STATE OF ALASKA

Department of Health and Social Services

Division of Public Assistance

TRANSMITTAL NUMBER:   MC #24

MANUAL:  Aged, Disabled and Long Term Care Medicaid Eligibility Manual

DATE:  March 1, 2012

We are making several changes to clarify existing policy as a result of suggestions from the field. 

Highlights of these policy revisions are described below. If you have any questions please contact the Policy and Program Development Team at 465-3382 or email dpapolicy@alaska.gov.

OVERVIEW OF CHANGES

MS 516  Retroactive Medicaid

• Adds language to indicate that the eligibility criteria for the same category of Medicaid the family is currently receiving or was receiving at the time requested is used in determining eligibility for Retroactive Medicaid.

MS 520-A  Application and Review Process

• Adds two exceptions to the APAAdult Public Assistance application requirements to clarify that a new application is not required when: (1) an individual is already part of an active public assistance case and the existing case file already includes the information needed to make a prospective Medicaid determination.  (2) the individual is already a Medicaid recipient in another eligibility category.
• Adds an exception to the APAAdult Public Assistance interview requirements for applicants to clarify that if a client has an active public assistance case, an interview is not required unless the caseworker feels it is necessary to correctly determine eligibility.

MS 528  Processing Cases with Trusts

• Revises language to throughout this section indicate that a copy of the trust document must be emailed to dpapolicy@alaska.gov for review and approval.  The current policy requires trust documents to be faxed to the Medicaid Eligibility Program Officer or designee.

• Revises language to indicate throughout this section that trust information that is required to be sent to the DHCSDivision of Health Care Services TPLThird Party Liability unit must be emailed to dmatpl@alaska.gov.  The current policy requires trust documents to be faxed to the DHCSDivision of Health Care Services TPLThird Party Liability unit.

• Removes three notes in subsections B, C, and D that states to contact the LTCLong Term Care Coordinator to get the MED 21, 22, and 23 brochures.  These are now available on eForms so these notes are obsolete.

• Removes B(4) and C(5) because this language is now found in A(6) which provides general case processing procedures.

MS 528-D  Processing Renewals with Trusts

• Adds language to step 6 that requires the M140 notice to be sent in addition to the M144 notice when processing renewals for cases with a QITQualifying Income Trust.  The M144 notice states that a separate notice will be sent explaining the amount of money that the client may access for living allowance and there is not another notice that currently meets this requirement.

MS 528-G  Trust Changes

• Adds a note to indicate that caseworkers must request and obtain a copy of the court document showing that the court approved revisions to an irrevocable trust.

MS 533  Disabled Children at Home (TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248)

• Removes AKA acronym from the section title because it is not needed.

• Revises language in the first paragraph to indicate that caseworkers in the LTCLong Term Care unit process TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 cases.  Previous policy stated that designated caseworkers in each DPADivision of Public Assistance region process TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 cases.

• Removes language throughout this section that states that the LTCLong Term Care Coordinator is in Field Services because this position is now in Policy and Program Development, but the information is not necessary.

• Replaces “Long Term Care” with the LTCLong Term Care glossary term where appropriate throughout this section.

MS 533-A  TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 Eligibility        

• Adds exceptions to the APAAdult Public Assistance income and resource policies for Coverdell funds, 529 plans (also known as a Qualified Tuition Program), and UTMA/UGMA accounts used when determining TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 eligibility.

• Adds an exception that indicates that only the TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 child’s income and resources are countable for TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 eligibility.  

MS 533-C  Referral and Interagency Communications

• Adds language in subsection 3 that indicates that if the DDSDisability Determination Service decision is a denial of disability, the DPADivision of Public Assistance LTCLong Term Care Coordinator will issue a closure letter to the parent(s).

• Adds language in subsection 4 that indicates that the DPADivision of Public Assistance caseworker is responsible for sending the MED 15 and entering a CANOCase Notes stating that both the MED 15 and MED 16 were sent to the parents or guardian whenever an application is received for TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 Medicaid. 

MS 533-E  TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 Reviews

• Revises language to indicate that TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 cases now have a twelve-month continuous eligibility period.   Previous policy indicated that TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 cases had a six-month continuous eligibility period.   

MS 534-C  Income

• Adds a note to clarify that an income allocation for an ineligible child is not allowed in the Family Income Test because income allocations are part of the APAAdult Public Assistance spousal deeming process.  Includes a link to APA Manual Section 460-5A.

MS 534-K  Example of an Eligibility Determination

• Updates the Income Standards to the 2012 amounts throughout this subsection. 

MS 534-M  Example of an Eligibility Determination with a Medicaid Qualifying Trust  

• Updates the Income Standards to the 2012 amounts throughout this subsection.  

