agreement with the Dept. of Health may determine presumptive eligibility for the following coverage groups.  Client statement is accepted for all eligibility factors.

CHIP

Child Medicaid

Pregnant Woman Medicaid

Former Foster Care Individuals Medicaid

Breast and Cervical Cancer Medicaid

Parent/Caretaker Relative Medicaid.  

354-3 Former Foster Care Individuals

There is a new Medicaid coverage group titled Former Foster Care Individuals.  This coverage group is for individuals who age out of foster care and are under age 26.  Individuals are eligible for this Medicaid coverage group if they meet the following criteria:

Ineligible for SSI Recipient Medicaid, poverty level Child Medicaid, Parent/Caretaker Relative Medicaid or Pregnant Woman Medicaid

Age 18-26.  Eligibility runs through the month they turns 26.

Was concurrently enrolled in Medicaid and Foster Care in Utah at age 18 or higher when Foster Care ended.

Was in the custody of DCFS, DHS, or an Indian tribe when foster care ended.  Persons in the custody of Juvenile Justice Services are not eligible.

There is no income or asset test.

A client with a minor child living with them who receives Medicaid is required to cooperate with medical support enforcement unless they can show good cause for not cooperating.

390 Medicaid Cancer Program

390-1 Screening

390-2 Health Coverage and Medicaid Cancer Program Eligibility

390-3 Medicaid Cancer Program Eligibility Periods

390-4 Cancer Program Eligibility Review

Policy was updated to reflect that men may now qualify for the Medicaid Cancer Program.  All other factors of eligibility remain unchanged.

305 Determining Countable Income for AM, BM, DM, MWI and Medicare Cost-Sharing Programs

370-1 Eligible for a Medicaid Program

380-1 Waiver Asset Requirements

386-2 NCW General Requirements

386-3 NCW Coverage Groups

387 Physical Disabilities Waiver

409-1  Health Insurance Premiums

409-9  Medical Bills for Long-Term Care and Waiver Programs

409-10  Personal Needs Allowance

409-11 Spousal Impoverishment Deductions

409-11.2  When to Deduct the SNA

409-12 Deduction for Dependent Family Members

409-16 New Choices Waiver Deductions

409-17  Physical Disabilities Waiver Deductions

Table II

Deductions for the waiver programs have been aligned to reflect ACA changes.  

All waiver customers are now allowed to use medical expenses to reduce the amount they must pay for medical coverage.

New Choice Waiver references have been removed from section 305, as NCW has been aligned with the other HCB waiver programs.

The NCW Community Medicaid and Institutional Medicaid coverage groups have been updated with the new ACA changes.

Spousal Impoverishment added to NCW community and medically needy groups.  Also added to Physical Disability Groups.  Spousal impoverishment includes asset assessments and spousal and dependent income allowances.

The deductions for the NCW have changed and are now separated into two different categories:

SSI recipient, SSI protected, 100% FPL aged or disabled and spenddown groups

Special income groups

The deductions for the Physical Disabilities Waiver have increased and include such things as SNA and shelter costs.

400  Income Standards

401-1  Income Inkind

401-2  Countable Income

403-2  VA Benefits

403-3  When the Entitlement Differs from the Payment Amount

403-4  Unearned Income Exclusions

403-5  Unearned Income from Rental Property

403-6  Child Support Payments

403-7  Educational Assistance

403-8  Certain Interest or Dividend Income; Irregular and Infrequent Income

403-9  Sales Contracts

403-10 Payments to replace or repair lost, stolen or damaged property

403-11  Food or Shelter

403-15  Deposits to Joint Accounts; Payee or  Fiduciary Accounts

405-1 Sources of Earned Income

405-4  Earned Income Exclusions

405-5  Hostile Fire or Imminent Danger Pay; Other Combat Zone Pay when Deeming Income (deleted)

409  Income Deduction

409-3  Earned Income Disregards for Family Medicaid

409-4  Twelve Month Income Disregard for LIFC (deleted)

409-7  Unearned Income Disregards for Family Medicaid

451 Benefit Month-Income Begins or Terminates in the Month (deleted)

Section titles and content have been changed to specify the sections for Non-MAGI or Family Medically Needy.  

MAGI information has been added to specify if income is countable.  Links have been added for the new MAGI sections where applicable.

Section 405-5 has been deleted and the information has been incorporated into section 405-4.  Section 451 has been deleted and the information is included in the 435 sections.

403-14 Deeming Income from an Alien’s Sponsor

Determining the countable amount to be deemed from a sponsor has clarified and new information about MAGI-based households has been added.

Policy has been reformatted and clarified in regards to subtracting allocations from the parent’s income for the other children in the household.

