ACA Director’s Memo

DATE: October 1, 2013

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FROM: Terry R. Smith (X) POLICY

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VERSION TO: Family Services Specialists

SUBJECT: Overview of Affordable Care Act-Related Medicaid Changes

EFFECTIVE DATE: October 1, 2013

The Patient Protection and Affordability Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010, collectively known as the Affordable Care Act (ACA), will provide individuals with access to health insurance coverage through:

· Changes in policy to improve and streamline the Medicaid and CHIP programs;

· Establishment of Affordable Insurance Exchanges/Marketplaces (Marketplace); and

· Assurance of coordination between Medicaid, CHIP, and the Marketplace.

HOW MEDICAID ELIGIBLITY IS CHANGING:

The ACA will bring new requirements and options for Medicaid coverage beginning January 1, 2014. However, starting October 1, 2013, individuals can apply for ACA-associated coverage. The coverage will not begin until January 1, 2014. This memo is to give a general overview of the changes.

· Formal policy changes will be issued via SR 14-04 prior to January 1, 2014.

· The attached “DCS Health Care Reform Participation Guide” contains more detailed policy information and procedures.

· Also attached is an overview of the ACA.

What is NOT Changing in Medicaid Eligibility Effective January 1, 2014:

o Adult categories of Medicaid: Old Age Assistance (OAA), Aid to the Needy Blind (ANB), and Aid to the Permanently and Totally Disabled (APTD);

o Medicaid for Employed Adults with Disabilities (MEAD);

o Home Care for Children with Severe Disabilities (HC-CSD);

o Children with Severe Disabilities (CSD);

o Coverage for Newborns;

o Breast and Cervical Cancer Program (BCCP);

o Children in Foster Care;

o Medically Needy Spenddown (In & Out);

o Long-Term Care (nursing facility and home and community-based care services);

o Qualified Medicare Beneficiaries (QMB), Specified Low-Income Medicare Beneficiaries (SLMB and SLMB135) and Qualified Disabled and Working Individuals (QDWI)

What IS Changing in Medicaid Eligibility Effective January 1, 2014:

o Mandatory coverage for former foster care children under age 26;

o Hospitals can determine presumptive eligibility for all MAGI-related groups, subject to rules established by DHHS;

o Eligibility rules for all children under age 19, pregnant women, and parents/caretaker relatives:

§ Household composition and income eligibility based on IRS-related Modified Adjusted Gross Income (MAGI);

§ No resource test;

§ Self-attestation for pregnancy and the number of fetuses;

§ Electronic verification of information whenever available;

§ Self-attestation of household information will be initially accepted to determine eligibility for MAGI-related Medicaid. The only exceptions to self-attestation are citizenship, immigration status and Social Security Number (SSN). Self-attested information that needs to be verified, will be verified post-eligibility via electronic means, or by the individual, as appropriate;

§ Eligibility will always be determined on an individual basis;

§ Residency of students who are claimed as tax dependents by their parents are residents of the of the state where the parents reside;

§ Income limits for MAGI-related groups are increasing; and

§ Elimination with most income disregards and implementation of a 5% FPL across-the board deduction from income.

Comparison of Current Eligibility to Eligibility in 2014:

CHILDREN

Current Eligibility

Eligibility as of January 1, 2014

§ Eligibility based on household size, income and Federal Poverty Limits (FPL);

§ Income disregards: $90 earned income, child care expenses, child support payments, etc.;

§ No resource test;

§ Children ages 0 up to 19 are potentially eligible for the following Medicaid programs:

o Children’s Medicaid if household income is no higher than 185% FPL,

o Expanded Children’s Medicaid if household income is higher than 185% FPL but no higher than 300% FPL.

§ Medicaid eligibility for all children under the age of 19 will be determined in this group;

§ Eligibility will be based on IRS-related definitions for household composition/size and income;

§ Most income disregards have been eliminated and replaced with a standard 5% FPL disregard based on household size;

§ No resource test;

§ Initial verification for most information will be self-attestation, followed up with electronic verification, followed by documentation, if necessary;

§ Children ages 0 up to 19 are potentially eligible for the following programs:

o Children’s Medicaid – household income no higher than 196% FPL;

o Expanded Children’s Medicaid – household above 196% FPL, but no higher than 318% FPL;

o Premium Tax Subsidy Credit (through the Marketplace) – households with income higher than 318% FPL, but no higher than 400% FPL.

PREGNANT WOMEN

Current Eligibility

Eligibility as of January 1, 2014

§ Eligibility based on household size (including the number of fetuses), income and Federal Poverty Level (FPL);

§ Pregnancy must be verified;

§ No resource test;

§ Income disregards: $90 earned income, child care expenses, child support payments, etc.;

§ Pregnant women are eligible for categorically needy Medicaid if their household income is no higher than 185% FPL.

§ Eligibility will be based on IRS-related definitions for household composition/size and income;

§ Self-attestation of pregnancy and number of fetuses;

§ Initial verification for most information will be self-attestation, followed up with electronic verification, followed by documentation, if necessary;

§ Most income disregards have been eliminated and replaced with a standard 5% FPL disregard based on household size;

§ No resource test;

§ Pregnant women are potentially eligible for the following programs:

o Pregnant women’s Medicaid if household income does not exceed 196% FPL; or

o Premium Tax Subsidy Credit (through the Marketplace) – households with income higher than 196% FPL, but no higher than 400% FPL.

PARENTS/CARETAKER RELATIVES

Current Eligibility (TANF)

Eligibility as of January 1, 2014

§ Must have a dependent child who is deprived of the support or care of a parent;

§ Resource limit;

§ Income test is based on actual dollar amounts based on household size:

o Household 1: $464/$539

o Household 2: $531/$606

o Household 3: $600/$675

o Household 4: $663/$738;

§ Income deductions: 20%/50% earned income, child care expenses, child support payments;

§ Must provide documentation to verify information.

§ Eligibility of caretaker relatives does not include the caretaker relative’s spouse.

