To comply with section 1557 of the Affordable Care Act we are adding language about applicant/recipient rights to language services for people with limited English proficiency and, access to auxiliary aids and services to people with disabilities.

• Information on completing the DAC income test for married clients is added to policy.  

• If the DAC client has a spouse with deemable income, the DAC client’s countable income is compared to the maximum SSI allotment for two.

We are adding a clarification that reports of income changes during the second six-month period should not be acted upon, except at the second and third quarterly report. This conforms with an earlier clarification that for the first six months of the 12 Month Transitional program in which income changes are not acted on.  

• Removed 72nd Street Clinic and the Stephen D. Ratcliffe Health Center from the approved BYB Table XV.

Added BYU Idaho

 We are clarifying policy regarding which is the appropriate extended program for a household when multiple changes happen in the same month. We have provided examples of moving a family to 4-Month Extended or 12-Month Transitional.

We have added a clarification which states that when an absent spouse rejoins the household with an open PCR program, the new member will be considered to have the same number of PCR months as the ongoing family members.

We are changing policy to state that children are to be moved to the 4 Month Extended or 12 Month Transitional Medicaid along with their parents when the parents' income increases above the PCR limit.

403-2 VA Benefits

403-4 Unearned Income Exclusions

403-16 Countable Payments to American Indians

Exempt income listed in 403-4 was taken out of 403-4 and placed into individual sub-sections.  This is similar to the format of policy volume 521. 

Exempt VA annuities was moved from 403-4 to 403-2.

A new section, 403-16 was created to cover countable payments to American Indians.

Links were modified to reflect the changed sections.

The standard utility allowance (SUA) will increase from $328 to $347

The without heating allowance (WOHA) will increase from $244 to $267

The telephone only allowance (TOA) will increase from $42 to $60. 

eFind is being replaced by eVerifs. The term eFind is being replaced with the term 'electronic verification'.

sCHIP is a new method of citizenship, identity and SSN verification. The term sCHIP is added to Table VIII.

Language about clients receiving prescription drug coverage through Medicaid while eligible for Medicare A and/or B has been removed.  These clients may receive prescription drug benefits through Humana LINET if they do not have a chosen or assigned Part D plan.

We are adding a clarification to Sec. 320 that explains that an individual receiving a Medicare Cost Sharing program is eligible for the Part D low-income subsidy.

We obsoleted the Medicare Decision Tree because it was out of date and rarely used as a resource.

Minor policy clean-up was done.

The 10-A resource is no longer needed. Obsolete the policy and the resource section.

Removed the incorrect language "with some exceptions for the New Choices waiver"

It will now read "Individuals who are applying for waiver services."

This section is being reorganized for clarity and to eliminate duplication.

Section C is more specific rather than general in nature. Anticipating future income will be moved to the respective MAGI and non-MAGI sections of 435-2.

We are re-formatting  to better highlight the different types of income: stable, new, terminated, seasonal income.

We are clarifying section B to state when to use actual income rather than an average to determine eligibility and the spenddown for a particular month such as the application or a retroactive month in the following situations:

In retroactive months.

In the application month. Factor the income for weekly or bi-weekly pay periods for family related Medicaid, when all checks are available.

In the application month. Do not factor if the client received fewer than a normal month's checks.

Do not include income that is not being received yet for a current month.

Use current and past checks, or an employer statement, to average or anticipate income and spenddowns future months.

The referring physician should call HCF for prior authorization of out of state medical travel reimbursement.   Other minor wording clean-up was done.

Language regarding faxing SSA has been removed.  We no longer have a fax process with SSA.

We also removed references to specific electronic interface screens and replaced it with "electronic interface".

Removing making work pay language from policy 381, 383, 385 and 388.