407-1 What are Lump Sum Payments?

407-2 Exempt Lump Sum Payments

407-3 How to Count Lump Sum Payments

407-5 VA Aid and Attendance, Homebound Payments, Unusual Medical Expenses and $90 Payments to Nursing Home Residents

Federal tax refunds, including refundable credits such as Child Tax Credit payments are not lump sum payments.  Payments that will recur, even if only once a year, are not lump sum payments.

Count the net amount of all lump sum payments from a countable income source only in the month of receipt.  Do not prorate the lump sum payment over the certification period.  Any amount remaining after the month of receipt is considered an asset for Medicaid programs that have an asset test.

Lump sum payments of excluded unearned income, such as VA benefits and child support payments are exempt.

If the lump sum is received in the application month, and it would make the child ineligible for CHIP, deny the application month and determine CHIP eligibility for the following month without including the lump sum.

415 Spenddown  

415-1 What is a Spenddown

415-2 Who is Eligible Without a Spenddown

415-4 Spenddown with Cash

415-7 Rules for All Medical Bills

415-8 Applying the Rules for Medical Bills

415-17 Time Limit for Meeting Medicaid Spenddown

415-18 Cases with Family Members in Common

MAGI-based coverage groups do not allow spenddowns.  The coverage groups that offer spenddowns are:

Family Medically Needy

Child Medically Needy

Pregnant Woman Medically Needy

Aged, Blind and Disabled

Long-term care cases may owe a cost-of-care contribution, and may be able to use medical bills to meet it

MWI clients may owe an MWI premium.

417 Income Test for Poverty Level Programs (deleted)

417-1 Income Test for QMB and 100% Poverty-Related Aged or Disabled Medicaid (deleted)

417-2 Income Test for SLMB (deleted)

417-3 Income Test for Qualifying Individuals (QI) (deleted)

417-4 Income Test for the Medical Work Incentive Program (deleted)

All sections in 417 have been deleted.

435 Budgeting Income

435-1 Definitions

435-2 Determine a Best Estimate of Income

435-3 Best Estimate of Income (old policy deleted and 435-4 renumbered to 435-3)

435-3 Methods of Establishing a Best Estimate (renumbered from 435-4)

435-5 Documenting the Best Estimate (removed)

435-6 Income Factoring for Family Related Medicaid (removed)

Determine an income best estimate prospectively for all benefit months except retroactive months for the MAGI-based and non-MAGI-based groups.

For MAGI-based groups, determine a best estimate of income to be received during the certification period to arrive at a monthly amount.

For non-MAGI-based groups, use a best estimate of income and household size that will exist in the benefit month.  The best estimate could change in future months due to changes.

Information from 435-3, 435-5, and 435-6 were moved to 435-2.  Section 435-4 was renumbered as 435-3.  

445 Retroactive Period Income

445-2 Retroactive Period Income For All Other Programs Except QMB

612 Retroactive Assistance (Removed)

612-1 Determining the Retroactive Period (Removed)

612-2 Determining Eligibility for the Retroactive Period (Removed)

612-3 Requesting Retroactive Coverage After the Application is Processed (Removed)

612-4 Payment of Bills from the Retroactive Period

705 Retroactive Assistance (Removed)

705-1 Determining the Retroactive Period

705-2 Determining Eligibility for the Retroactive Period

705-3 Requesting Retroactive Coverage after the Application is Processed

705-4 Payment of Bills from the Retroactive Period

Sections 612, 612-1, 612-2, 612-3, and 612-4 have been moved to 705, 705-1, 705-2, 705-3, and 705-4 respectively.  

When retroactive assistance is requested on applications taken in Jan., Feb., and Mar. 2014, workers must apply financial rules that were in effect in 2013.  This includes the verification of assets and use of actual income.

Use actual income received for MAGI-based as well as non-MAGI-based coverage groups.

465 Parents Under Age 18, or Parents Between Age 18 and 19 for Medically Needy Coverage

465-1 Minor Parents Under Age 18 Who Live With Their Parents or Stepparents

465-2 Minor Parents Between Age 18 and 19 Who Live With Their Parents or Stepparents

465-3 Duty of Support Procedures for Minor Parents Who Reside With Their Parents (removed)

465-4 Minor Parents Under Age 18 Living Separately From Their Parents (removed)

465-5 Minor Parents Between Age 18 and 19 Living Separately From Their Parents or Stepparents (removed)

Eligibility under a MAGI-based coverage group for a child under age 19 follows the MAGI-based policies for tax filers and non-tax filers.  It doesn’t matter whether the child is a parent but rather the status of whether the child is claimed as a dependent by a parent or not.  When a minor parent doesn’t qualify for Medicaid, the parent may be eligible for CHIP.

