Kansas Department of Social
and Rehabilitation Services
Gary Daniels, Acting Secretary
Integrated Service Delivery - Candy Shively, Deputy Secretary (785)
Economic and Employment Support - Bobbi Mariani, Director
EES Chiefs and Staff
March 16, 2005
Implementation Instructions for Poverty Level Increases
This memo provides implementation instructions for the increases
in the federal poverty level standards which take effect
May 1, 2005.
POVERTY LEVEL CHANGES
- Medicaid Poverty Level, HealthWave, QMB, LMB, and
QWD Programs - The following instructions
are for the increases in the federal poverty level
standards in the Medicaid poverty level, HealthWave,
QMB, LMB and QWD programs. These new standards also
the minimum community spouse income allowance and the
dependent family member allowance under the spousal
effective May 1.
The poverty level table in KAECSES will be updated on 03-18-05
to incorporate the new poverty level amounts effective 05-01-05.
Eligibility for any cases copied into May, 2005 after this date
was computed using the new poverty level amounts. The Medicaid
poverty level/HealthWave, Working Healthy and QMB programs are
affected by this update. Since eligibility for the LMB and QWD
programs is determined manually, automated processing for these
programs as well as the spousal impoverishment changes, are not
affected by this action.
- Medicaid Poverty Level and HealthWave
Programs - Because changes in the poverty level
standards will not impact the majority of
poverty level eligibles, except for certain premium payers
at noted below mass change will not occur
for the MP program. Because
changes in financial eligibility do not effect eligibility
until the end of the family continuous
are not transferred from HealthWave XXI to Medicaid or vice
versa solely because of the change in
poverty standards. No coverage
changes are made at this time unless a child is at the end
of his/her continuous eligibility period.
Because ongoing cases
will rebudget based on the new amounts if PLID is accessed
for the benefit of May or later, staff
need to be aware that poverty
level percentages may be altered but medical subtypes should
remain unchanged. Although this could result in some inconsistency
in the information present on the system, eligibility will
not automatically change.
As indicated previously, certain HealthWave XXI households
assigned a family premium amount may be impacted by
this change. If the change in poverty
standard results in a decrease in the family’s poverty level percentage
so that the premium amount is either reduced or eliminated, action should
be taken to reflect that change. Cases currently in premium status with
participating individuals who fall between 151% -157% of poverty or 176%
-182% of poverty are to be reviewed by staff in order to determine if the
premium amount will be adjusted. To assist with this review a printout listing
all cases meeting this criteria will be produced and sent electronically
to the Regional Report Distribution List the week of April 11, 2005. These
cases are to be rebudgeted under the new standard prior to the first medical
card cutoff for May on April 21, 2005. Any necessary premium changes are
to be made effective May, 2005. KAECSES Notice P703, HealthWave 21 - Premium
Amount Change, shall be sent for any premium adjustments.
In addition to the review of current premium cases, spenddown cases with
either a child or pregnant woman recipient are to be reviewed in the month
of April for potential poverty level Medicaid coverage under the higher
standards. These spenddown cases are identified on the MA Spenddown Report.
This report lists all open MA cases without a program subtype regardless
of spenddown status. Those cases which include a pregnant woman (including
postpartum coverage) are identified with a Y in the PW/PP column. The report
is sorted by worker and will be sent within a few days. All cases are to
be reviewed for potential Medicaid poverty level or HealthWave eligibility
with any changes effective May 1, 2005.
NOTE: While reviewing MA programs careful attention must be given to those
without existing subtypes to ensure program coding is correct. In instances
where the MA program provides Family Medical coverage (including TransMed
and Extended Medical) a subtype must be present. Without a subtype of CM,
WT or EM, the MA program is regarded as a spenddown case and the family
is not assigned to managed care.
For spenddown cases in which a child(ren) and/or pregnant women
is included and meet the Medicaid poverty level or HealthWave
criteria, an MP program is to be added in KAECSES with a proration
date of 5-01-05 and the current base is shortened to end in April.
Individuals who have not met spenddown previous to the change
are to be notified of the new spenddown amount for the shortened
base. In addition, persons who met spenddown previous to the
poverty level determination are to be notified of the shortened
base and decreased spenddown so they have the opportunity to
have a portion of their spenddown expenses covered.
Eligibility work for any of the above changes must be completed by April
21, 2005 (medical card cutoff for May) in order for eligibility/coverage
to be correct for May.
- QMB PROGRAM - A mass change run will
occur at the time of rollover in March
and will determine QMB eligibility for
all MS cases
based on financial and non-financial criteria. A mass change
detail report (MR330) will be produced following the run
and will list all MS cases, not just
those cases with potential or
ongoing QMB eligibility. This report will be available on
SAR as of 03-28-05 (Report ID SWM03828-B59).
