This manual letter lists new and revised material for the Health Care Programs Manual. Unless otherwise noted, new and revised instructions are effective February 1, 2008.
Social Security Number (SSN) Requirements for MA Children Under Age 21 - New Policy
Currently, parents who fail to cooperate with the SSN requirement for their children under age 21 who are requesting or receiving MA are ineligible for MA for themselves unless the children meet an exception from the SSN requirement. Under the new policy issued in this manual letter, children for whom an SSN has not been provided or applied for are ineligible for MA unless they meet one of the exceptions in Social Security Number. The parents' eligibility is not affected.
Beginning with renewals due on or after March 1, 2008, children active on MA who do not currently meet an exception and have not applied for or provided SSNs must do so no later than the month in which their next renewal is due. Children who meet an exception as of March 1, 2008, but later lose it (for example, auto newborns who turn age one) must apply for or provide an SSN by the month following the month in which the exception ends. This change was also conveyed via MAXIS e-mails 7478827 and 7479347 dated January 24, 2008, and e-mail to health care liaisons dated January 23, 2008. See below for further information.
Chapter 03 - Eligibility Groups and Bases of Eligibility.
Chapter 10 - Social Security Number.
Prior to January 2008, MinnesotaCare adults without children had two different income limits and eligibility group statuses (75% FPG, Group One or 175% FPG, Group Three). The income limit determined whether they received the Basic Plus One or the MinnesotaCare Limited Benefit set.
Effective with eligibility month January 2008, all MinnesotaCare adults without children have the same increased income limit (200% FPG) and Group One status, and receive the Basic Plus One benefit set. The MinnesotaCare Limited Benefit set no longer exists. See below for further information.
Chapter 03 - Eligibility Groups and Bases of Eligibility.
Chapter 21 - Income Calculation (Community).
Chapter 22 - Standards and Guidelines.
Chapter 28 - Health Care Service Delivery.
Several sections of chapter 07, Applications, contain revised and clarified policy.
l It is no longer necessary to obtain the original application when an application is submitted via fax or e-mail.
l Unsigned applications can be accepted to set the date of application.
l New applicants for MA payment of LTC services must complete the New Applicant Request for Payment of Long-Term Care Services (DHS-4803) unless they apply using the new Minnesota Health Care Programs Application for Long-Term Care and Waiver Services (DHS-3531) or a version of the HCAPP that contains the LTC questions. These instructions were updated in bulletin #07-21-12, Redesign of Minnesota Health Care Programs Application and Introduction of Long-Term Care and Waiver Services Application.
See below for further information.
This manual letter includes a number of other updates and policy clarifications, such as correcting and clarifying policy for SCHIP-funded MA for pregnant women; adding instructions on steps to take when MA is declined for an auto newborn; and revising the asset assessment section for greater clarity. See below for further information.
Chapter 03 - Eligibility Groups and Bases of Eligibility.
Chapter 21 - Income Calculation (Community).
Chapter 22 - Standards and Guidelines.
Chapter 23 - Long-Term Care (LTC) and Elderly Waiver (EW).
Chapter 28 - Health Care Service Delivery.
SSN requirements for MA children under age 21 have changed. Children who do not meet an exception from applying for or providing an SSN are now ineligible for MA. Their parents can receive MA if they meet all eligibility requirements.
Chapter 03 - Eligibility Groups and Bases of Eligibility
l Section 03.25.15, Medical Assistance for Children Under 21.
Replaces the text under "Social Security Number" with ”Follow standard MA guidelines.”
Chapter 10 - Social Security Number
l Chapter 10, Social Security Number.
Removes the note under ”Not Requesting Coverage” stating that children can receive MA if otherwise eligible when their parents refuse to apply or provide SSNs for them, while the parents are ineligible.
Bulletin #07-21-10, Legislature Enacts Changes to MinnesotaCare for Adults Without Children Effective January 1, 2008
The following sections were updated with changes from bulletin #07-21-10, Legislature Enacts Changes to MinnesotaCare for Adults Without Children Effective January 1, 2008. See each of the updated sections for further information.
