Kansas Department of Social and Rehabilitation Services
Gary Daniels, Secretary
Integrated Service Delivery - Candy Shively, Deputy Secretary (785)
Economic and Employment Support - Bobbi Mariani, Director (785) 296-3349
....Enriching lives today and tomorrow
EES Program Administers & Staff
HealthWave Clearinghouse Staff
March 16, 2006
Implementation Instructions for 2006 Poverty Level Increases
This memo provides implementation instructions for the increases in
the federal poverty level standards which take effect May 1, 2006.
POVERTY LEVEL CHANGES
- Medicaid Poverty Level, HealthWave, QMB, LMB, QWD , Working
Healthy and Medicare Part D Subsidy 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 increase the minimum community spouse income allowance and the
dependent family member allowance under the spousal impoverishment
The poverty level table in KAECSES will be updated on 03-17-06 to incorporate
the new poverty level amounts effective 05-01-06. Eligibility for any
cases copied into May 2006 after this date was computed using the new
poverty level amounts. The Medicaid poverty level/HealthWave, Working
Healthy, QMB and Medicare D Subsidy 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
level eligibles, except for certain premium payers at noted below
mass change will not occur for the MP program. Because changes
eligibility do not effect eligibility until the end of the family
continuous eligibility period, persons 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
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
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.
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
will change. To assist with this review a printout listing all cases
criteria will be produced and sent electronically to the EES Report
Distribution List the week of April 10, 2006. These cases are to be
the new standard prior to the first medical card cutoff for May on
2006. Any necessary premium changes are to be made effective May 2006.
P703, HealthWave 21 - Premium Amount Change, shall be sent for any
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 is included with this memo. All cases are to be reviewed for potential
Medicaid poverty level or HealthWave eligibility with any changes effective
May 1, 2006
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 5-01-06
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 20,
2006 (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
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 03-27-06 (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 following:
- Cases that are newly eligible for QMB will have an
alert sent to the worker. The case must then be authorized
by going through MSID and
authorizing the SPEN screen for the benefit month of May
so that QMB status begins effective May 1, 2006. In addition,
a notice of QMB eligibility,
N197 or similar notice, must be sent.
- 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. The worker must
reauthorize the case for the benefit month of May. A notice
of QMB termination must
also be sent by the worker. Potential eligibility for LMB
coverage should be reviewed, especially for those covered
only under QMB previously.
- For all cases, if the cost-of-living adjustment (COLA)
for January 1 per KEESM 6410 (50)(b) is excluded, the PICK
and SEPA 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:
- Situation: Following the poverty level update a
person retains QMB only eligibility. The SSA COLA was
exempt between Jan - April and the
QO code was used on PICK to provide QMB.
Action: The QO subtype is retained
but the PICK code of QO is removed and QMB authorized on
- Situation: A medically needy and QMB individual retains
QMB eligibility. The SSA COLA was exempt between Jan
- April and the QS code was used
on PICK to provide QMB and medically needy (spenddown) coverage.
Action: There is no medical program subtype on this case, so the medical program
subtype does not change. The QS code on PICK is removed and QMB is authorized
- Situation: An individual moves from QMB only
to LMB only.
Action: The medical program subtype changes from QO
to LO and a PICK code of LO or LL is used.
- Situation: An individual is no longer eligible for
Action: A Part D Subsidy determination is completed.
The LO medical program subtype is removed. The PICK codes
is changed from LO to MD. A SUDD record
is completed with the appropriate Subsidy Type.
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 EES 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 2006 and thereafter. For
current recipients, a regular LMB (120% of poverty) determination is
to be completed based on the new standard as affected cases are identified,
but no later than the next scheduled review period.
