MEMORANDUM
DATE: March 21, 2005
TO: All Family Medicaid Manual Holders
FROM: Policy and Program Development Team
Ellie Fitzjarrald, Chief
SUBJECT: Family Medicaid Manual Change #30
This manual change implements new policy on estimating income and child support assignment and cooperation. It updates the Income Standards in Addendum 1 with the 2005 Federal Poverty Guidelines for Alaska and adds Addendum 3 listing the Family Medicaid subtypes. Third Party Liability and Recovery policies are merged into Section 5065, and information about Medicare coverage is removed as it is located in the Aged, Disabled, and Long Term Care Medicaid Manual. Highlights of these policy revisions are described below.
If you have any questions, please contact any member the Policy and Program Development Team at 465-3347 or email us at dpapolicy@health.state.ak.us.
Estimating Income
Two recent fair hearing decisions identified an inconsistency between our policy and the federal food stamp regulations for estimating income in the application month. This change corrects that policy. Application month income will no longer be determined based on the amount of income received by the interview date. Instead, the policy for estimating income will be the same for the application month and subsequent months.
In addition, we have clarified and simplified the manual sections. The conversion factors section is simplified by addressing only the two factors that truly convert income to a monthly amount – bi-weekly 2.15 and weekly 4.3, i.e., the third and fifth paycheck situations.
We are adopting these changes for the Food Stamp, APA , ATAP and Family Medicaid programs, so that policy is still aligned, with one exception. The Family Medicaid program prohibits the use of conversion factors when converted income causes Medicaid ineligibility.
The new policy for estimating income in the application months may be applied right away, however, it must be applied to all applications processed on and after May 1, 2005.
Child Support Assignment and Cooperation
In response to changes at the Child Support Services Division, errors found through the QARC process, and policy questions from staff, this chapter has been rewritten to clarify and improve the presentation of policy. It has been aligned in the Temporary Assistance and Family Medicaid manuals as much as possible.
A number of the changes made clarify the processing of child support forms and the effect of noncooperation. Even if the caretaker does not cooperate with child support requirements, children are still included in the case and benefits approved, if otherwise eligible. A penalty is imposed on the caretaker, if included in the case, and they do not have good cause for not cooperating. CSSD will still pursue enforcement of a child support or medical support order without the caretaker’s cooperation unless good cause is established.
OVERVIEW OF CHANGES
5016 – Child Support Cooperation
Changes references from the Child Support Enforcement Division (CSED) to the Child Support Services Division ( CSSD ).
Removes references to the APA -related Medicaid categories.
Replaces the term “absent parent” with “noncustodial parent”.
Replaces the term “specified relative” with “caretaker relative”.
Adds section about the Child Support Information form CSED 1603a .
Updates and adds to the process of obtaining the completed CSED 1603a form, providing the opportunity for the caretaker to claim good cause, and entering information into EIS concerning the noncustodial parent.
Adopts Temporary Assistance guidance of accepting a caretaker’s statement of good cause if the claim is not questionable.
Includes an e-mail contact at CSSD for good cause decisions made after eligibility has been determined.
Clarifies that a penalty is imposed on the caretaker included in the case if they do not have good cause for not cooperating with CSSD , and that CSSD will still pursue enforcement of a child support or medical support order without the caretaker’s cooperation. The application is NOT denied or the children excluded due to the lack of CSSD cooperation.
5050 – Complaints Of Quality Service
This section is removed. Complaints of quality service are managed by the Division of Health Care Services.
5060 – Medicare Coverage
This section is removed. Medicare coverage is included in the Aged, Disabled and Long Term Care Medicaid Manual.
5065 – Medical Resources
This section is renamed Third Party Liability ( TPL ) and Recovery, and incorporates information previously located in Section 5070.
5070 – Third Party Resources Recovery
This section is removed. Information from this section is included in Section 5065.
5160-1 – Determining The Household’s Monthly Income
Changes the policy for determining the household’s monthly income.
Reorganizes and expands some sections to better explain how averaging is used in converting and estimating income.
Includes a reminder that Family Medicaid policy requires the worker to determine Medicaid eligibility by disregarding the third or fifth payment if using converted income causes the household to exceed the Medicaid income limit.
Replaces the estimating income in application month policy with expanded sections on policy for estimating full and partial month’s income.
Updates policy on using work schedules instead of pay history to apply to any situation when changes occur that result in the pay history no longer reflecting the income the individual expects to receive.
5162-1 Child Support Income
Clarifies how to count child support payments and pass-through payments received by applicants and recipients.
MANUAL CHANGE FILING INSTRUCTIONS
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Table of Contents, pgs iii-ix |
Table of Contents, pgs iii-ix |
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GP-11a – GP-11l |
GP-11a – GP-11n |
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18 -- 26 |
GP-18 – GP-26 |
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Addendum 1 – Denali KidCare Income Standards |
Addendum 1 – Denali KidCare Income Standards |
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Addendum 2 – Self-Employment Income and Transitional Medicaid Income Standards |
Addendum 2 – Self-Employment Income and Transitional Medicaid Income Standards |
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Addendum 3 – Family Medicaid Subtypes |
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