403-4 Unearned Income Exclusions

405-4 Earned Income Exclusions

413-1 How to Deem Income from Parents for ABD and MCSP

412-3 Deeming Income for ABD and MCSP

415-8 Applying Rules for Medical Bills

Utah Legislature has approved a CHPRA 2009 option to expand Medicaid and CHIP to "lawfully present" children and LPR children who have not met the 5 year bar. This CHIPRA provision pays the State an enhanced Federal payment for extending Medicaid to this population.

We are adding a new section 205-2.1 and CHIP 202-2.1 identifying categories which those newly eligible children must fall into to qualify for Medicaid or CHIP.

We are adding "change in alien status" to 107-4 as a reportable change.

Once these children getting Medicaid meet the qualified alien and/or have met the 5 year bar, the CHIP enhanced rate will end and the State will receive the normal Medicaid Federal rate.

We are adding a paragraph in 349, which explains that a pregnant client, who is eligible as a lawfully present child or has not met the 5 year bar, will lose eligibility upon turning 19 if her birthday arrives without gaining a qualified alien status.

ABLE accounts are savings accounts for disabled individuals.

These are exempt assets.

Any distributions from the account for qualified disability expenses are not countable as income.  Qualified disability expenses are expenses related to the eligible individual’s blindness or disability, which are made for the benefit of the eligible individual.

An individual whose SSI is in suspended status due to an ABLE account with a balance greater than $100,000 is considered an SSI recipient when determining Medicaid eligibility.

The state is treated as a creditor of the ABLE account, and may file a claim to recover funds to the extent of prior Medicaid assistance expended on behalf of the beneficiary.

The Federal government released its updated numbers for the spousal needs minimum maintenance standard of $2,003.00 and the spousal needs allowance shelter standard of $601.00.  The changes to the spousal needs standards will become effective for July 2016.

Adding examples of how to verify relationship:

Self-declaration

Death record

Divorce record

Documents from other state agencies stating verified relationship

Also, removed eFIND language and replaced with Electronic Interface.

Updating phone numbers

107-1 – Added a description to address FFM account transfers

703 – Added information about receiving application from the FFM and added hyperlink subsections for reference.

703-1 Added information about the application coordination between the FFM and CHIP.

703-4 – Added a statement that an applicant with a FFM plan who does not qualify for Medicaid must be screened for CHIP, UPP or PCN and added the links.

703-5- Added a statement that an applicant who does not qualify for Medicaid or CHIP will be transferred to the FFM

PCN

903 Reformatted and added links to address FFM transfers added hyperlink subsections for reference.

903-2 Added a statement that an individual with a FFM plan who is ineligible for Medicaid may be found eligible for PCN.  Added a link to 903-11 to determine what actions to take to coordinate with FFM plans.

903-7 Added an exception to the 180-day sanction period when an individual ends there FFM plan.  

903-11Added a new section on how to coordinate coverage for individuals with a FFM plan.

909-3 Added effective dates for a spouse moving from the FFM to an open PCN case.

UPP

1003- Reformatted and added links to address FFM transfers

1003-7  Added an exception to the 90-day sanction period when ending a FFM plan.

1003-11 Added a new section on how to coordinate coverage for individuals with a FFM plan.

1009-3 Added effective dates for individuals moving from the FFM to an open UPP case.  Changed the reporting timeframes from 30 days to 60 days to align with the FFM.

DOH received guidance from CMS mandating a seamless transition for individuals moving from a Federally Facilitated Marketplace (FFM) plan to Medicaid, or CUP.

Policies were updated to create a seamless transition from the Federally Facilitated Marketplace (FFM) to Medicaid or CUP programs. 

The following changes were made.

The FFM application transfer process was better defined.

How a new person can be added to a current Medicaid, PCN, CHIP or UPP program.

An exemption to the 180-day sanction period for PCN was added for individuals transferring from the FFM.

An exemption to the 90-day sanction period for CHIP and UPP was added for individuals transferring from the FFM.

Added effective date policy for individuals transferring from the FFM to CUP programs.