Chapter 03 - Eligibility Groups and Bases of Eligibility
l Section 03.05 - MinnesotaCare Eligibility Groups.
Removes the material under "Eligibility Group Three" since this group status is no longer used starting with eligibility month January 2008, and replaces it with a brief explanation about Group Three and a link to bulletin #07-21-10.
Updates the adult income guidelines to 200% FPG under "Eligibility Groups" and "System Coding." Also replaces the coding information under Group Three with a statement that this code is no longer used.
l Section 03.05.05 - Change in MinnesotaCare Eligibility Group.
l Section 03.15 - Enrollee Becomes Pregnant.
Updates all references to the eligibility group status for adults without children from Group Three to Group One in both sections. Also updates the income limit to 200% FPG in section 03.15.
l Section 03.20.25 - MinnesotaCare for Adults Without Children.
Updates income guidelines from 75% or 175% FPG to 200% FPG and removes material pertaining to the MinnesotaCare Limited Benefit set under "Eligibility Group," "Income Guidelines," and "Covered Services."
l Section 03.50.10 - GAMC Hospital Only (GHO).
Replaces a link to information about the MinnesotaCare Limited Benefit set with a link to section 03.20.25, MinnesotaCare for Adults Without Children, under "Other Groups/Bases to Consider."
l Section 07.20.50 - Program Overlap.
Replaces all references to the MinnesotaCare Limited Benefit set with references to MinnesotaCare under "MCRE and GHO Overlap." Also updates text under "Minnesota Family Planning Program" to emphasize current policy that workers may approve more beneficial health care program coverage before MFPP is closed by DHS staff.
Chapter 21 - Income Calculation (Community)
l Section 21 - Income Calculation (Community).
Updates income guidelines from 75% or 175% FPG to 200% FPG and removes material pertaining to the MinnesotaCare Limited Benefit set under "Income Standards."
Chapter 22 - Standards and Guidelines
l Section 22.05.05 - 75% FPG.
l Section 22.05.30 - 175% FPG.
l Section 22.05.40 - 200% FPG.
Removes all references to MinnesotaCare major program BB from sections 22.05.05 and 22.05.30, and adds major program BB to section 22.05.40. 75% FPG and 175% FPG are no longer income limits for MinnesotaCare adults without children. 200% FPG is the only income limit starting with eligibility month January 2008.
Chapter 28 - Health Care Service Delivery
l Section 28.05.05 - Benefit Sets by Major Program.
Removes all material pertaining to the MinnesotaCare Limited Benefit set and now states that there are four (rather than five) benefit sets under "MinnesotaCare Benefit Sets." Also replaces a reference to the MinnesotaCare Limited Benefit set with a reference to the Basic Plus One benefit set under "Transitional MinnesotaCare Benefit Sets."
This chapter contains several policy updates and clarifications. There are also corresponding glossary updates.
l Section 07.05, How to Apply.
Rewords the first paragraph to clarify that clients must complete and submit an application form to apply for Minnesota Health Care Programs but may submit a request for coverage to set the date of application before submitting the completed application.
Changes the subsection ”Requesting Coverage” to ”Requesting an Application” to distinguish between applications and requests for coverage, and removes the material on setting the date of application from this section. Requests for coverage are covered in more detail in date of application.
Adds that clients may request applications by e-mail and that scanned applications received via e-mail can be accepted.
Removes all instructions about requiring the original application when an application is received by fax. It is no longer necessary to obtain the original of faxed or scanned applications.
Under ”Help for Clients Applying,” adds that "application assistors" may help clients with the application process but cannot sign the application or receive information from the agency without a signed release from the client.
l Section 07.05.05, Application Forms.
Removes the words ”signed and dated” from the first sentence under ”General Application Form Requirements” and adds a bullet stating that unsigned applications can be accepted to set the date of application.
