Obsolete 0118 - What's New 2017

• Removed policy regarding parents needing to report TPL for newborn children.

• Payments from the sale of bodily fluids are not countable as income.
• Clarified that payments received through Easter Seals are not countable as income unless the payment is in the form of wages.
• Removed language concerning children who lost SSI due to a welfare reform law, as the group is now gone.

• Retention of documents has been organized into two groups:  6 years and permanent.
• Centerville Family Nursing Services is now an approved BYB provider.

• Clarified DACA individuals are only eligible for Emergency Medicaid services.

• Clarified when to add a baby born to a mother on Medicaid, when the report is not timely.  
• Added RMA to programs where the baby is not eligible for Child 0-1 coverage.
• Section 347 has been updated and renamed to now include Child Medically Needy from Section 353.
• Clarified how to add a newborn to the household, regardless of who reports the birth, and even when the pregnancy was not reported before the baby's birth.

The Targeted Adult Medicaid program or TAM, is a new Medicaid program for adults with no dependent children and no countable income.  TAM focuses on 3 groups: Chronically Homeless, Justice Involved and Needing Treatment.   

TAM will include the following:

• MAGI methodology

• 12-month continuous enrollment

• Open enrollment periods

• Some policies in section 300 have been either renumbered, moved to sections 200, 400 and 500.
• These changes clean up and move policies that do not deal directly with a Medicaid program into the section where it best fits.  Examples of this are moving the MAGI methodology, income and asset policies.  

• Children on CHIP will not transition with parents to TR, unless requested or at the next certification period.
• Families on PCR that have an increase in both earned income and spousal support will move to TR.

• Unmarried couples cannot move to 12 month transitional together.
• Clarified that families maybe be penalized for not reporting the beginning of new employment.
• Minor parents living independently qualify to transition with their children using normal TR criteria.
• Sanctioned parents who are otherwise PCR eligible can transition to TR when income increases, if their children were receiving Medicaid and HH income was below PCR income standards.   

A new application is not required when moving a sanctioned parent to TR.

State law allows clients receiving Disability and Blind Medicaid to receive dental services through Medicaid as of July 1, 2017.

PCN open enrollment for adults without dependents will be from August 14 - August 28, 2017.

•   Central Utah Health Department-Junction has been added as an approved BYB administrator.
•   Davis Count Health Department-Farmington and Neighborhood Community Health Center-SLC have   been removed as approved BYB administrators.  

303-3  When to Establish and Redetermine Blindness or Disability Through the State Medicaid Disability Office

Clarified that the MRB will not review the disability status of an applicant who is in an appeal status with SSA, unless the applicant has a new disabling condition.

341-1  Tax Filer's MAGI Houshold

Changed the word parent to spouse to make policy language consistent in both the Medicaid and CHIP manuals.

372-1  Determining Total Income

Removed obsolete language concerning past federal tax returns.

512-2.3  Excluded Trusts for Disabled Individuals Established on or after August 11,        1993

Disabled individuals are now able to establish their own special needs trusts.

409-1  Health Insurance Premiums

Health insurance premiums paid weekly and biweekly will now be factored to align with how income paid weekly or biweekly is factored.

Welcome Page

Table IX  Phone Numbers

Phone numbers for DOH and other agencies were removed from the Welcome Page and incorporated into Table IX.

349  MAGI-Based Medicaid for Pregnant Women

352-3  Medically Needy Pregnant Woman Medicaid Period of Eligibility

603-1  Medicaid Benefits

• Clarified the time frame a pregnant women is eligible for the 60-day postpartum coverage.

• Traditional medical benefits will now begin the month the a pregnancy is reported.

356 Presumptive Eligibility

356-1  Presumptive Medicaid Eligibility for BYB (Eliminated)

356-2  Presumptive Medicaid Eligibility for HPE (Eliminated)

• Sections 356-1 and 356-2 were combined into one section (356).

• Clarified how to treat a baby whose is born on Medicaid.

801-1  Case Record Requirements

Table VIII-A  Data Retention (New)

Time frames for data retention has been removed from Section 801-1 and incorporated into a new table.

815  Changes

815-4  Changes in Household Composition

815-5  Income Changes

• Clarified any change that is a positive change and reported timely will have an effective date of the month of report.

• A redetermination of income for a PCN recipient who reports a change in income and the income was already anticipated in a best estimate of income, will only occur if the recipient requests a new income determination.

• Clarified how to treat certain types of anticipated income when a new income determination is completed.

Table II  Aged, Blind and Disabled Figures

Table II-A  Long Term Care Institutional and Waiver Income Limits and Other Important Figures

Table V  Sponsor Deeming

Table VII  Income Limits for Medical Assistance & Medicare Cost Sharing Programs

Table VII-A  Medicaid Work Incentive

Table VII-B  5% Federal Poverty Level Deduction Amount

Tables were updated with new Federal Poverty Level (FPL).

303-3  When to Establish and Redetermine Blindness or Disability Through the State Medicaid Disability Office

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

303-7  Blind or Disabled Medicaid Recipient who Appeals an SSA Decision that the Recipient is not Blind or Disabled

• Clarified when a referral should be made to the State Medicaid Disability Office when SSI or SSDI is denied and there is a new disabling medical condition.

• Language about an SSA appeal being filed within 60 days has been removed, as SSA will allow more that 60 days to appeal.

343  4 Month Extended and 12 Month Transitional Medicaid

• The term 'caretaker relative' has been added back to policy.

215-3  Who is a "Resident of an Institution?"

215-6  Residents of Non-Medical Institutions

Table XVI  Approved Halfway Houses

Individuals residing in certain types of halfway houses are now eligible for Medicaid coverage.  A new table listing the qualified halfway houses has been added to policy.

341-1  Tax Filer's MAGI Household

Separated spouses who are not living together but are still planning on filing a joint tax return will now be treated as separate households.

341-1  Tax Filer's MAGI Household

341-2  Non-Tax Filer's MAGI Household

A child who is placed up for adoption and the adoption is pending will follow non-tax filer policy.

400  Income Standards

703-4  What to Do With an Application

Individuals who have expenses with little or not income will need to verify how they are meeting their expenses.

229  Relationship

229-1  Parent

229-2  Establishing Parental Relationship (Eliminated)

229-3  Spouses (Eliminated)

341-1  Tax Filer's MAGI Household

345  MAGI Based Parent/Caretaker Relative

345-3  Caretaker Relative for MAGI-Based Program

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

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

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

Table VIII  Verification and Interface Match

Defined different household relationships and when to take customer statement on questionable relationships.

Clarified who is considered to be a legal parent and how to establish parental relationship.

Updated common law marriage policy in regards to filing a federal tax return and common law marriages established outside the State.  

Clarified the relationship between a minor parent and their parents for MAGI-based programs and the treatment of a pregnant minor's boyfriend.

Clarified how to treat spouses who are separated, not living together and filing a joint tax return.

New policy concerning how to comprise the household size when a child is in the process of being adopted, but the adoption is not yet finalized.

1003-1  Definitions

1003-2  Health Insurance Coverage

1007  Effective Dates

1008  Certification Periods

1009-3  Adding an Eligible Spouse or Child to an Open UPP Case

1010  Program Benefits

Clarified the different benefit effective dates for the certification period, reimbursements and the insurance start date.

Updated the definitions to clarify when the certification period and reimbursements will begin.

Table II  Aged, Blind and Disabled Figures

Table II-A  Long Term Care Institutional and Waiver Income Limits and Other Important Figures

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

Table XI  Pickle Reduction Figures

Tables updated for yearly cost of living adjustment (COLA).