PCN open enrollment dates for parents living with their minor children: December 10 - December 23, 2011.
Policy is being changed that affects inmates in a public institution such as a jail or prison. Inmates in public institutions are not eligible for Medicaid services during the time they are inmates in the public institution. This policy change allows an individual who is an inmate of a public institution to be eligible for Medicaid if they are admitted as an inpatient to a hospital, an IMD, State Training School, or a long-term care facility. They are not an inmate of the public institution during the inpatient stay. The individual must meet all other eligibility criteria for a Medicaid coverage group. Eligibility runs from the date of admission through the date of discharge.
107-1, 107- 3, 225-1, 225-2, 225-3, 903-10: These sections are being modified to make it clear how to update TPL information when a review goes into the due process month, the client submits verifications late, and the receipt of verifications triggers an application like process.
107-7 Cooperation with Quality Reviews (new section), 731, 825: Explains a client's requirement to cooperate with quality control and PERM reviews.
731 Verification, 731-1, 731-2, 731-3, 731-4 and 731-7: To clarify some of the requirements about providing verification. In particular we clarify that:
the notice asking for verification must be as complete as possible,
the agency may choose to extend the time to return verifications,
the Prudent Person method of verifying information has actually been taken out, but the basic concept has been incorporated into the Client Statement method of verification. To use Client Statement as verification, the worker is using professional judgment and available information to decide that the statements the client has given are an acceptable and believable form of verification,
the agency must verify income with available, reliable computer matches when possible before asking the client for it,
collateral contact can be used to verify income when other methods are not available,
benefits cannot be stopped when a client does not verify a change that is beneficial to the client,
we can use the online citizenship match with SSA as a form of verification,
we added language about the PARIS match information which closely matches what DWS workers are doing now,
we changed PACMIS language to erep language about finding match information.
New sections were added to UPP Policy: 1011 Improper UPP Payments, 1011-1 Causes of Improper UPP Reimbursement, 1011-2 What to Do When An Improper UPP Reimbursement Occurs.
403-14 Deeming Income from an Alien Sponsor: Clarify that sponsored aliens cannot be excluded from eligibility if they do not provide information about their sponsors.
521-32 ABD, 521-32 LTC, 521-23 Family, 372-1 Determining Total Income, 371-4 When not to apply a penalty period
These sections need to be changed to include an exclusion from resources of federal tax refunds from resources. This exclusion applies for refunds received between January 1, 2011 and December 31, 2012. The exclusion period is for 12 months after the month of receipt. The refunds are also excluded from treatment as a transfer of resources if they are transferred during the time they are excluded. Tax refunds are not counted as income and so they are also not counted as income to determine a person's cost of care contribution.
UPP 1003-4 and PCN 903-8
When determining if the cost of insurance is more than 5% of a household’s income, use the family cost of coverage when there is an unborn included in the household, unless the household composition is a pregnant woman and an unborn.
1003-10 COBRA Coverage, 1003–1 Definitions
Include eligible FIA COBRA and Mini COBRA plans for coverage under ARRA reimbursement
501-3 Deemed Assets of SSI Recipients, 501-4 Deeming Assets of Parents and Spouses. We have added information to these sections to match SSI rules. Real and personal property exempted by SSI must also be exempted for Medicaid eligibility.
Many changes to section 700, including 707, 721, 721-1, 721-4 – there will be additional changes to other sections of the manual, but 700 contains the bulk of the policy change Cases cannot be closed for review without 10-day notice If the review and/or needed verifications return any time after the cut-off, but before the end of the review month, eligibility must be forwarded into the next month as the review process continues. If the agency has sent an auto closure notice, send a new notice indicating the closure is now reversed (eligibility continues into the next month while review is processed.) If case is determined ineligible, send a closure notice with the correct reason for closure giving 10-day notice If the review and/or needed verifications return any time after the end of the review month (the case will have closed at cut-off--i.e., auto closure) but before the end of the month following, consider the receipt of review/info as an application – date of application is the date the review/info is received. Process review/info using application time lines. Send application decision letter.
811-4 - This policy change is modifying the returned mail policy for general delivery cases. The change for Medicaid/PCN/UPP is that medical cards or UPP premium payments in two consecutive months must be returned to the eligibility agency as undeliverable before the agency can close the Medicaid case due to whereabouts unknown.
PCN 906, 907, 908, 908-1, 909-1, UPP 1007, 1008, 1008-1, 1009: Due Process Reviews Case cannot be closed for review without 10-day notice. If the review and/or needed verifications return any time after the cut-off, but before the end of the review month, eligibility must be forwarded into the next month as the review process continues. If the agency has sent an auto closure notice, send a new notice indicating the closure is now reversed and continue eligibility into the next month while the review is being processed. If case is determined ineligible, send a closure notice with the correct reason for the closure, giving 10-day notice. If the review and/or needed verifications return any time after the end of the review month (the case will have closed at cut-off – i.e., auto closure) but before the end of the month following, consider the receipt of review/info as an application. Process review using application time lines. Send application decision later.
The income limits on these tables have been updated: Table VII and Table VII-A.
223-1 - Resource - Medicare section explains the difference between the 2 Medicare Part B premiums.
303-3: Clarification for MRB re-determinations – when they should be referred, conditions when they are not necessary, relation to eligibility reviews and details of disability reconsiderations.
412-2, 414, 414-2, 415, 415-18 When Do We Not Deem Income from a Spouse for ABD, QM and QI Programs?: Do not deem income from the non- waiver spouse to waiver spouse beginning the month the person will be approved for the waiver. DO deem income from waiver spouse to the non-waiver spouse if the non-waiver spouse is also eligible for Medicaid and they are living together.