Updates the instructions on when to require the New Applicant Request for Payment of Long-Term Care Services (DHS-4803) under the HCAPP and CAF subsections to correspond with the changes in bulletin #07-21-12, Redesign of Minnesota Health Care Programs Application and Introduction of Long-Term Care and Waiver Services Application.
Revises the instructions in the subsection ”Long-Term Care (LTC) Requests and Applications” to correspond with the changes in bulletin #07-21-12, Redesign of Minnesota Health Care Programs Application and Introduction of Long-Term Care and Waiver Services Application.
Clarifies which forms are required for new MA applicants requesting payment of LTC services and which are required for enrollees requesting MA payment of LTC services.
l Section 07.15, Who May Apply.
Adds that "application assistors" may assist with the application process.
Revises the bullet on providers setting the date of application to clarify that it only applies to GAMC applicants when providers submit unique identifiers on behalf of clients unable to apply on their own behalf because of a medical condition or disability.
l Section 07.15.05, Application Signature.
Rewords some text under ”Signature Requirements” for clarity.
Adds a note to clarify that the authorized representative’s signature is not required for an application to be considered complete, but the person cannot serve as the authorized representative without signing the application.
Revises step 1 under ”Requesting a Signature” to state that unsigned applications should be pended on MAXIS in PND2 until the end of the processing period.
l Section 07.20, Processing Applications.
Rewords two sentences under ”What Does it Mean to Process an Application?” for clarity.
Rewords the Note under the first bullet of ”What is a Complete Application?” and adds an example of the type of question that need not be answered.
Rewords the third bullet to match the style of the first two bullets.
Under ”Application Processing Step 1- Review for Completeness,” removes instructions about requiring the original application for applications submitted via fax.
l Section 07.20.05, Date of Application.
Replaces the bullet in the introduction about the date of application determining the order in which applications are processed with a bullet stating that the date of application determines the processing period.
Removes the subsection ”Setting Date of Application - General Provisions” because the provisions differ by program. MinnesotaCare does not accept requests for coverage to set the date of application, while MA and GAMC do.
Updates the information under ”Setting Date of Application - MA/GAMC” to describe the minimum information needed on an application or request for coverage to set the date of application. Only the client’s name and address or another means to locate the client are required. Accept and pend requests that are not signed or dated.
Under ”Setting Date of Application - MCRE,” clarifies what the date of application is and adds that a written request to apply does not set the application date for MinnesotaCare.
Moves and rewords the definition of the date of application when the household reapplies within 11 months of closure.
Removes the statement about the order in which applications are processed, since this is a MinnesotaCare Operations procedure and not a general policy.
Under ”Setting Date of Application - MA/GAMC,” removes the information on pending the request and replaces it with a definition of the MA/GAMC application date.
Under ”Date of Application - Providers,” adds the information on pending requests on MAXIS that was removed from the previous subsection.
l Section 07.20.10, Pending an Application.
Revises the instructions for pending MA and GAMC applications to reflect that MAXIS no longer includes language on auto denial notices after 30 days about failure to attend an interview. Instead, the notice states the denial is for failure to follow through with the application process.
Adds to reinstate auto-denied requests if a completed application is received after 30 days but before the end of the processing period.
Adds to pend any application form for health care programs on PND 2.
l A-F.
Expands the definition of "60-day postpartum period" to fully reflect current policy. The 60-day postpartum period begins on the last day of the pregnancy and ends the last day of the month in which the 60-day period that began on the last day of the pregnancy ends.
Modifies the definition of ”application” to differentiate between application forms and requests for coverage.
Adds a definition of ”application assistor.”
Updates the definition of ”break in long-term care services” to include people who become ineligible for MA payment of LTC services.
Revises the definition of "continuous enrollment" for clarity. Definition now states that this is enrollment in MinnesotaCare, MA, or GAMC without a break in coverage of one month or more (rather than "with a break of less than one month").
Updates the definition of ”continuous LTC/EW period” to match the change in Asset Assessments.
l M-R.