The report lists cash
and food stamp cases first for the whole state with the medical
cases at the end. The mass change run will result in the
- Cases that are newly eligible
for QMB will have an alert
sent to the worker. The case
then be authorized by going
through MSID and authorizing the SPEN screen for the benefit
May so that QMB status begins effective May 1, 2005. In addition,
a notice of QMB eligibility, N197 or similar notice, must
- Cases which have been QMB
eligible but now fail eligibility
will be identified by a FAILED message on the mass change
report. In addition, the QMB
indicator on MSID will be deleted.
must reauthorize the case for the benefit month of May. A
notice of QMB termination must
also be sent by the worker.
eligibility for LMB coverage should be reviewed, especially
for those covered only under
- For all cases, if the cost
-of-living adjustment (COLA)
for January 1 per KEESM 6410
(50)(b) is excluded, the PICK
screens must also be updated.
- Some cases may have a change
in the spenddown amount since
all MS cases will be processed in the mass change. This will
likely happen when an individual is on two cases, income
was changed, and only one of
the cases was authorized.
For all other programs (MA, MA CM, etc.), the worker will need to review
any case in which a Medicare Part A recipient is not currently listed in
QMB status and who may be eligible under the new poverty standards.
Such review should occur no later than the next scheduled review.
QMB status would be effective the month following the month in
which the case is reviewed.
NOTE: For all cases in which QMB or LMB eligibility is changing,
care must be taken to ensure the PICK and SEPA codes remain compatible.
Consider the following examples:
- A person retaining QMB only
eligibility whose SSA COLA
was exempt between Jan - April
would retain the QO subtype
PICK code of QO would be removed
and QMB authorized with a Y
- A medically needy and
QMB individual whose SSA
COLA was exempt between
Jan-April would not have
a medical program subtype,
the medical program subtype would
not change. The QS code
on PICK would be removed
and QMB is authorized
with a Y on MSID.
- An individual moves
from QMB only to LMB only
would have the medical
program subtype changed
from QO to LO and would
have a PICK code of LO or LL.
All cases which may lose QMB coverage must be reviewed to ensure proper
eligibility information is entered and the coding remains consistent.
To identify these cases, a printout of all MS cases with a QO medical
program subtype as well as those with a QS, QM or WQ subtype have been
identified. The printout will be sent within the next few days to the
Regional Report Distribution List. The cases need to be reviewed beginning
with the benefit month of May. A similar printout will be provided
in May for final review purposes
- LMB PROGRAM - The higher 120% and 135%
standards become effective on all LMB
determinations for the month of May,
2005 and thereafter.
recipients, a regular LMB (120% of poverty)
determination is to be completed based
on the new standard as affected cases
but no later than the next scheduled
- QWD PROGRAM - The
higher 200% standards become effective
on all QWD determinations for
the month of May, 2005 and thereafter.
For current recipients,
a determination is to be done under
the new standards as affected cases
are identified, but no
later than the next scheduled review
- SPOUSAL IMPOVERISHMENT INCOME
ALLOWANCES - The higher community
spouse and dependent family member allowances take effect
as of May 1, 2005 for all determinations
made on or after this date.
Current cases are to be reviewed during the month of April
necessary adjustments made effective May 1.
To aid in the review process, a printout will be produced based
on KAECSES records and will list all cases in which an AI or
AI/DI code is reflected on EXNS. These codes reflect cases in
which income is being allocated. The printout will be in alphabetical
order by case name and be in caseload by county order. It will
also list the expense code as well as the allocated amount. This
information will be based on KAECSES information as of mid-March
and will be sent separately
to be adjusted
in some of
as the community
now get at least
can get $535
or her income
is not in
month. The new
can now be
given is $773.50.
all that can
less than $993.50
but more than
allowance in some
- Working Healthy (Including
Medically Improved) - Because
- Child Care Program - The monthly gross income amounts
will be updated on the Child Care Family Income and
Share Schedule to reflect changes in the new federal
poverty guidelines. KsCares will be updated by 7:30
am on Monday April 11, 2005 with the changes effective
May 1, 2005. The changes will not affect Family Shares already
attached to existing child care plans on CHCP.
In order to have the Family Share recalculated
in INEL with the new income levels, it will be necessary
to press PF12 on INEL,
however, it is not necessary to change any of the
income on INEL first.
Staff should be reminded that any time a change has occurred which
may effect the family share - income level table changes, adding
a household member, removing a household member, changing income
- it is necessary to press PF12 in INEL in order to accurately
update the case. Once INEL is updated, any pre-existing child
care plans will also need to be updated on CHCP accordingly.
Cases have been seen where an income change was reported, INEL
updated, but the existing child care plans were not updated and
continued to show/assign the old family share amount.
With annual poverty level adjustments, changes to existing child
care plans will be implemented at the next review (which may
be as far as 12 months in the future) unless requested/required
earlier. Any cases processed after the table changes will use
the new Family Share table on KsCares with the new income levels.
This includes new plans with an effective date prior to May 1,
2005 if initial eligibility is completed on or after the date
the table changes are made. Poverty level updates are a positive
change, so staff need not be concerned that some plans with a
start date prior to May 1, but processed after the table changes
will use the new income/share amounts. Since there will be no
mass change to child care plans, no mass notice is necessary.
- Income Allowance Determination Form
Medicaid and HealthWave Standards
Monthly Family Income and Share Schedule for Child Care Services