343-2 12-Month Transitional Medicaid

A household should remain on 12 Month Transitional uninterrupted for the first six months, regardless of any change in the parent's earnings. The only exception would be for the reasons which would close TR at any point: no eligible child living in the home, or the family moves out of state.

A pregnant woman, who has no other child besides the unborn, must accumulate the 3 of 6 months in her third trimester to allow her to move to the 12 Month Transitional program. The woman must have a born child by the end of the first TR month to continue to be eligible for the 12 Month Transitional program.

Added a line to clarify that deprivation is not a requirement during the transitional period.

Made some miscellaneous wording changes which do not change policy in a substantive way.

380-1 Home and Community Based Waiver Medicaid Eligibility

721-1 Conducting an Eligibility Review

342-1-  Income for MAGI-Based Programs

342-2 - Specific Treatment of Income for MAGI-Based Programs

342-4 - Calculating Income for MAGI-Based Programs

1004 - Income Standards

1008 - Certification Periods

1008-2 - Conducting an Eligibility Review

1009 – Changes

1009-2 –Income Changes

1009-3 - Adding an eligible spouse or child to an open UPP case

1009-5 - Transitions between UPP and Other medical programs

1000 - Utah’s Premium Partnership for Health Insurance (UPP)

1000-4 - Eligibility Decisions

1003-4 - Access to Employer-Sponsored Health Insurance

The client has 30 days to enroll in employer sponsored insurance and we must allow a client 45 days from the mailing date on the UPP – Program Premium Verification notice to verify their enrollment.

The notice has been updated to give a verification return date of 45 days before the case is denied.  We have also added language informing the client that if they need more time, they can request it.

Tables II, II-A, V, VII, VII-A and VII-B  updated figures based on new FPL.  

The annual changes to the spousal needs minimum maintenance standard and the spousal needs allowance shelter standard will be effective in July 2016.

342-2 Specific Treatment of Income for MAGI-Based Programs

405-4 Earned Income Exclusions

521-5 Indian Land or Accounts Held in Trust

521-5: Culturally significant items such as pottery, jewelry, or other types of items created or manufactured by American Indians or Alaska Natives are excluded as assets.  When these items are sold, the assets are converted into cash.  Cash is considered another exempt asset.  The receipt of the cash is not considered income.

405-4 and 342-4: The creation and sale of these culturally or religiously significant items are an excluded type of self-employment income. However, an employee's wages of a business that sells Native American items are not exempt.

Updated the statement “The nursing home will send any excess money collected to ORS”

Updated initial paragraph by adding co-payment statements.

We were notified that the resource section of policy section 603-1 contains a procedure that also lists a Department of Health workers name listed as a contact person.  This should not be listed in policy.  We are removing this resource the policy manual. DWS has a procedure with all of the information.

Currently our policy states that if a client reports a decrease in income and that decrease causes a decrease in spenddown, MWI premium or cost of care and the change is verified timely, the effective date of the change is the month following the month of report. We would like that policy to read: If a change results in a decrease in spenddown, MWI premium or cost of care and the change is verified timely, the effective date of the change is the month of report. If the change is not verified timely, the effective date of the change is the month following the month of report.

PCN open enrollment for adults without dependent children will close as of 12/31/2015 at 11:59 P.M.

The yearly SSI and Medicare related changes.  These are the figures updated by the Social Security Administration, Medicare and CMS.

There was not a COLA this year from the Social Security Administration.  SSI payment amounts will remain the same and most other figures related to them will remain the same.

The Substantial gainful activity for disabled individuals changed from $1090.00 to $1,130.

The Medicare part b premium was split into two premiums and they are:

Clients who pay Medicare on their own remains the same at $104.90.

Clients who receive help paying their Medicare premiums will be $121.80.

Both numbers are now found on Table II.

The skilled nursing home co-insurance amount changed from $157.50 per day to $161.

The Medicare part d premium allowance went from $39.74 to $39.51