Revises the definition of "postpartum period" to match the expanded definition of "60-day postpartum period." See "A-F" above.
Adds a definition of ”request for coverage.”
Chapter 03 - Eligibility Groups and Bases of Eligibility
This chapter contains several policy updates and clarifications. There are also corresponding glossary updates.
l Section 03 - Eligibility Groups and Bases of Eligibility.
Makes minor wording updates in the sentence beginning "For MinnesotaCare" and adds a link to section 03.35 in the sentence about Medicare Savings Programs.
l Section 03.05 - MinnesotaCare Eligibility Groups.
Adds the words "applicant or" to "enrollee" where applicable in the introductory section, and under "System Coding," adds a link to the MMIS User Manual.
Resequences some material for greater clarity. Under "Eligibility Group One," "Eligibility Group Two," and "Eligibility Group Four," moves paragraph about who is or is not exempt from insurance barriers to the end of each subsection (after the descriptions of who is included in each group). Also, under "Eligibility Group Two," moves bullet point about "parents or relative caretakers" below bullet point about "pregnant women."
See bulletin #07-21-10 above for information about additional updates to Groups One and Three.
l Section 03.05.05 - Change in MinnesotaCare Eligibility Group.
Under "Change in Income," adds sentence defining "next available month" for MinnesotaCare and adds links to the system coding material in section 03.05, MinnesotaCare Eligibility Groups for codes A2, A4, M2, and M4. Also revises the second sentence of the Stuart example to reflect current policy; verification of income changes between renewals is not required.
Adds a new subsection, "Change in Number of People in Household," to describe current policy regarding the possible impact on group status (especially for children) when the household size increases or decreases. Under "Child Turns 21," clarifies examples by adding further information about how to set up a new case for Donny, and deletes the Emily example.
See bulletin #07-21-10 above for information about additional updates to "Change in Parental Status" and "Child Turns 21."
l Section 03.15 - Enrollee Becomes Pregnant.
Revises wording of second sentence under "GAMC Enrollee Becomes Pregnant" to clarify when eligibility may begin.
Removes all but the first two sentences of step 3 under "MinnesotaCare Enrollee Becomes Pregnant." This material is now located in the "Verification" subsection of section 03.20.05, MinnesotaCare for Pregnant Women.
Updates the "Mary" example under "Effect of Pregnancy on MCRE Eligibility Group" by highlighting current policy that Mary will change to Group Four status only if the child continues to live with her. Also, in the bullet point beginning "If the pregnant woman is married" adds text to clarify current policy that her husband is considered a parent as well.
See bulletin #07-21-10 above for information about additional updates to "Effect of Pregnancy on MCRE Eligibility Group."
l Section 03.20 - MinnesotaCare.
Makes minor wording changes to clarify the differences between MinnesotaCare and Medical Assistance (MA) and adds a link to section 03.10, MA/GAMC Bases of Eligibility.
l Section 03.20.05 - MinnesotaCare for Pregnant Women.
In the introductory section, revises the second sentence in conjunction with the revised glossary definition of "60-day postpartum period." Also adds a link under "Eligibility Begin Date" to the section of the MMIS User Manual that describes the related system coding procedures.
Adds details of the current verification request process under "Verifications." This material was formerly located in section 03.15, Enrollee Becomes Pregnant.
Under "Citizenship/Immigration Status," makes minor formatting changes to highlight the link to section 11.15, Funding Health Care for Noncitizens. Also adds a link to section 28.05.05, Benefit Sets by Major Program.
Makes minor formatting and wording changes under "Household Composition" to emphasize current policy that the husband of a pregnant MinnesotaCare enrollee is considered part of a family household for MinnesotaCare. Also adds a link to related material in section 03.15, Enrollee Becomes Pregnant.
Under "Service Delivery," adds a note that, if an enrollee who becomes pregnant subsequently receives additional benefits for past months, she must contact the provider directly to bill DHS.
l Section 03.20.10 - MinnesotaCare for Auto Newborns.