§ Must have a dependent child who is deprived of the support or care of a parent;

§ Eligibility will be based on IRS-related definitions for household composition/size and income;

§ Income test still based on actual dollar amounts; however the income test has been converted to MAGI-related amounts:

o Household 1: $670

o Household 2: $816

o Household 3: $965

o Household 4: $1,108;

§ Most income disregards have been eliminated and replaced with a standard 5% FPL disregard based on household size;

§ No resource test;

§ Eligibility for caretaker relatives include the spouse;

§ Initial verification for most information will be self-attestation, followed up with electronic verification, followed by documentation, if necessary;

§ Parents/caretaker relatives are potentially eligible for the following programs:

o Parents/Caretaker Relatives Medicaid if household income does not exceed the new dollar-related income limits (starts at 70% FPL); or

o Premium Tax Subsidy Credit (through the Marketplace) – households with income higher than the Parents/Caretaker Relatives limit, but no higher than 400% FPL.

FORMER FOSTER CARE CHILDREN

Current Eligibility

Eligibility as of January 1, 2014 – Non MAGI-Related

§ None

§ Individual was in IV-E or Non IV-E Foster Care in New Hampshire and receiving Medicaid at the time the individual turned age 18;

§ Is currently under age 26;

§ Always a household size of one;

§ No income test;

§ No resource test;

§ Individual remains eligible until he/she turns age 26.

OPEN ENROLLMENT PERIOD

Although the policy provisions of the ACA do not go into effect until January 1, 2014, the open enrollment period for applying for coverage through the Marketplace or the State Medicaid agency begins October 1, 2013. The Marketplace and the State Medicaid agency must begin accepting a single, streamlined application for health coverage effective October 1, 2013 to ensure a coordinated transition to new health coverage that will become available in Medicaid and through the Marketplace on January 1, 2014. The intent of the federal requirement is that no matter where applicants submit the single, streamlined application during the open enrollment period, they will receive an eligibility determination for all insurance affordability programs and be able to enroll in appropriate coverage for 2014, if eligible, without delay.

Beginning October 1, 2013, a new application, DFA Form 800MA, Application for Health Coverage & Help Paying Costs, will be available in paper form and in electronic format on the DHHS website. This application can be used to apply for Medicaid benefits or for other insurance affordability programs available through the Marketplace. In addition, modifications have been made to NH EASY so that individuals can apply for MAGI-related Medicaid via NH EASY. DFA Form 800, Application for Assistance, and DFA Form 800P, Application for Children’s Medicaid (CM) and Medical Coverage for Pregnant Women (MCPW), may still be used to apply for Medicaid; however, household tax information will need to be collected because these forms do not collect that information.

NOTE: Individuals who submit application DFA Form 800MA any time from October 1, 2013 – December 31, 2013 may elect to have their eligibility for Medicaid determined for the current time period using 2013 rules; however, if the single, streamlined application is submitted, additional information will be required to determine eligibility based on 2013 rules. In addition, if an individual wishes to apply for other assistance such as Food Stamps, FANF or SSP cash assistance or Child Care Subsidies, the individual will need to complete DFA Form 800, Application for Assistance, in addition to the Form 800MA.

On October 1, 2013, the NH Department of Health and Human Services (DHHS) and the federal Marketplace will communicate electronically with each other regarding new applications for Medicaid, Advance Payment Tax Credits, Qualified Health Plans, etc. When DHHS receives an application for health care coverage and determines the individual is not eligible for NH Medicaid, the application information will be forwarded electronically to the Marketplace to determine if the individual is eligible for other insurance affordability programs. If an individual is denied for being over income, the Notice of Decision will indicate that the individual’s application will be sent electronically to the Marketplace for a determination of eligibility for insurance affordability programs and that the individual need not do anything more until they hear from the Marketplace. Similarly, if the Marketplace receives an application for enrollment in health coverage and assesses that the individual may be eligible for NH Medicaid, the application information will be forwarded electronically to DHHS. DHHS will then determine whether the individual is eligible for Medicaid.

NOTE: The “Application for Health Coverage & Help Paying Costs” that an individual obtains from the Marketplace or through the federal website is slightly different from DFA Form 800MA, Application for Health Coverage & Help Paying Costs developed by NH; however, both applications request basically the same information. Either application will be acceptable through the Marketplace and DHHS.

TRAINING:

The DCS Training Unit will have completed statewide training of all DCS staff by October 2, 2013.

If you have any policy-related questions, please call Dawn Landry at 271-9315 or Joyce St.Onge at 271-9279. New HEIGHTS system-related questions should be addressed via the New HEIGHTS Help Desk.

Provisions of the Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010 – collectively known as the Affordable Care Act (ACA

