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For policy issues contact the designated Health Policy Specialist:  Table IX

October 2018


What's New

503 Household Size and Asset Limits
503-3 How to Apply the Asset Limit (deleted)
Table II - ABD Figures, Income Limits and Other Important Figures
Table VII - Income Limits for Medical and Cost-Sharing Programs
  • QMB, SLMB and QI income limits were removed from 503 and added to Table II.
  • 503-3 has been deleted and this information is in 503.
  • QDWI asset limits were added to Table II.
  • QDWI income limits were added to Table VII
521-19 Conversion of Assets (renamed)
531-3  Sales Contract Lump Sums (renamed)
  • Clarified what is countable when converting an asset.
  • Extensions have been changed and to be granted by DOH.
Table II-A LTC Institutional & Waiver Income Limits and Other Important Figures
  • Utility allowance was updated for the HCB shelter deduction.
Table XVII - TAM Agencies
  • DCFS was added to be able to complete the 42A and 43A.
Table XVIII - IMD's With a Licensed SUD Treatment Program
  • The Haven was added as an approved IMD/SUD facility.  

September 2018

107-3   Assign Rights to Medical Benefits and Medical Support
225-1   TPL Requirements of Applicants
225-4   Good Cause for Non-Cooperation with TPL
903-10  TPL Requirements
  • Removed the signature requirement for TPL.  TPL information can be given verbally.
Table VIII  Verification and Interface Match
  • Added what is acceptable documentation to verify tribal member status for descendents.  

August 2018

Table II  Aged, Blind and Disabled Figures
  • 1619b threshold was updated.  
Table VII  Income Limits for Medical Assistance & Medicare Cost Sharing Programs
  • Threshold for 'Dependents Expected to File' was updated.   

103 Employee Requirements

801-1 Case Record Requirements

  • Updated requirements for actions that require case narration.  
731-3 Client Statement Verification
  • Added situations of when self-attestation of verification will be excepted.

900 Q&A PCN Open Enrollment Periods

  • Open enrollment for all adults in the month of August

July 2018

Table II-A Long Term Care Institutional And Waiver Income Limits and Other Important Figures
  • Minimum Spousal Needs Standard changed to $2,058
  • Spousal Needs Allowance Shelter Standard changed to $618  
Table XVII TAM Agencies
  • Bear River Health Department is being added to complete all questions on 43A.
  • Cache County Jail is being added to complete question 1 on the 43A.  

105 Rights of Applicants and Recipients

107 Responsibilities of Applicants and Recipients

107-6 (Deleted as it was a duplicate)

226, 226-1, 226-2, 226-3 (Obsolete and information moved to 601)

415-8 Applying Rules for Medical Bills

600 Program Benefits and Services

601 Health Plan Selection and Education

602 Medicaid Member Card (New section)

603 Medicaid Benefits

603-1, 603-2, 603-4, 603-5 (Obsolete and information moved to 600, 601 and 602)

631, 631-1, 631-2, 641-1, 641-2 (Obsolete and information moved to 600)

651-3 Mileage Reimbursement for Travel

910 Program Benefits & Education

910-1 Cost Sharing Requirements

Resource - 223-1 Medicare

Resource - 603-1 Medicaid Benefits (Obsolete)

Table III Covered Medications (Obsolete)

Table VIII Verification and Interface Match

  • Reorganization of information regarding benefits and services.  


June 2018

346 Targeted Adult Medicaid
  • Clarifying that one is eligible for TAM coverage even though they are eligible for (but not receiving) a Medically Needy program.  (program hierarchy)  Adding this to 346 as it was already stated in policy in 715. 
Resource - Household Summary for Family Related Medicaid Programs
  • This is an updated resource/chart which used to exist in policy prior to ACA legislation. It compares household composition with who will be receiving benefits on the specific program.
205 Citizenship and Alien Status Requirements
Table IV Proof of Us Citizenship and Identification
  • Adding the reasonable opportunity period for documentation of immigration status.
  • Updating the verifications of citizenship and what documents can be accepted.
Table XVIII IMD's With a Licensed SUD Treatment Program
  • Adding Foothill Residential Treatment Center to Table XVIII as they are an approved IMD/SUD under UT County Drug and Alcohol.
320-4 QI
  • Do not open QI if the client is receiving Medicaid.
Table XVII TAM Agencies
  • Adding Psychiatric and Behavioral Solutions (PBS) for Form 43A Utah County Jail for question 1 on 43 A.