Makes minor wording changes in the introductory section to highlight current policy that auto newborn status is available to children born to mothers who are enrolled in MinnesotaCare or Medical Assistance. Also makes minor wording changes under "Application Process" to clarify the process for a request for retroactive MA.
Under "Renewals," revises the Note to reflect the current procedure, and adds a link to the MMIS User Manual. Agencies are now notified about infants who are canceled for non-renewal with an InfoPac report rather than an e-mail from the MMIS Help Desk.
Adds a statement under "Premiums" that children under age two are not canceled for failure to pay premiums, and updates existing link to section 03.20.15, MinnesotaCare for Children Under 21, to link specifically to the "Premiums" subsection. Under "Service Delivery," adds a link to section 28.10.05.05, Adding a Newborn or Newly Adopted Child, for information on what to do if the mother was not enrolled in a health plan at the time of the birth.
l Section 03.20.15 - MinnesotaCare for Children Under 21.
Makes minor updates in the introductory section to remove extraneous system coding information and highlight correct auto newborn policy.
Under "Application Process," adds a statement to emphasize that, while clients ages 18-20 may apply on their own behalf, they are generally not considered a separate household if they live with a parent or relative caretaker. Also adds a link to section 17.10, Determining Household Size for MinnesotaCare (and under "Household Composition" below).
Adds a link to section 17.20, Adding a Household Member, under "Eligibility Begin Date" to highlight begin dates for some special situations. Under "Citizenship/Immigration Status," makes minor formatting changes to highlight the link to section 11.15, Funding Health Care for Noncitizens, and adds a link to section 28.05.05, Benefit Sets by Major Program.
Revises wording under "Premiums" about when other household members wish to re-enroll "after their four-month penalty period" to "or reapply after a break in coverage." Also adds text under "Other Requirements" about children who do not live with a parent or caretaker, and adds a link to section 16.05.15, Minor Child Lives Apart From Both Parents.
Under "End of Eligibility in Group," adds reminder about re-evaluating group status when children turn 21, and links to section 03.05.05, Change in MinnesotaCare Eligibility Group. Also adds text about premiums for children under 21 who are pregnant, and links to section 03.20.05, MinnesotaCare for Pregnant Women.
l Section 03.20.20 - MinnesotaCare for Adults With Children.
Clarifies that relative caretakers, foster parents, and legal guardians are considered MinnesotaCare adults with children if they:
n Reside with one or more children in their care (as opposed to whether they apply for MinnesotaCare with the children). See the introductory section for the revised language.
n Include the children as part of their own MinnesotaCare household. See "Household Composition" for this updated text.
Revises "Application Process" and "Household Composition" to eliminate redundant information. "Application Process" now contains only a brief statement with a link to "Household Composition" below, where the majority of the material is now located. Also adds a link to section 17.10.15, All or Nothing Rule, under "Household Composition."
Under "Citizenship/Immigration Status," adds a statement that legal guardians and foster parents are eligible for state-funded MinnesotaCare only. This statement was formerly under "Household Composition." Also makes minor formatting changes to highlight the link to section 11.15, Funding Health Care for Noncitizens.
Under "Covered Services," simplifies the text by replacing the phrase "parents, legal guardians, relative caretakers, and foster parents who apply with the children in their care" with "MinnesotaCare adults with children."
Adds the term "legal" to two uses of the term "guardian" to clarify relationship under "Other Requirements."
l Section 03.20.25 - MinnesotaCare for Adults Without Children.
In the opening paragraphs, adds a "note" to highlight that the husband of a pregnant MinnesotaCare enrollee is also considered to be a parent, and adds a link to section 03.15, Enrollee Becomes Pregnant.
See bulletin #07-21-10 above for information about additional updates to this section.
l Section 03.25.05 - MA for Pregnant Women.
Updates the first paragraph to add that some women may be eligible for SCHIP-funded MA, and notes the system coding distinction between SCHIP- and state-funded MA. Also updates the last sentence in conjunction with the revised glossary definition of "60-day postpartum period."