- QWD PROGRAM - The higher 200% standards become effective
on all QWD determinations for the month of May 2006 and thereafter.
recipients, a determination is to be done under the new standards as
affected cases are identified, but no later than the next scheduled review
- MEDICARE D SUBSIDY - The higher standards become effective
on all Subsidy D determinations for the month of May, 2006 and
current recipients, a new determination shall be completed under the
new standards during the month of April and all necessary adjustments
made effective May 1, 2006. QMB, LMB, Expanded LMB are to be considered
in this review as well as the subsidy level.
To assist with this review, a report of active SUDD records has been
produced and is included with this material. If the individual now qualifies
for QMB or LMB, the SUDD record must be closed. The medical program subtype
and the PICK code must be changed to reflect correct eligibility. If
the level of subsidy changes, the Subsidy Type field on SUDD must be
updated. An appropriate notice must also be sent. For changes in the
subsidy level use the N728 - Subsidy D Change. For cases moving from
subsidy to LMB use the N193- Approval for LMB and Subsidy D Benefits.
For cases moving from subsidy to QMB use the N197- Approval for QMB and
- SPOUSAL IMPOVERISHMENT INCOME ALLOWANCES - The higher community
spouse and dependent family member allowances take effect as of May 1,
2006 for all determinations made on or after this date. Current cases
are to be reviewed during the month of April and 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
Income allowances are to be adjusted in some of the cases as the
community spouse can now get at least $1650 a month and any dependent
can get $550 a month provided his or her income is not in excess
of $1650 per month.
The new community spouse standard affects the outcome of the excess shelter
calculation. The maximum amount of excess shelter which can now be given
is $839. Excess shelter expenses are now reduced by a standard of
if the person’s shelter payment equals or exceeds $1052.00 all that
can be allocated is $839. Any payment less than $1052 but more than $213
produce a varying standard. These new guidelines may decrease or eliminate
the excess shelter allowance in some cases.
- Working Healthy (Including Medically Improved) - Because
of the new poverty level both the maximum income level and premium
will be adjusted. The new income limits and ranges become effective for
all Working Healthy determinations for the month of May 2006 and thereafter.
A mass change will occur at the time of rollover in March to incorporate
the new maximum income level and minimal premium threshold. The mass
change detail report (MR330) noted in item (b) above will list all cases
processed during this mass change. Any case with income in excess of
the limit will be identified with an UNABLE TO PROCESS message, although
none are expected. The SAR report will be available on 03-27-06 (Report
Premium adjustments necessary because of the new income levels will
not be automated. All Working Healthy premium cases must be reviewed
to determine if the premium obligation will be reduced or eliminated
based on the new income levels. Countable income shall be compared to
the new standard and, if a reduced premium results, the new premium is
effective May 1, 2006. A new notice, N743 - Change - WH Premium Levels,
has been created for this purpose. Premium cases are identified on the
Working Healthy Premium Report (MR410) and is available on SAR, report
ID SWYO183T-R04. Please make note that only the premium income levels
are changing, the premium amounts are not being adjusted this year.
- 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 10, 2006 with the changes effective May 1, 2006. 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
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, 2006 if initial eligibility is completed
on or after the table changes. 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.
- Report Summary - The following reports are associated to this mass
- HealthWave XXI Premium Report - Lists cases in premium status
with incomes close to the current premium limits. These cases shall
to determine if the premium amount is adjusted with the poverty level
change. This report will be available the week of April 10, 2006.
- MA Spenddown Report - Lists current MA spenddown cases. These
cases shall be reviewed to determine if the child or pregnant woman
eligible for Medicaid or HealthWave XXI. This report is included with
- QMB Cases - Lists all QMB cases with a QO medical program subtype
of a QS, QM or WQ PICK code. These cases are to be reviewed for continued
QMB eligibility. This report is included with this material.
- Medicare Part D Subsidy - Lists all persons with an active
SUDD record reflecting Medicare D Subsidy. These cases are to be
to determine ongoing eligibility and the level of eligibility. This report
is included with this material.
- Spousal Impoverishment Report - Lists all cases with allocated
income. These cases are to be reviewed to determine ongoing Community
and Dependent Family member allowances. This report is included with