Coordinating Enrollment: Medicaid, CHIP, and the New Premium Credits for Coverage in the Marketplace
No Wrong Door	§ The Secretary of Health and Human Services (HHS) will establish a system that will allow individuals and families to apply for whichever forms of assistance they are eligible: premium credits (for coverage through the Marketplace), Medicaid, or CHIP. Applicants will be screened for eligibility for all three programs and will be referred to the appropriate program for enrollment. § The Secretary of HHS will provide states with a single, streamlined application form for all three programs. States may also use their own forms, subject to HHS approval. § Individuals must be able to submit their application online, in person, by mail, or by phone. They will be able to file applications with either the Marketplace or with the state Medicaid agency.
Data Sharing	§ The law requires each state to establish a secure, electronic interface that will facilitate data exchanges that will allow for the determination of applicants’ eligibility for the premium credits, Medicaid, or CHIP based on one application. This interface will also allow enrollees to renew their coverage online. § The Marketplace and Medicaid must participate in data matching, and whenever possible, must use data that are available in existing federal databases to establish, verify, and update eligibility. § Individuals may seek a determination of eligibility for Medicaid or the premium tax credits without completing applications forms, by authorizing the disclosure of personal information in existing government databases.
The Role of State Agencies	§ States must screen individuals who are found to be ineligible for Medicaid to see if they are eligible for premium credits. § States have the option to allow Medicaid agencies to determine eligibility for premium credits, as well as for Medicaid. Or the Marketplace can determine eligibility for premium credits for coverage in the Marketplace and assess or determine (at State option) eligibility for Medicaid. § By no later than January 1, 2014, each state is required to establish and maintain a website that is linked to the Marketplace’s website that enrollees and prospective enrollees can use to compare benefits, premiums, and cost-sharing among Medicaid and plans in the Marketplace. § No provision changes current law that requires Medicaid eligibility to be determined by public agencies.
Health Information Technology (HIT) Standards	§ The Secretary of HHS, in consultation with the HIT Policy Committee and the HIT Standards Committee, developed recommendations for enrollment in health and human services programs (including but not l limited to health coverage programs). The recommendations were issued in September 2010. § The recommendations that were issued in September 2010 are consumer-oriented and call for enrollment processes that meet the following criteria: o Are online, transparent, and easy to use. o Accommodate people with different online user capabilities and language preferences; o Seamlessly integrate public and private insurance options; o Connect consumers with a range of human services programs, including health coverage programs and other programs (such as the Supplemental Nutrition Assistance Program (SNAP); and Temporary Assistance to Needy Families (TANF); and o Provide strong privacy and security protections. § These recommendations will apply to the Marketplace, and they will likely be tied to future federal funding opportunities with respect to designing and updating eligibility and enrollment systems. These recommendations will apply to the Marketplace, and they will likely be tied to future federal funding opportunities with respect to designing and updating eligibility and enrollment systems.
Medicaid and CHIP
Enrollment Processes	§ The law requires states to establish procedures that will allow individuals to apply for Medicaid through a website to be established no later than January 1, 2014. § States must establish online enrollment, renewal, and consent through an electronic signature for Medicaid. § People that a Marketplace assesses to be eligible for Medicaid must be referred to the state Medicaid agency for a determination of such eligibility.
Income Methodology	§ Starting in 2014, all states will be required to use modified adjusted gross income (MAGI) to determine income eligibility for children, pregnant women and parents/caretaker relatives. § Most income disregards have been eliminated and replaced with a standard 5% FPL income disregard. § Other Medicaid rules about how income is counted continue to apply, including prospective budgeting and sources of income. § There is a hold-harmless provision that is designed to ensure that no one who was eligible for Medicaid when health reform was enacted will lose coverage because of the transition to using MAGI to determine eligibility. States will have some flexibility in determining income during the transition period.
Resource Tests	§ The law removes resource tests beginning on January 1, 2014, for MAGI-related Medicaid groups.
Presumptive Eligibility	§ States that use presumptive eligibility for children or pregnant women can now also use presumptive eligibility for parents/caretaker relatives. § Beginning on January 1, 2014, hospitals that participate in Medicaid may conduct presumptive eligibility determinations for Medicaid regardless of whether the state is using presumptive eligibility in any other settings or for any other Medicaid eligibility groups.
Other Provisions	§ The CMS issued a proposed rule that will allow states to draw a 90% federal match when they invest in improvements to their Medicaid eligibility and enrollment systems. Once the rule is finalized, this 90% match will be available to qualifying states until December 31, 2015. States that qualify for this enhanced funding will also receive a 75% federal match for maintaining these systems in 2016 and beyond. § The law requires states to conduct Medicaid outreach to vulnerable and underserved populations. § Heal reform includes an additional $40 million for outreach and enrollment grants under the CHIP Reauthorization Act (CHIPRA) that are to be used during fiscal years 2009 – 2015.
§ The Marketplace
Enrollment Processes	§ The Secretary of HHS must develop a model template for the web portals that are used for the Marketplace and assist states in developing and maintaining their portals. § The initial open enrollment period will be established, as determined by the Secretary of HHS (the determination must be made by no later than July 1, 2012). The Secretary of HHS will determine annual open enrollment periods for calendar years after this initial enrollment period. § Individuals must provide their name, address, date of birth, and Social Security number in order to enroll in Marketplace coverage (whether or not the individual is eligible for a premium credit). § To prevent undocumented immigrants from receiving premium credits or enrolling Marketplace coverage, legally residing immigrants must also provide other information that the Secretary of HHS, in cooperation with the Secretary of Homeland Security, specifies in order to verify immigration status. Citizens’ status will be verified by the Social Security Administration. The immigration and/or citizenship status of non-citizens and those who attest to be citizens but whose status cannot be confirmed by the Social Security Administration will be verified by the Secretary of Homeland Security. § Applicants for premium credits must not be required to provide information beyond the minimum amount that is needed to authenticate their identity, determine their eligibility, or determine the level of assistance for which are eligible.
Income Methodology (for premium credit eligibility	§ As with Medicaid, income will be based on modified adjusted gross income (MAGI). States must use MAGI for the taxable year ending in the second calendar year that precedes the calendar year during which the plan year begins. For example, they would use the 2012 tax year for coverage that states January 1, 2014.

Health Care Reform

The Patient Protection and Affordable Care Act of 2010 (ACA)

Participation Guide

Version September 2013

All rights reserved. Printed in the United States of America. Except as permitted under the United States Copyright Act of 1976, no portion of this manual may be reproduced in any form or by any means without the written permission of DCS Training, its successors, or assigns.