Adds information about the specific types of outstation locations that are available under "Application Process," and makes minor wording changes to the Rachel example under "Eligibility Begin Date," including a reminder to deny eligibility for September. Also specifies under "Social Security Number" that it is pregnant noncitizens who are eligible for SCHIP-funded MA or EMA who are not required to provide SSNs.
Makes significant updates to "Citizenship/Immigration Status" to correct and clarify the criteria for each funding source (federal, SCHIP, state) for MA for pregnant women, and describe when SCHIP- and state-funded MA are available for the pregnancy or postpartum period for noncitizens who do not qualify for federally funded MA. These updates include:
n Deletes the incorrect information that an undocumented or nonimmigrant status is a criterion for SCHIP-funded MA to reflect current policy. The only relevant criteria for SCHIP-funded MA pertain to other health insurance and spenddowns.
n Clarifies that access to other health insurance is not a barrier to SCHIP-funded MA; the pregnant woman must actually have other health coverage.
n Replaces the link to bulletin #05-21-09, Attachment B, with a separate document containing the same information.
Under "Insurance and Benefit Recovery," makes a correction by deleting the incorrect Note about an undocumented or nonimmigrant status leading to eligibility for only EMA. Also adds an Exception to describe current policy about SCHIP-funded MA not having cost-effective requirements.
Makes minor revisions to the text under "Income Guidelines" and "Deductions/Disregards" to emphasize current policy about when not to act on income increases, and when to consider eligibility with a spenddown.
Adds several paragraphs and an example under "Spenddowns" to describe and illustrate current policy about when and how to consider income for a six-month or monthly spenddown for a pregnant woman, and when to act on income changes.
Adds text under "End of Eligibility in Basis" to describe current policy on when to use the current or a new certification period to redetermine eligibility at the end of the 60-day postpartum period.
Under "Relationship to Other Groups/Bases," adds description of current policy for a woman who is eligible for MA for Breast/Cervical Cancer (MA-BC) and becomes pregnant. If she does not have a spenddown under a pregnant woman basis, she must change to that basis. However, if she does have a spenddown under a pregnant woman basis, she may choose to remain eligible with an MA-BC basis.
l Section 03.25.10 - MA for Auto Newborns.
Makes minor revisions to the introductory section to highlight that the mother must be enrolled for the birth month. Under "Renewals," adds a link to the "End of Eligibility in Basis" subsection to point to the related material there.
Updates text under "Verifications" and "Citizenship/Immigration Status" to match the current policy for citizenship and identify documentation that was updated in Manual Letter #6 for section 11.05, Verification of U.S. Citizenship.
Under "Household Composition," replaces "both parents" with "the mother" to more accurately reflect current policy. Also adds links to sections 17.20 (Adding a Household Member) and 17.25 (Removing a Household Member), and updates the example to reflect current policy that a new application is not required when redetermining MA eligibility under another basis.
Adds new instruction under "Service Delivery" on the steps to take if MA eligibility is declined for an auto newborn. Also adds instruction to document any exclusion in case notes.
In the example under "Other Requirements," adds a statement to highlight that Morgan would qualify for Title IV-E foster case funding, and links to section 03.25.20, Foster Care. Adds a statement under "Other Groups/Bases to Consider" to reflect current policy that all children under age 21 have an MA basis of eligibility.
l Section 03.25.15 - MA for Children Under 21.
Adds new information under "Income Guidelines" about when MA is funded with SCHIP funds for some children ages 0-2. No worker action is required.
See Social Security Number above for further updates to this section.
l Section 03.45.30.10 - Presumptive Eligibility Providers for MA-BC.
Updates the list of providers who participate in the Sage Screening Program and have registered with DHS to become presumptive eligibility providers for Medical Assistance for Breast and Cervical Cancer (MA-BC).
