Obsolete What's New 2014

 

November 2014

410-2 Self Employment Income
412-4 Calculating Income for MAGI Based Programs
When determining reasonable compatibility, if the test indicates the client is eligible for CHIP, the worker will use the electronically verified amount to determine the CHIP plan.
700-1 Presumptive Eligibility for Children The Presumptive Eligibility Program for children determined by DHS will end October 31, 2014.

 

 

September 2014

 

402-4 Unearned Income Exclusions

402-8 Cash Contributions and Gifts

412-1 Income for MAGI Methodology

412-3 Whose Income Counts for MAGI Household?

o      Recurring cash contributions given to tax dependents by the tax filer when that tax dependent is not the spouse or child of the tax filer are counted as income to the dependent in the full amount when that average is more than $300 per month.  One-time payments or amounts averaging less than $300/month are not counted as income to the dependent.

o      If the MAGI-based income of such a tax dependent has to count toward the tax filer's household income (because the tax dependent is expected to be required to file a tax return), DO NOT INCLUDE the amount of the cash contribution from the tax filer.

 

 

June 2014

220-8 Termination of Health Insurance Coverage

o      The HIP program no longer exists.  HIP language was removed from the Medicaid and CHIP policy manuals.

o      The language regarding 2011 premiums and the hold harmless provision was removed because it is no longer applicable.

402-1 Examples of Unearned Income

402-4 Unearned Income Exclusions

402-10 Educational Income

410  Earned Income

410-8 Earned Income Exclusions

412-1 Income for MAGI Methodology

412-2 Income That Does Not Count (Obsoleted)

o      Earned in-kind income counts, and unearned in-kind income does not count for MAGI programs.

o      Personal services such as house cleaning, baby sitting, etc., which are done sporadically, without intent to establish self- employment, and render nominal amounts of money are not considered self-employment income.

o      Educational loans and Workers’ Compensation are not sources of countable income for MAGI programs.

o      The Medicaid 405-1 section had an incomplete sentence regarding non-taxable deferred wages for MAGI-based programs. This sentence was completed with a complete thought.

Table I-A

Tables have been modified to match the 5% income disregard amounts with the methodology used in the erep calculation.

 

 

May 2014

220-4 Access to Employer Sponsored Health Insurance When determining the cost of coverage for available health insurance include the amount of the deductible.

 

 

April 2014

120-3 Fair Hearing Requests

120-5 Benefits Pending a Hearing Decision

o        Continue CHIP or Medicaid assistance if the client asks for a hearing any time before the effective date of the action or by the close of business on the 10th day after the date the Notice of Decision is received, whichever is later.  The date which the notice is received is considered to be 5 days after the date on the notice, unless the client can show he did not receive the notice within that 5 day period.

o        If the client can demonstrate that he or she did not receive the Notice of Decision in the mail, mail a new notice of decision and allow the enrollee 15 days from the mailing date of this notice to request the hearing and continued CHIP or Medicaid benefits. 

210 Age of a Child

o        Policy is clarified to state that the month in which a customer turns 19 is the first month they may have PCN.

o        If a customer applies during open enrollment and turns 19 in the application month, the customer may receive Medicaid or CHIP in the month of application and PCN in the month following.

o        A new application is not required.

o        All factors of eligibility must be considered when determining eligibility for the individual’s PCN.

220-4 Access to Employer Sponsored Insurance

The countable income, after any applicable 5% disregard is deducted, is used when determining the cost of available health insurance.

220-8 Termination of Health Insurance Coverage

Clients are not required to reapply after their 90 days sanction for voluntary termination of health insurance has passed.

412-4 Calculating Income for MAGI-Based Programs

The 5% disregard will only be deducted from CHIP Plan C.

601-1 Cost Sharing Requirements

The maximum dollar amount in co-payments, deductibles and quarterly premiums an individual is required to pay per certification period is no more than 5% of the individual’s total annual countable income that was used to determine eligibility for the certification period.  If the 5% disregard was applied in the calculation of countable income, the amount of income before the application of the 5% disregard is the income used when determining the out of pocket maximum.

601-2 Quarterly Premiums

The period of time that clients are ineligible for CHIP due to unpaid CHIP premiums is changing from 12 months to 3 months.  Unpaid premiums can’t be collected after 3 months.

702-1 Transitions from CHIP to UPP, Medicaid or PCN (renamed)

703-1 Length of the Certification Period

Policy has been simplified to explain what is required to move clients between the PCN, CHIP, UPP and Medicaid programs.  This was done to align the programs’ requirements.  Policy clarifies when a new income determination, access to insurance test, lack of a break in coverage and open enrollment are requirements in order to transition from one program to the other.

 

 

March 2014

These Tables have been updated to reflect 2014 FPL changes

 

February 2014

2013 Policy

2013 Policy has been moved into the Obsolete policy folders.

Obsolete Policy

Obsolete Policy deleted before 2010 has been deleted. Contact Linda Asa if you need the old policy.

 

January 2014

220-8 Termination of Health Insurance Coverage

New exceptions to the 90 days sanction period for voluntarily terminating health insurance have been added to CHIP policy. 

·       The premium paid that includes the CHIP childl exceeds 5% of the total household income.

·       The cost of the premium and deductible that includes the CHIP child exceeds 9.5% of the total household income.

·       Individuals are determined eligible for APTC’s through the FFM because employer sponsored insurance is determined unaffordable.

·       The CHIP child has special healthcare needs.

·       Coverage was lost due to the death or divorce of a CHIP parent or UPP individual.

Added examples regarding involuntary termination of coverage:

·       An employer stopped offering coverage under an employer- sponsored health insurance plan.

·       A change in employment, including involuntary separation, results in the loss of employer-sponsored insurance

704 Eligibility Review

·       For CHIP, when completing a review for Jan., Feb., and March 2014 benefits, if an individual fails eligibility using the MAGI methodology, apply the 2013 rules to the program and if eligible, re-certify the program for the 1-year certification period.

 

·       Reviews in 2014 for both MAGI-based and non-MAGI-based coverage groups and for all CHIP cases will require client participation.  The review policies have been modified to explain this.  Sometime, during 2014, we intend to start ex parte reviews for non-MAGI-based Medicaid groups, which do not require clients to participate in the review.  For now though, all reviews will require the client to respond to the review.

 

·       If a child is eligible for Medicaid in December 2013, and could be eligible for CHIP except for the fact that the child has other health insurance, we must provide one year of CHIP coverage for the child even though the child has health insurance.

804 Changes

804-5 Income Changes

·    Redetermine eligibility when an income change is reported if the client asks for Medicaid or requests a new income determination.  Gather the information needed to make a MAGI determination.  If the child is eligible for Medicaid or a lower cost CHIP plan, change the child's coverage.  If the income change would make the child ineligible for CHIP, do not process the change until the next review.

Table I-A 5% Federal Poverty Level Deduction Amount

A new table was created to store the 5% FPL deductions; it is titled Table I-A 5% Federal Poverty Level Deduction Amount.