Table of Contents

Section One 4

Section 1.1 5

Overview of Healthcare Reform 5

What is NOT Changing? 6

What WILL Be Changing? 6

New MAGI-based Medicaid Categories 7

Former Foster Care Children – Changes to Foster Care 8

Basic Medicaid Requirements 9

Self-Attestation 10

MAGI 11

Definitions 12

Section 1.2 15

Household Composition 15

Individualized Assistance Group (AG) 15

MAGI-based AG Size Scenarios 16

Scenario 1 – Single Mother of One 16

Section 1.3 23

Financial Requirements 23

MAGI Budgeting Methodology 24

How to Determine MAGI AG Income 25

MAGI-based AG Income Scenarios 26

Answer: 32

Section Two: New HEIGHTS 35

Section 2.1 35

Client Registration 35

Individual Demographics 36

Program of Assistance 37

Household Relationship Screen 38

Household Relationship Screen/ Tax Dependent 39

Individual meets MAGI verification requirements 40

Additional Demographics /Marital Status 41

Additional Demographics Joint Filing Questions 44

SSN Information Cooperation Change on Screen 45

Demographics Screen / Individual Demographics 46

SSN “Not Yet Validated” 46

Case Characteristics – Expense will auto populate the answer to “Yes” 47

Tax Dependent/Joint Filer Screen Details Tab 48

Tax Dependent/Joint Filer Screen MAGI Details Tab 49

Employment Screen MAGI Verification check box 50

Self-Employment Screen 51

Unearned Income Screen 53

Case Characteristics - Tax Credit Screen 54

Former Foster Care Children 57

Section Three 58

Section 3.1 59

Federally Facilitated Marketplace (FFM) 59

Visual of the Marketplace and HUB 59

Section 3.2 60

The HUB 60

Appendices /Appendix A 61

How to Determine MAGI AG Size 61

Appendix B 62

Determining MAGI Household Size Flow Chart 62

Appendix C 62

Appendix C 63

How to Determine if an Individual’s Income Should Be Counted 63

Appendix D 64

How to Determine MAGI AG Income 64

Appendix E 65

IRS Filing Requirements Chart 65

Appendix F 67

2013 Federal Poverty Income Limit Guidelines 67

Appendix G 68

Income Limits Parent/Caretaker Relative 68

Section One

Section One will be provide an overview of the Affordable Care Act (ACA) and the resulting changes to Medicaid, including a new methodology used to determine Assistance Group (AG) and income determination referred to as MAGI; the transformation from current FANF categorically needy Medicaid programs into MAGI-based Medicaid categories; a review of basic Medicaid requirements; and new MAGI-based definitions.

There will be working scenarios detailing how to first determine MAGI-based AG size. Building upon the answers from the AG size scenarios, MAGI-based income determination will be explained.

Section 1.1

Overview of Healthcare Reform

October 1. 2013 is the start of the open enrollment period for MAGI-related groups. Individuals applying for and wanting Medicaid to start any time during October – December 2013 can have their eligibility determined using 2013 rules. The alignment of the methods for determining eligibility is part of an overall system established by the Affordable Care Act (ACA) that strives to allow for real-time eligibility determinations.

The system allows for prompt enrollment of individuals in the Insurance Affordability Program (Medicaid/CHIP, Qualified Health Plan, Advanced Premium Tax Credits and Cost Sharing Reduction) for which s/he qualifies.

Eligibility determinations for certain categories will be made starting October 1, 2013. However, MAGI eligibility begin dates will only be set starting January 1, 2014.

Healthcare Reform is necessary to comply with the Affordable Care Act (ACA) by:

· Simplifying Medicaid eligibility categories;

· Modernizing eligibility verification rules;

· Streamlining Medicaid/CHIP applications and renewals with the help of NH EASY and New HEIGHTS;

· New single, streamlined paper application that is also available for download on the DHHS website; and

· Coordinating eligibility across Medicaid, CHIP and the Federally Facilitated Marketplace (FFM), which we will exchange (both in and out-going) eligibility data with the FFM.

Note: Application for the new MAGI categories will be accepted as of October 1, 2013. The eligibility is effective January 1, 2014. New HEIGHTS will start to build eligibility periods for January 1, 2014, in October 2013, for those applications that are received.

What is NOT Changing?

There are no changes to the Medicaid eligibility rules for:

· Old Age Assistance (OAA)

· Aid to the Needy Blind (ANB)

· Aid to the Permanently and Totally Disabled (APTD)

· Medicaid for Employed Adults with Disabilities (MEAD)

· Home Care for Children with Severe Disabilities (HC-CSD)

· Children with Severe Disabilities (CSD)

· Qualified Medicare Beneficiaries (QMB), Specified Low-Income Beneficiaries (SLMB and SLMB135; and Qualified Disabled and Working Individual (QDWI));

· Foster Care Children up to age 18

· FANF Medically Needy

· In and Out spenddown for any category

· Adoption Subsidy

· Breast and Cervical Cancer Program

· Family Planning Program

· Newborn eligibility

What WILL Be Changing?

· Mandatory Medicaid coverage for former foster children under age 26;

· Hospitals can determine presumptive eligibility for all MAGI coverage groups;

· Eligibility rules for MAGI-related coverage groups (e.g., no resource tests, self-attestation, etc.);

· Eligibility for MAGI-related Medicaid is always determined on an individual basis, not by a household;

· Self-attestation for pregnancy, as well as for the number of fetuses;

· Child Support and VA benefits will NO LONGER be counted.

New MAGI-based Medicaid Categories

The new MAGI-based Medicaid categories effective January 1, 2014, are:

Pregnant Women

· Any age and pregnant

· Include the number of fetuses in the household size

· Income limit 196% of the Federal Poverty Level (FPL)*

Children’s Medical

· Up to age 19

· No deprivation requirement

· No requirement to reside with a parent or caretaker relative

· Income limit 196% FPL

Once determined eligible for Medicaid, there is 12-months continuous eligibility regardless of changes in household composition, income, etc. The only exceptions to 12-month continuous eligibility are death of the individual, the individual moves out of the state, and the individual requests termination of assistance.

Expanded Children’s Medical

· Up to age 19

· No deprivation requirement

· No requirement to reside with a parent or caretaker relative

· Once determined eligible for Medicaid, there is 12-months continuous eligibility regardless of changes in household composition, income, etc. The only exceptions to 12-month continuous eligibility are death of the individual, the individual moves out of the state, and the individual requests termination of assistance

· Income limit 318% FPL

Parent/Caretaker Medical

· Individual must be a parent/caretaker of a “dependent child” (under 18 or 18 and a fulltime student expected to graduate before 19) and deprived of parental support and care (single parent household due to death or continued absence or a 2-parent family based on Incapacitated Parent (Incap) or Unemployed/Underemployed Parent UP requirements)

· In the case of a caretaker relative, the household also includes the caretaker relative’s spouse

· Income limits vary by AG size – see Appendix for Parent/Caretaker income limits*

Former Foster Care Children – Changes to Foster Care

· The Former Foster child can not be eligible for any mandatory categorically needy group

· Age 18 to 26 (Note: Children age 18 will only be in this category if income exceeds 318% of the FPL for the Expanded Children’s MA Category). January 1, 2014, there will be former foster care children that are under 26, but who have been closed Medicaid since they turned 18. These individuals are also covered under this group. The group is not limited to individuals currently eligible.

