Kansas Department of Social and Rehabilitation Services
Janet Schalansky, Secretary
Integrated Service Delivery - Candy Shively, Deputy Secretary
Economic and Employment Support - Bobbi Mariani, Director
EES Chiefs and Staff
March 19, 2004
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,
POVERTY LEVEL CHANGES
- Medicaid Poverty Level, HealthWave, QMB, LMB, and QWD
Programs - The following instructions are for the increases in the federal
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 provisions effective
The poverty level table in KAECSES will be updated on 03-19-04 to incorporate
the new poverty level amounts effective 05-01-04. Eligibility for
any cases copied into May 2004 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 eligibility period, persons are not transferred
from HealthWave 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
As indicated previously, certain HealthWave 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% -155% of poverty or 176% -180%
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 Area Report Distribution List
the week of April 12, 2004. These cases are to be rebudgeted
under the new standard prior to the first medical card cutoff
for May on April 22, 2004. Any necessary premium changes are
to be made effective May, 2004. 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, 2004.
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 5-01-04
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
22, 2004 (medical card run 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 03-29-04 (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, 2004. 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
be reviewed and updated if necessary.
- 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
exempted between Jan - April would
retain the QO subtype but the PICK
of QO would be removed and QMB
authorized with a Y on MSID.
- A medically needy and QMB individual
whose SSA COLA was exempted between
Jan-April would not have a medical
program subtype, so 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 moving from QMB
only to LMB only would have the
medical program subtype changed from QO to LO and would also have
a new PICK code of LO, or LL for Expanded LMB.
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 OR a QS, QO, QM or WQ subtype have been
identified. The printout will be sent within the next few days
to the Area 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, 2004 and thereafter.
For current recipients, a regular LMB (120% of poverty) or Expanded
LMB (135% 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, 2004 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
- SPOUSAL IMPOVERISHMENT INCOME ALLOWANCES
higher community spouse and dependent family member
allowances take effect as of May 1, 2004
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 $1562 a month and any
dependent family member can get $521 a month provided his or
her income is not in excess of $1562 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
$757. Thus, if the person’s shelter payment equals or exceeds
$964 all that can be allocated is $757. Any payment less than
$964 but more than $207 would produce a varying standard. These
new guidelines may decrease or eliminate the excess shelter allowance
in some cases.
- Working Healthy - Because of
the new poverty level both the maximum income
level and premium
standards will be adjusted. The new income
limits and ranges become effective for all Working Healthy determinations
for the month of May 2004 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 03-31-04 (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, 2004. 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
- 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
after 5:00 pm on April 9, 2004 with the changes effective May
1, 2004. The
changes will not affect Family Shares already attached to
existing child care plans on CHCP. In order to have the Family
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.) Changes
child care plans will be implemented at the next review
(which may be as far as 12 months in the future) unless requested/required
Any cases processed on or after May 1, 2004 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, 2004 if initial
eligibility is completed on or after the table changes. Poverty
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.