Manual Letter #18

This manual letter lists new and revised material for the Health Care Programs Manual. Unless otherwise noted, new and revised instructions are effective December 1, 2008.

Annual Changes.

A number of sections have changes to reflect the annual updates that are effective January 1, 2009.


Several sections of Chapter 19 relating to real property, life estates and vehicles are updated.

Other Updates.

Chapter 03 - Eligibility Groups and Bases of Eligibility.

Chapter 15 - Third Party Liability (TPL).

Chapter 29 - Quality Assurance.

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Annual Changes

The following sections were updated with the annual changes that are effective January 1, 2009.

l  Section 04.15 - Supplemental Security Income (SSI).

The individual maximum payment amount will increase to $674 and the couple maximum amount will increase to $1,011.  

l  Section - Pickle Disregard Cost of Living Adjustment (COLA) Chart.

The Pickle Disregard computation factor increases to 1.023 to reflect the 2009 COLA increase.

l  Section 21.50.40 - Blind or Disabled Student Child Disregard.

Adds the maximum disregard amounts for 2009:  the disregard increases to $1,640 per month, and $6,600 per year.

l  Section 22.10 - Special Income Standard (SIS).

Adds the Special Income Standard for 2009:  the limit increases to $2,022 per month.  

l  Section 22.40 - Minimum/Maximum Asset Allowance.

Adds the asset allowance figures for 2009:  the minimum spousal asset allowance increases to $31,094, and the maximum spousal asset allowance increases to $109,560.

l  Section 22.45 - Long-Term Care (LTC) Allowances.

Increases the personal needs allowance for 2009 to $89.

l  Section 22.50 - Remedial Care Expense.

Increases the remedial care expense amount to $215 for January 1, 2009 to June 30, 2009.

l  Section 22.55 - Medicare Cost-Sharing Amounts.

Adds new Medicare amounts for 2009, including:  

n  Part A hospital deductible increases to $1,068.

n  The main Part B premium remains $96.40.

n  The average premium for the Part D standard benefit decreases to $28.00.

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l  Section - Homestead Real Property.

n  Expands the definition of homestead to clarify that it is not necessary for a client to own the actual shelter (e.g. mobile home) if they own the land on which it is located.

n  In the LTCF Residents subsection, clarifies that the homestead is excluded in the first partial month of LTCF residence, if the client is expected to remain the LTCF permanently.

l  Section - Non-Homestead Real Property.

n  Includes minor wording changes and edits throughout this section.

n  Clarifies that unless good cause exists, non-homestead real property is considered a counted, available, and non-excluded asset.

l  Section 19.25.25 - Vehicles.

n  Expands the definition of a vehicle to include a registered or unregistered conveyance used for transportation.

n  Further explains the process of determining a vehicle’s equity value and which vehicle(s) to exclude based on values.

n  Minor wording changes throughout this section.

l  Section 19.40 - Transfers.

Wording change clarifies that uncompensated transfer provisions apply to transfers both before and after the LTC or EW spouse is approved to receive MA payment for LTC services.

l  Section 19.40.05 - Transfer Penalty Exceptions.

Clarifies that in order for a transfer of a homestead to a child to be exempt from a penalty, the child must have lived in the client’s home for at least two years before the client entered a long-term care facility (LTCF) or began receiving services through a home and community-based waiver program.

l  Section 19.45 - Asset Assessments.

Clarifies that an asset assessment should be based on the first day of the long-term care spouse’s first continuous LTC/EW period.

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Other Updates

Chapter 03 - Eligibility Groups and Bases of Eligibility

n  Section 03.45.05 - Emergency Medical Assistance (EMA).

m Clarifies that EMA is available for up to three months of retroactive eligibility if all eligibility factors are met.

m Clarifies eligibility requirements for pregnant noncitizens. Pregnant noncitizens with a status that does not qualify for FFP may be eligible for SCHIP-funded MA (NMED).

n  Section 03.45.15 - Center for Victims of Torture (CVT).

m Clarifies that people who are not eligible for federally or state-funded Medical Assistance (MA) under standard program guidelines may be eligible for state-funded MA (NMED) if they are receiving care and rehabilitation services from the CVT.

m Minor wording changes throughout this section.

Chapter 15 - Third Party Liability (TPL)

n  Section 15.10 - Other Health Care Coverage - MA and GAMC.

Clarifies that people who do not enroll in, cooperate with or assign rights to other health coverage may continue to be eligible for MA and GAMC if they cannot do so on their own behalf. An example is added to illustrate this policy.

n  Section 15.10.05 - Cost Effective Health Care Coverage - MA and GAMC.

Clarifies that adults, as well as children, who do not enroll or maintain enrollment in cost effective health plans may remain eligible if they cannot do so on their own behalf.

Chapter 29 - Quality Assurance (QA)

n  Section 29.10 - Fraud.

Adds information about the need to establish an Intentional Program Violation (IPV) to establish fraud for an Administrative Disqualification Hearing (ADH).

n  Section 29.10.05 - Administrative Disqualification Hearings (ADH).

m Removes the definitions from the top of this section; information is included in the text when terms are used.  

m Adds a new subsection to explain requirements to establish an Intentional Program Violation (IPV) for ADH.

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