· Income and Resources do not count

· Former Foster Care Children will always be a household of one.

NOTE: New Hampshire has not elected at this point to have the new “Adult Expansion” category for non-disabled adults age 19 to 64.

* See Appendix for Income Charts.

Basic Medicaid Requirements

These requirements apply to all MAGI-based categories for every individual requesting Medicaid. The requirements are NOT applicable to individuals NOT requesting Medicaid.

· SSN

· US Citizen or Eligible

· Lawful Presence (for Eligible/Qualifying Alien)

· Identity

· Resident of NH (College students are not residents of NH if the parent(s) are residents of another state and claim the student as a tax dependent)

· Willing to cooperate with applying for other benefits

· Cooperates with Child Medical Support (Single Parent/Non Custodial Parent)

· Yearly redetermination for MAGI-based Medicaid

· Care Management requirements apply – this is not an eligibility requirement, it is a service- related requirement.

Other Eligibility Criteria

· 12 month EMA is applicable to Parent/Caretakers only – it no longer applies to children; the children will remain in their current MAGI-based medical category until the 12-month renewal is due

· 4 Month EMA is now only applicable to Parent/Caretakers only due to an increase in Alimony/Spousal Support as child support is no longer a countable income – it no longer applies to children; the children will remain in their current MAGI-based medical category until the 12-month renewal is due

Self-Attestation

Self-Attestation is only applicable for MAGI-based MA categories. The State temporarily accepts the individual’s verbal claim to the accuracy of the information provided without documented proof.

This does not mean that the information, such as proof of income, will not be requested. What it does mean is that the MAGI-based medical assistance will be determined with the client’s verbal claim, so that MAGI-based medical assistance can be promptly provided as required by the ACA. (Note: All other eligibility requirements must still be met.)

Verification of self-attested information will be obtained via electronic matches with the Hub, SSA, NHUIS, etc. whenever possible. Electronic data that does not verify the client’s self-attestation will generate a post-enrollment verification checklist to require the individual to provide the proof. New HEIGHTS will set an expected change for the worker to follow-up on the requested verifications as the case will not show on the worker’s dashboard as the MAGI-based medical assistance was opened.

Any other type of medical assistance or programs applied for may still pend for that program’s current eligibility proofs, even if the MAGI-based medical assistance opens.

· This is not applicable for:

o SSN

o US Citizenship or eligible alien

o Identity

MAGI

Modified Adjusted Gross Income (MAGI) is based on the IRS tax rule. It is the methodology for how Medicaid eligibility for Children, Pregnant Women and Parents/Caretaker Relative will be reviewed for AG size and countable income. It is a very different way from how we currently construct determine Medicaid eligibility for categorically needy Children, Pregnant Women and Parent/Caretaker Relatives.

MAGI is a methodology for household composition, family size and income is counted in determining eligibility for each individual

· MAGI is based on the IRS rules for determining adjusted gross income (with some modifications), but it is not a number on a tax return

· MAGI modifications – refers to how certain incomes (earned, unearned and self-employment), depreciation, resources, and expenses are treated or even counted in each AG

· There is no resource test for any MAGI-related eligibility group

· There is a 5% FPL disregard (for the AG size when the individual is determined to be over income).

Note: No more State determined disregards like the $90/working adult in Children’s Medicaid/PW or the NHEP percentage disregards for categorically needy MA.

Definitions

There will be new terminology as well as redefining already known terms due to the implementation of the MAGI methodology. Such as the following:

· Tax filer

o The person expects or intends to file a federal tax return; and

o The person does not expect to be claimed as a tax dependent by anyone else

§ Joint filer is a designation available when the person is married and living together or separated, but still intending to file their federal tax return with the spouse who is living in or out of the home.

· Tax Dependent

o The person expects to be claimed as a tax dependent by someone else (whether or not the tax dependent expects to file a federal tax return), but must be checked to see if the person falls into one of three exceptions to the tax dependent rule.

o If a tax dependent exception is met, then the tax dependent will be treated as a Non-Filer.

Tax Dependent Exceptions

1. Claimed as a tax dependent by someone other than a spouse or natural/biological, adopted or step parent.

2. Child (under age 19) living with two parents who do not expect to file a joint tax return (step-parents count).

3. Child (under age 19) claimed as a tax dependent by a non-custodial parent

· Custody to be established according to the following –

o A court order or binding separation, divorce or custody agreement establishing physical custody controls; OR

o If there is no such order or agreement or in the event of a shared custody agreement, the custodial parent is the parent with whom the child spends most nights.

? Non-filer rules apply to tax dependents who meet one of these exceptions

· Non-Filer

o The person does not expect or intends to file a tax return; and

o The person does not expect to be claimed as a tax dependent by someone else; OR

o The person cannot be reasonably established as a tax dependent by the Tax-filer

o The person is treated as a Non-filer due to meeting one of the tax dependent exception conditions

· Expects/Intends/Plans to File Taxes

o This means the client is planning to file a tax return for the year in which eligibility is being determined. For example, if the current year is 2014, and the individual is applying anytime in 2014, then the individual is planning to file his/her 2014 taxes in 2015.

§ This question will help to determine the Tax Household and MAGI-based AG size

§ This question is separate from the ‘Required To File’ question.

· Required to File Taxes

o A person who is required to file a federal tax returned based on IRS rules.