Some of the material in these sections has been revised and rearranged for greater clarity. Although there are extensive text changes and additions, asset assessment policy remains the same. Major revisions are noted below.
l Section 19.45 - Asset Assessments.
Adds introductory material describing the three steps of the asset assessment process.
Updates the "Definitions" of long-term care spouse and community spouse to match the glossary definitions. Also adds a link to section 23.20, Long-Term Care Consultation, to the definition of that term.
Rewords the explanations of when estimated and actual spousal asset allowances are calculated.
Updates the definition of continuous LTC/EW period and eliminates repetitious material elsewhere in the section for consistency and clarity. The policy is unchanged.
Changes references to "applying for MA" to "requesting MA payment of LTC services."
l Section 19.45.05 - Asset Assessment Determination.
Changes ”r;spousal asset allowance” to ”r;community spouse asset allowance” in the title of the second subsection and throughout the text.
Rearranges the text under "Evaluate Effective Date Assets" so that the list of assets to exclude from the asset assessment precedes the list of counted assets.
Revises and consolidates the information on treatment of trusts in the asset assessment. Count the value of trusts that do not meet the definition of special needs trusts on the date of the assessment.
Adds an example of treatment of an unavailable asset in the asset assessment.
Clarifies that the community spouse asset allowance is finalized at the time the LTC spouse first requests MA for payment of LTC services, which may or may not be at the time of the initial MA application.
Adds a new subsection, "Conversion of Assets from Excluded to Not Excluded," on how to treat excluded assets that are converted to a non-excluded status after the asset assessment is completed.
l Section 19.45.10 - Spousal Asset Determination.
Moves the material on treatment of retirement funds and annuities to the first subsection, ”Asset Calculation – Initial Application” and replaces a retirement fund example with an annuity example.
Rewords and rearranges the instructions for transferring income-producing assets and adds an example.
Changes references to "applying for MA" to "requesting MA payment of LTC services" and changes ”spousal asset allowance” to ”community spouse asset allowance” throughout the text.
Revises the instructions for the ongoing division of assets to clarify how to treat the community spouse’s assets after the initial approval of MA payment of LTC services for the LTC spouse.
Chapter 21 - Income Calculation (Community)
l Section 21.35 - Medicare Savings Programs Income Calculation.
Adds the spousal and family member allocation deductions for LTC/EW under unearned income. They were previously incorrectly listed only under earned income.
Chapter 22 - Standards and Guidelines
l Section 22.05.50 - 280% FPG.
Adds a link to the new SCHIP funding information in section 03.25.15, MA for Children Under 21.
Chapter 23 - Long-Term Care (LTC) and Elderly Waiver (EW)
l Section 23.40.20 - LTC Needs Allowance.
Revises the "Home Maintenance Allowance" subsection to clarify that, although the DHS-1503 estimates the length of a nursing home stay in days rather than months, the time period that determines whether a client qualifies for the home maintenance allowance is three full calendar months rather than 90 days. Modifies both text and examples throughout the subsection to reflect this.
Clarifies that the home maintenance allowance can only be used by clients who are temporarily residing in long-term care facilities (LTCFs), not in other facilities such as board and care, assisted living or GRH facilities.
Adds that EW enrollees who move temporarily from board and care, assisted living or GRH facilities to LTCFs can receive the home maintenance allowance if they meet all of the conditions. Adds an example to illustrate this.
Modifies the last example to clarify that the three-calendar-month period does not change when all or part of an LTCF stay is paid by insurance.
l Section 23.40.40 - LTC Family Allocation.
Changes the title of the subsection ”Children Not Living with The Community Spouse” to ”Children Not Living with A Community Spouse” and makes corresponding changes where applicable throughout the section. The purpose of these changes is to clarify that the family allocation is available regardless of whether there is a community spouse.
Chapter 28 - Health Care Service Delivery
l Section 28.15.30 - Adding/Removing People From Managed Care.
Replaces the second sentence of the Note under "Adding a Newborn" with a link to the updated instructions in section 03.25.10, MA for Auto Newborns.