MS 553  Preventing Spousal Impoverishment

• Updates the Maximum Community Spousal Resource Allowance to the 2012 standard of $113,640 in the examples in subsection D.   Previous manual uses 2004 standard of $92,760 which is outdated.

• Removes the terms “Long Term Care” and “Home and Community-Based” because they are duplicated by glossary terms and clutter up subsections D, E, F, and G.

MS 554  Transfer of Assets

• Removes the language about how to treat a transfer of asset for less than fair market value before implementation of the Deficit Reduction Act of 2005 provisions in subsections D, E, and L.  By February 2011, any transfer of assets for less than fair market value will require a 60-month look-back period.

• Renumbers remaining examples as 1- 10 throughout this section due to deleted policies.

MS 554-J  Life Estates

• Updates the link to the current life estate tables published by SSASocial Security Administration at https://s044a90.ssa.gov/apps10/poms.nsf/lnx/0501140120.

MS 560-B  HCBHome and Community-Based Waiver Types

• Revises language to indicate that there are five types of HCBHome and Community-Based waivers.  Previous policy stated that there were four types of HCBHome and Community-Based waivers.

• Adds FASDFetal Alcohol Spectrum Disorder waivers as a type of HCBHome and Community-Based waiver.

MS 560-C  Eligibility for HCBHome and Community-Based Waiver Services

• Adds FASDFetal Alcohol Spectrum Disorder waivers as a type of HCBHome and Community-Based waiver.

MS 560-F  HCBHome and Community-Based Waiver Services and Institutional Eligibility

• Adds a note that indicates that the Preventing Spousal Impoverishment (Section 553) and Post-Eligibility (Section 570) policies do not apply to FASDFetal Alcohol Spectrum Disorder waivers.

MS 561-F  APD, MRDD, or OA Waivers with APA Cash Assistance

• Corrects AO waiver to OA waiver in title.

MS 561-I  FASDFetal Alcohol Spectrum Disorder Waiver

• Adds new policy for FASDFetal Alcohol Spectrum Disorder waiver EISEligibility Information System codes.

MS 562  Processing HCBHome and Community-Based Waiver Cases

• Revises the policy to state that all HCBHome and Community-Based waiver cases have a twelve-month review period in subsections B, J, and L.  This policy changed a while ago, but a few references to a six-month review period were not changed.

MS 562-B  Processing HCBHome and Community-Based Waiver Cases When a DDS Determination is Pending  

• Removes language that states that the LTCLong Term Care Coordinator is in Field Services because this position is now in Policy and Program Development, but the information is not necessary.

MS 562-F  Processing HCBHome and Community-Based Waiver Cases for Title IV-E Eligible Individuals

• Adds the word “Title” before “IV-E” in step 3 for clarity.

MS 562-K  Processing FASDFetal Alcohol Spectrum Disorder Waiver Cases

• Adds new section K that provides processing procedures for FASDFetal Alcohol Spectrum Disorder waiver cases.  Includes information on the benefit start date, a list of notices, and HCBHome and Community-Based waiver policies that do not apply to the FASDFetal Alcohol Spectrum Disorder waiver type.

• Renumbers remaining sections as 562-L to 562-N.

MS 570-F  When a Cost-of-Care Liability Begins and Ends

• Clarifies that if only a screening coupon is issued for a benefit month, the caseworker must notify the EISEligibility Information System Help Desk to add a cost-of-care liability amount on the EISEligibility Information System COCACost of Care screen for that month.

MS 570-H  Nursing Home Examples

• Updates the Community Spouse Monthly Maintenance Need Standard to the 2012 amount of $2,841.00 in example 2.

MS 570-J  Home and Community-Based Waiver Case Examples  

• Updates the Community Spouse Monthly Maintenance Need Standard to the 2012 amount of $2,841.00 in example 1.

• Updates the Special LTCLong Term Care Income Standard to the 2012 amount of $2,094 in example 2.

Addendum 1  Program Standards

• Corrects the 2012 Special Long Term Care Income Standard from $2,095 to $2,094.

• Corrects the 2012 Monthly Need Standard for Additional Household Members from $913 to $947.

• Updates Federal Poverty Guideline Table for 2012. 

• Updates Pickle Amendment Table to show new reduction factor amounts through December 2011.

Addendum 5  Medicaid EISEligibility Information System Notices

• Adds missing notices to the table:

M321 - Pend Waiver Start - Child on DKCDenali KidCare

M724 - Waiver Services Denied – Medicaid Cont.

• Corrects number of RPTCResidential Psychiatric Treatment Center Waiver: Info Needed – FMFamily Medicaid/DKCDenali KidCare Child notice from M321 to M323 and reorders the table.