§ If the person is required to file, per IRS rules, then the answer is Yes, even if the person does not expect or intend to file a federal tax return

· This question will help to determine whose income is counted in each AG

· This question is separate from the ‘Expects/Intends/Plans’ to file question.

o Example: A high school student who is working may not intend to file taxes, but may be required to file due to how much s/he made during the year.

§ Per 2012 Guidelines from IRS – based on the amount you made during a year determines if you are required to file a federal tax return.

· Single under age 65 $9,750; Married Filing Jointly under age 65 $19,500 (combined); dependent under age 65 $950 unearned income or $5,950 earned income.

· Tax Household

o The tax household is made up of the tax filer (including married couples living together or living apart but filing jointly) and all claimed tax dependents of the tax filer. In the case of married couples who are living together, each spouse will be included in the household of the other spouse regardless of whether they expect to file a joint return. If spouses do not reside together, but still expect to file a joint tax return, each spouse will be included in the other spouse’s household.

· Modified Adjusted Gross Income (MAGI)

o MAGI is a methodology used to determine AG size and whose income counts based on IRS tax rules with some modifications.

o No resource test.

o When the individual is over the income limit a 5% FPL disregard is applied to the adjusted gross income.

· Target

o The potentially qualifying applicant will be considered Target for the Individualized eligibility determination.

· Relationships

o Parent – includes natural/biological, adoptive or step.

o Child – includes natural, adoptive or step.

o Siblings - includes natural, adoptive or step.

o Medicaid Child Age - to age 19 (No full-time high school requirements).

Note: in determining whether there is a dependent child for the Parent/Caretaker Relatives MAGI group and to determine household composition. We use “under age 21 and full time student in high school or its equivalent”.

· MAGI Participation Status Codes

o Eligible – the target individual being considered for medical assistance is initially considered to be eligible and will remain eligible if all eligibility criteria are met.

o Counted – any individuals added to the eligible target’s AG, The counted individual will be included in the eligible target’s household size and his/her income will also be counted.

o Group – any individuals added to the eligible target’s AG, whose presence increase the AG size, but whose earnings are not counted in the AG income.

o Excluded – those individuals who are not added to the target individual’s group on the basis of household composition (such as an ineligible alien or any person included with a Former Foster Care MA individual) and whose income will not be counted.

Section 1.2

Household Composition

Eligibility is determined based on tax rules and each individual applying for medical assistance will be evaluated based on their tax filing status. The evaluation will be used to determine the HH Composition or MAGI-based AG size based on each individual’s tax filing status. See Appendix A for Chart.

Individualized Assistance Group (AG)

Each Assistance Group (AG) will only have one potentially eligible individual regardless of the AG size and the number of household members that will be eligible for Medicaid.

*Use the chart found in the Appendix for the example on the following page.

MAGI-based AG Size Scenarios

Scenario 1 – Single Mother of One

Household Description:

Barbara is a tax-filer (35 years old) applying for herself and her son, Kyle. Kyle is Barbara’s tax dependent.

Kyle is 15 years old and does not plan to file taxes.

Barbara has never been married.

Determine Barbara’s HH size:

A. Does Barbara plan to file taxes? YES

a. Does she expect to be claimed as a tax dependent by anyone else? NO

b. Is she filing a tax return? YES

Answer: Barbara’s household consists of herself and her tax dependent, Kyle. She is potentially eligible for Parent/Caretaker Relative

Determine Kyle’s HH size:

A. Does Kyle expect to file taxes? NO

B. Does Kyle expect to be claimed as a tax dependent? YES

a. Does he expect to be claimed as a tax dependent of someone other than his parents? NO

b. Is he under 19 living with both parents, but the parents do not expect to file a joint return? NO

c. Is he under 19 and expects to be claimed but a non-custodial parent? NO

Answer: Kyle does NOT meet any of the exceptions; the household is the same as the household of the tax-filer claiming him as a dependent.

MAGI AG Size Results

Medicaid Eligibility For	Barbara	Kyle	MAGI AG Size
Barbara-mother	Eligible	Counted	2
Kyle-child	Counted	Eligible	2

Scenario 2- Married Couple with Single Child and Pregnant Mother

Household Description:

John (29 years old) lives with his wife, Donna (26 years old) who is pregnant with John’s child and his stepdaughter, Donna’s daughter Kate (3 years old).

Determine Donna’s HH size – Joint tax filer with John:

A. Does Donna plan to file taxes? YES

a. Does she expect to be claimed as a tax dependent by anyone else? NO

b. Is she filing a tax return? YES

Answer: Donna’s household consists of herself, her spouse (John), their dependent (Kate), and her unborn child. She is potentially eligible under the Pregnant Woman Category.

Determine John’s HH size – Joint tax filer with Donna:

A. Does John plan to file taxes? YES

a. Does he expect to be claimed as a tax dependent by anyone else? NO

b. Is he filing a tax return? YES

Answer: John’s household consists of himself, his spouse (Donna) their tax dependent (Kate), and unborn child. He is potentially eligible as a Parent/Caretaker Relative.

Determine Kate’s HH size – Tax Dependent of John and Donna:

A. Does Kate plan to file taxes? NO

B. Does Kate expect to be claimed as a tax dependent? YES

a. Does she expect to be claimed as a tax dependent of someone other than her parents? NO

b. Is she under 19 living with both parents, but the parents do not expect to file a joint return? NO

c. Is she under 19 and expects to be claimed by a non-custodial parent? NO

Answer: Kate does NOT meet any of the exceptions; the household is the same as the household of the tax-filer claiming her as a dependent.

MAGI AG Size Results

Medicaid Eligibility For	John	Donna	Kate	MAGI AG Size
John- husband	Eligible	Counted + 1	Counted	4
Donna- wife	Counted	Eligible + 1	Counted	4
Kate- child	Counted	Counted + 1	Counted	4

John is not eligible for a Medicaid program at this time and his information will be forwarded to the Marketplace for a determination of eligibility for Advanced Premium Tax Credit (APTC), Qualified Health Plan (QHP), etc.