May 2018

205-3 Verification of Alien Status
  • Form G-845 is no longer an acceptable verification of alien status.  Policy has been updated to reflect the new process of verifying non-citizenship status.
Table XVII - TAM Agencies
  • Iron County Care and Share approved to complete the Chronically Homeless form (42A).
  • U.S. Probation approved to complete the Justice Involved form (43A).


April 2018

227-1 Cooperation Requirements
227-2 Refusal to Cooperate with MSE
227-3 Good Cause for Refusal to Cooperate
  • Clarified policy on when to require a pregnant woman to cooperate with MSE.
223-2 Application for Part B Medicare
409-1 Health Insurance Premiums
731-7 Verification of SSA Benefits
Resource 223-1 - Medicare
  • Removed procedural language concerning Medicare Numbers, as SSA will no longer use the SSN as the Medicare Number.

349 Pregnant Woman Catergory

721-4 Time Limited Program
815 Changes
827 Eligibility for Other Programs
  • Clarified that a pregnant woman on any Medicaid program should not lose coverage through the postpartum period.
  • Clarified the postpartum period should be looked at when a woman applies for coverage after giving birth.


March 2018

412-2 When do we not Deem Income from a Spouse for ABD and Cost-Sharing Programs
  • Clarified cash contributions the waiver spouse makes to the community spouse are countable as income.
Table II - Aged, Blind and Disabled Figures
Table II-A - LTC Institutional and Waiver Income Limits and Other Important Figures
Table V - Sponsor Deeming
Table VII - Income Limits for Medical Assistance & Cost-Sharing Programs
Table VII-A - Medicaid Work Incentive
Table VII-B - 5% FPL Deduction Amount
  • Updated tables with the new FPL figures.
Table XVIII - IMD's with a Licensed SUD Treatment Program (New)
  • A new table has been created listing the IMD's that a client can reside in and still be eligible for medical coverage.
900 Q&A - PCN Open Enrollment Date
  • PCN open enrollment for adults with no children ended as of February 28, 2018.  Open enrollment for adults with children is still ongoing.


February 2018

Table VIII - Verification and Interface Match
  • Clarifying that the Indian Health Services (IHS) face sheet as verification of American Indian identity.
Table XIV - Hospitals Authorized to Approve HPE
  • Added Central Valley Medical Center to table.
900 Q&A - PCN Open Enrollment Date
  • PCN open enrollment for all adults is February 1 - February 28, 2018


January 2018

450-3 Whose Income Counts for the MAGI Household
Table VII - Income Limits for Medical Assistance and Medicare Cost-Sharing Programs
  • Filing threshold income limits were added to Table VII.   A link to that table was also added to 450-3.

500 Asset Requirements (re-titled)

503 Applying the Asset Limit  (was 503-3)(re-titled)

503-1 Whose Assets to Count (was 585)

503-2 When Assets Must be Below the Asset Limit

503-4 Declaration of Assets (deleted)

731 Verification

731-1 Electronic Verification (re-titled)

731-2 Who Must Provide Verification (deleted)

731-3 Client Statement Verification (re-titled)

731-5 Collateral Contact Verification (re-titled)

731-6 U.S. Treasury Regulations and Verification (deleted)

Table VIII Verification and Interface Match

  • Changing how items that must be verified at initial application for ABD are handled.
  • Currently, 503-4 states that all assets at ABD initial application must be verified with hard copy for ABD.  Other sections state that client statement is an acceptable form of verification and hard copy is not necessary.

  • Consolidated the verification items into one area of policy instead of having them scattered around.  Content did not change, just moving them to put it all on one area.
721-1 Conducting an Eligibility Review
  • Clarified when to take action on a positive change.  This lines up with policy in 815.

1008 Certification Periods
1009-1  Reportable Changes
  • UPP health insurance coverage verification timeframe has been changed to be completed semiannually and will be completed by ORS.
Table II - Aged, Blind and Disabled Figures
Table II-A - LTC and Waiver Income Limits
Table VII - Income Limits for Medical Assistance and Medicare Cost-Sharing Programs
Table XI - Pickle Reduction Figures
  • Tables were updated with the yearly COLA figures for 2018.



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What's New 2011