476 Household Size for Family Medicaid

476-1 Who to Include in the Family Medicaid Household Size

476-2 Deeming Ineligible Household Members

476-3 Multiple Family Medicaid Program Types (removed)

476-4 Foster Care Children

Policy has been updated to reflect updated rules in determining the household size for medically needy family, medically needy child, and medically needy pregnant woman Medicaid coverage groups.  These program types don’t follow MAGI methodology in determining the household size and whose income to count.

For MAGI-based coverage groups, a foster care child is counted in the household size if the child is claimed by a dependent on the tax return.  A foster child would not be included in the household size for all other medical assistance coverage groups.

Section 476-3 has been removed.

500 Asset Standards

501-4 Deeming Assets of Parents and Spouses (Removed)

503 Asset Limits

503-2 First Moment of the Month Rule and when Assets Must be Below the Asset Limit

503-3-How to Apply the Asset Limit

503-4 Verifying Assets (renamed)

521-1 One Home and One Lot

521-3 Household Goods, Personal Effects, and Other Personal Property

521-4 Vehicles

521-9 Retroactive and Reissued Social Security and Railroad Retirement

521-10 Educational Assistance

521-13 Retirement/Pension Funds

521-16 Life Insurance

521-29 Benefits Received From Programs Authorized Under the Older Americans Act of 1965 or the Domestic Volunteer Services Act.

531-1 SSI, SSA and RRB Lump Sums

553 Life Estates

554-1 Treatment of Annuities

585 Whose Assets to Count

592-4 Designation of Burial Funds, Date of Exclusion and Case Closure

592-11 Burial Fund Exclusion and Unreported Assets

Policy was updated to clarify when assets are considered when determining eligibility.

A client’s assets are used to determine eligibility for non-MAGI Medicaid programs:

Medically Needy Medicaid programs

Poverty level Aged, Blind, and Disabled Medicaid

Medicare cost-sharing programs

Long term care Medicaid

A client’s assets are not used to determine eligibility for MAGI based Medicaid programs:

Parent/Caretaker Relative Medicaid

Child Medicaid

Pregnant Woman Medicaid

References to the pregnant woman asset co-pay were removed.  

Section 503-4 was renamed Verifying Assets.  

Content from section 501-4 was moved to section 585.

600 Program Benefits

603-1 Medicaid Benefits

Policy has been updated to reflect new coverage groups.  Information on verifying American Indian Status was taken out of Section 603-1.

651-2 Modes of Medical Transportation

Has been updated to reflect current UTA transportation centers and phone numbers.

707 Reopening Cases without a New Application

715 Eligibility Period

715-1 Length of the Eligibility Period (removed)

721 Renewal of Eligibility

721-1 Conducting an Eligibility Review

721-4 Time Limited Programs

1000-3 Open Enrollment Periods

1008-1 Eligibility Review

1008-2 Conducting an Eligibility Review

Eligibility for MAGI based Medicaid programs and Medicare cost sharing programs should be reviewed every 12 months.  However when a review is completed for food stamps, financial, or child care during a Medicaid certification period, a Medicaid review can be completed if all factors of eligibility are reviewed.    If a client fails complete the review process and the case closes at the end of the review month, the client has 90 days to complete the review.  They can reapply by completing the review process or filing a new application.  The program remains closed while eligibility is being determined.  Complete reviews for all non-MAGI based Medicaid programs at least every 12 months.  

Ex parte reviews comparing electronic data with eligibility standards should be completed for all Medicaid and CHIP programs before including the client in the review process.  If eligibility can’t be renewed with the ex parte review, a prepopulated review will be sent to the client.

If the client is no longer eligible for Medicaid, a referral will be made to the Federally Facilitated Marketplace (FFM).

Section 715-1 has been moved to section 715.

801  Case Records

801-1 Case Record Requirements

801-2  Removing case records from the office

Policy has been updated to state that case records are stored in electronic systems such as Content Manager and eREP. It also adds information about transmitting case records with other agencies and the FFM.  

811  Notification

811-1  Advance Notice (deleted)

811-2  Exceptions to Advance Notice (deleted)

811-3  Five Day Advance Notice for Suspected

           Intentional Program Violation (deleted)

Policy has been updated to include language about the use of electronic notices.  Adverse action notices must contain the basis of the action for MAGI programs.   

Sections 811-1, 811-2 and 811-3 have been deleted and incorporated into section 811.

825-1 Underpayments and Overstatements of  Liability

825-2 Overpayments and Understatements of  Liability

825-3.1 Eligibility for Other Medical Assistance Programs

825-5.3 Resources – First Moment of the Month

825-5.4 Resources – Anytime During the Month

Wording has been changed to differentiate between the MAGI and Non-MAGI groups.  