Scenario 3 – Single Mother of One with Estranged Husband

Household Description:

Erica (27 years old) is applying for herself and her son, Donald (3 years old). Erica is married to her estranged husband, Adam (26 years old) who does not reside in the home and continues to file taxes jointly with him.

Erica is a Joint Tax-filer with Adam

Adam is a Joint Tax-filer with Erica

Donald is a Tax Dependent of Erica and Adam.

Complete the chart below:

Medicaid Eligibility For	Erica	Donald	Adam	MAGI AG Size
Erica-mother
Donald-son
Adam-absent father

Scenario 4 – Unmarried Couple with Child not Claimed as a Tax Dependent

Household Description:

Unmarried parents, Rick (25 years old) and Tara (23 years old), who is pregnant with one fetus, are applying for Medicaid along with their son, Charlie (2 years old) and Rick’s daughter, Angela (4 years old). Angela is the biological daughter of Rick and claimed as a Tax Dependent by her non-custodial biological mother, who does not live in the household.

Rick is a Tax Filer

Tara is a Non-filer

Charlie is a Tax Dependent of Rick

Angela is a Tax Dependent of Mother who is a non-custodial parent

Complete the chart below:

Medicaid Eligibility For	Rick	Tara	Charlie	Angela	MAGI AG Size
Rick-boyfriend
Tara-girlfriend
Charlie-common child
Angela-Ricks daughter

Scenario 5 – Three Generation HH with Married Child

Household Description:

Matilda (47years old) is applying for herself, her son, Dominic (17 years old), his wife, Lauren (18 years old) who is pregnant with one fetus and her Lauren’s son Cameron (1 year old). Matilda claims Dominic as a dependent. Lauren is a tax-filer and claims Cameron as a dependent.

Matilda is a tax-filer

Dominic is a tax dependent of Matilda

Lauren is a tax-filer

Cameron is a tax dependent of Lauren

Complete the chart below:

Medicaid Eligibility For	Matilda	Dominic	Lauren	Cameron	MAGI AG Size
Matilda-mother of Dom
Dominic-son to Matilda
Lauren-Dom’s wife
Cameron-Lauren’s son

Scenario 6 – Intact Family with Child Attending College Out of State

Household Descriptions:

Joanne (39 years old), her husband Andrew (41 years old), their daughter Ella (16 years old) and their son, Andrew Jr. (21 years old) are all applying for Medicaid. Andrew Jr. is currently attending college out of state.

Joanne is a tax-filer

Andrew Sr. is a Joint Tax-filer with Joanne

Ella is a tax dependent of Joanne and Andrew

Andrew Jr. is a tax dependent of Joanne and Andrew

Complete the chart below:

Medicaid Eligibility For	Joanne	Andrew Sr.	Ella	Andrew Jr.	MAGI Household Size
Joanne-wife
Andrew Sr.-husband
Ella-daughter
Andrew Jr.-son College Student

Section 1.3

This section will review the major financial requirement that changed, MAGI budgeting methodology and how to determine MAGI income logic along with practice scenarios.

Financial Requirements

¨ No resource tests

¨ Countable income is based primarily on IRS rules

o Earned income

· Depreciation is allowed for self-employment

· Employment

¨ Unearned income

o Child support is NOT countable

o VA income is NOT countable

o Workers’ Compensation is NOT countable

o All other unearned income is countable

¨ Allowable Expenses are very limited

o Alimony/spousal support – actual amount paid only

o Student loan interest paid

o Dependent care expenses are NOT deductible

¨ 5% FPL disregard for the AG size applied only when the individual is over income.

MAGI Budgeting Methodology

¨ MAGI is NOT a number on a tax return

¨ Gross earned income (minus depreciation & cost of doing business from self-employment)

+ Plus Countable unearned income

+ Tax-exempt interest

+ Tax-exempt Social Security income

= MAGI

¨ For Medicaid, a few additional MAGI modifications:

(Minus) - Certain scholarship & fellowship income

(Minus) - Certain Native American & Alaska Native income

(Add) + Count lump sum income only in the month received

How to Determine MAGI AG Income

Remember that this applies to the individual’s AG size that you determined using the ‘How to Determine MAGI AG Size’ steps.

These steps will allow you to determine whose income does or does not count for each Counted or Group AG member.

A. Is the AG individual the child or expected tax dependent of another member of the household?

i. If yes – is the individual expected to be required to file a tax return?

· If yes, continue to Step B and include the child’s or individual’s income in the total AG size income.

· If no, continue to Step B, but do not include the child’s or individual’s income in the total AG size income.

ii. If no, continue to Step B

B. Next, determine the MAGI-based income of each member of the individual’s AG, as self-attested to or if provided, by pay stubs, tax returns, etc.

Remember; do not include any income of any such member if it is flagged as not being counted in Step A.

Special income circumstances:

· An amount received as a lump sum is counted as income only in the month received.

· Scholarships, awards or fellowship grants used for education purposes and not for living expenses are excluded from income.

· Certain distributions, payments and student financial assistance for American Indians/Alaska Natives are excluded from income.

C. AG income equals the sum of the MAGI of every counted AG member of the individual’s AG as determined in Step B.

MAGI-based AG Income Scenarios

Scenario 1 – Single Mother of One

Household Description:

Barbara is a tax-filer (35 years old) applying for herself and her son, Kyle. Kyle (15 years old) is Barbara’s tax dependent.

Barbara has never been married.

Barbara is a tax-filer – Gross earned income $1,250 per month no pre-tax deductions.

Kyle is a tax dependent of Barbara – Unearned income $1,500 (child support) per month

Kyle is not required to file taxes.

Whose income is counted?

Medicaid Eligibility For	Income to be counted		FPL % for Group Type	Income limit for Household Size ($)	Total Countable MAGI-Based Income of the MAGI AG Size	Financial Results
Medicaid Eligibility For	Barbara	Kyle	FPL % for Group Type	Income limit for Household Size ($)	Total Countable MAGI-Based Income of the MAGI AG Size	Financial Results
Barbara-mother	ü		See chart Parent/Caretaker	$816	$1,250	Failed
Kyle-son	ü		196%	$2,534	$1,250	Passed

Explanation: Barbara is not eligible for a MAGI only Medicaid as she is over the income limit for Parent/Caretaker Relative and NH does not have the Adult Expanded Medicaid at this time.