References to Pregnant Woman copay has been removed

827 Eligibility for Other Programs

If individuals are no longer eligible for a MAGI-based program, they will be referred to the FFM.

1001    Eligibility for Other Medicaid Programs

1002    Medical Support Enforcement

1003

1003-1 Definitions

1003-4 Access to Employer Sponsored Health Insurance

1003-7

1003-10

1004

1004-1 What Income to Count (deleted)

1004-2 Whose Income to Count (deleted)

1004-3 How to Determine the Household Size (deleted)

1004-4 Determination of Income Eligibility (deleted)

1004-5 Documenting the Income Determination (deleted)

1007

1008    Certification Periods

1009    Changes

1009-1 Reportable Changes

1009-2

References to the pregnant woman asset co-payment were removed from sections 1008, 1001, and 1002.  The Utah Health Exchange (UHE) was renamed Avenue H in sections 1003-1 and 1003-4.  Sections 1004-1, 1004-2, 1004-3, 1004-4, and 1004-5 were removed.  MAGI policy in volume 300 can be referred to for detail on determining a best estimate of income and the household size.  Change reporting policy in section 1009 matches Medicaid change reporting policy.  ARRA COBRA information was removed from section 1009-1.

1003-2 Health Insurance Coverage

1000-3 UPP Open Enrollment Periods

1008-1 Eligibility Review

1008-2 Conducting an Eligibility Review

The agency must complete an ex-parte review using electronic sources without client involvement before involving the client in the review process.

Signatures aren’t required for ex-parte reviews.

UPP can’t be closed or benefits reduced based on the ex-parte review.

A form 116M is always needed for an UPP review.  A prepopulated review form and 116M should be sent to the client for review.

If an UPP recipient fails to complete the review process during the review month, the case closes at the end of the review month and the client has three months to complete the review.

Waive the ‘open enrollment’ and ‘already insured’ requirements if the review is completed or a new application is filed in the three months following the review month.

Application time processing rules apply.

If eligible, the effective date of the new certification period is the first day of the month that the review was completed.  There is no retroactive coverage.

If the agency can’t give ten day notice before deciding eligibility for a new certification period, extend benefits to the following month.

Benefits can’t be continued for an UPP eligible child who turns 19 or an UPP eligible adult who turns 65 in the review month.

1004 Income Standards

The income best estimate for the UPP program will be calculated using the MAGI methodology.  This policy is explained in sections 340, 341, and 342.

1009-3 Adding an Eligible Person to an Open UPP Case

If an adult or child was previously included on UPP and removed because they were eligible for PCN or Medicaid, the person may be added back to the UPP program when the eligibility for PCN or Medicaid ends.  A new eligibility determination isn’t required and it doesn’t have to be an UPP open enrollment if there hasn’t been a break in coverage.

If an adult or child was not previously on UPP, the person may only be added during UPP open enrollment periods.  A new eligibility determination is required and the person must meet all eligibility factors before they can be added to UPP.  The effective date is the first day of the month of request.  

1009-7 When Married Couples Separate During the Certification Period

When a married couple receiving UPP separates, remove one spouse from the original case and open a new case for that person for the remainder of the certification period if he remains eligible.

Table IV Proof of US Citizenship and Identification

Table VII- Income Limits for Medical Assistance and Medicare Cost Sharing Programs

Table VII-A- Medicaid Work Incentive

Table VIII-Verification and Interface Match

Table IX- Telephone Numbers

Tables II was reformatted and updated with new figures.  Table II-A was created to show figures which are specific to the long term care medical programs.  Table IX was updated with current names of Dept. of Health staff.  Table VII was updated with the new income limits.  Table VII-A was created to display Medicaid Work Incentive figures.  Table VIII was updated to reflect the need to verify all factors of eligibility electronically before asking a client to provide hard copy verifications.  Acceptable forms of American Indian and Alaska Native verification were moved from section 910-1 to Table VIII.

205-2  Resource – Qualified Aliens, Qualified Alien Categories for Medicaid Eligibility

205-3  Resource – Verification of Alien Status

386-3 Resource – New Choice Waiver

A chart has been created giving step by step instructions on determining if a client meets the criteria of being a qualified alien and if the client is a qualified alien, how to determine their eligibility for Medicaid.   

Tables have been created showing the different types of verification that need to be submitted to verify Afghan and Iraqi Special Immigrant status.

A table has been created with a step by step description on the new electronic way to verify alien status.

A table has been created giving a breakdown of the basic eligibility criteria for both NCW community and institutional groups.