Note: If the client would like a non- MAGI category Barbara could potentially be eligible for NHEP Medically Needy In/Out. Barbara’s information will be passed to the Marketplace to determine her eligibility for other insurance affordability programs, such as Advanced Payment Credits (APTC) and Qualified Health Plans (QHP).

Medicaid Eligibility For	Eligibility Category	Barbara	Kyle	MAGI AG Size
Barbara-Mother	Parent/Caretaker	Not eligible	Counted	2
Kyle-son	Children	Counted	Eligible	2

Scenario 2- Married Couple with Single Child and Pregnant Mother

Household Description:

John (29 years old) lives with his wife, Donna (26 years old), and his stepdaughter, Kate (3 years old). Donna is pregnant with one fetus with John’s child. All three household members are applying for Medicaid.

John is a tax-filer – Gross earned income $1,702 per month – no pre-tax deductions.

Donna is a tax-filer with John – Unearned income $1,000 per month – unemployment. Donna is the PWE and has been receiving unemployment and there is eligibility for the UP Medicaid for John.

Kate is a tax dependent of John – No income

Medicaid Eligibility For

Income to be counted

FPL % for Group Type

FPL for Household Size ($)

Total Countable MAGI-Based Income of the MAGI AG size

Financial Results

John

Donna

Kate

John- husband

$1,108

TANF/PIL Income limit

Not MAGI

In/Out

$2,702

Failed

Passed

Donna- wife

196%

$3,847

$2,702

Passed

Kate- child

196%

$3,847

$2,702

Passed

Medicaid Eligibility For

Eligibility Category

John

Donna

Kate

MAGI AG Size

John- husband

UP Med Needy MA In/Out

Eligible

Counted +1

Group Child

Donna- wife

Pregnant Women

Counted

Eligible + 1

Group Child

Kate- child

Children Medicaid

Counted

Counted + 1

Eligible

*MAGI AG size is 4 due to the fact that Donna is pregnant with one fetus and the fetus counts

Scenario 3 – Single Mother of One with Estranged Husband

Household Description:

Erica (27 years old) is applying for herself and her son, Donald (3 years old). Erica is married to her estranged husband, Adam (26 years old) and continues to file taxes jointly with him.

Erica is a Joint Tax-filer with Adam – Erica’s Gross earned income is $1,452 per month no pre-tax deductions

Adam is a Joint Tax-filer with Erica – Adam’s Gross earned income is $2,015 per month no pre-tax deductions.

Donald is a Tax Dependent of Erica and Adam.

Complete the charts below:

Medicaid Eligibility For	Income to be counted			FPL % for Group Type Parent/Caretaker Income Limit	Income Limit for Household Size ($)	Total Countable MAGI-Based Income of the MAGI AG size	Financial Results
Medicaid Eligibility For	Erica	Donald	Adam	FPL % for Group Type Parent/Caretaker Income Limit	Income Limit for Household Size ($)	Total Countable MAGI-Based Income of the MAGI AG size	Financial Results
Erica-mother
Donald-son
Adam-absent father

Medicaid Eligibility For	Eligibility Category	Erica	Donald	Adam	MAGI AG Size
Erica-mother	Parent/Caretaker	Eligible	Counted	Counted	3
Donald-son	Expanded Children	Counted	Eligible	Counted	3
Adam-absent father	Not Requesting – Out of Home Joint Filer	N/A	N/A	N/A	0

Scenario 4 – Unmarried Couple with Child not Claimed as a Tax Dependent

Household Description:

Unmarried parents, Rick (25 years old) and Tara (23years old) who is pregnant with one fetus, are applying for Medicaid along with their son, Charlie (2 years old) and Rick’s daughter, Angela (4 years old). Angela is the biological daughter of Rick and claimed as a Tax Dependent by her non-custodial biological mother, who does not live in the household.

Rick is a Tax Filer – Gross earned income $1,900 per month no pre-tax deductions

Tara is a Non-filer – No income – Rick is not claiming Tara

Angela is a Tax Dependent of Mother who is a non-custodial parent – No income

Charlie is a Tax Dependent of Rick – No income

Complete the chart below:

Medicaid Eligibility For	Income to be counted				FPL % for Group Type	FPL for Household Size ($)	Total Countable MAGI-Based Income of the MAGI AG size	Financial Results
Medicaid Eligibility For	Rick	Tara	Charlie	Angela	FPL % for Group Type	FPL for Household Size ($)	Total Countable MAGI-Based Income of the MAGI AG size	Financial Results
Rick-boyfriend
Tara-girlfriend
Charlie-common child
Angela-Ricks daughter

Answer:

Medicaid Eligibility For	Eligibility Category	Rick	Tara	Angela	Charlie	MAGI AG Size
Rick-boyfriend	Parent/ Caretaker	Eligible	Not Counted	Not Counted	Group	2
Tara-girlfriend	Pregnant Women	Not Counted	Eligible + 1	Not Counted	Group	3
Charlie-common child	Children	Counted	Counted + 1	Group	Eligible	5
Angela-Ricks daughter	Children	Counted	Excluded	Eligible	Group	3

Scenario 5 – Three Generation HH with Married Child

Household Description:

Matilda (47years old) is applying for herself, her son, Dominic (17 years old), his wife, Lauren (18 years old) who is pregnant with one fetus and Lauren’s son Cameron (1 years old). Matilda claims Dominic as a dependent. Lauren is a tax-filer and claims Cameron as a dependent.

Matilda is a tax-filer – Gross earned income $1,500 a month no pre-tax deductions

Lauren is a tax-filer – Gross earned income $1,100 a month no pre-tax deductions

Dominic is a tax dependent of Matilda – No income

Cameron is a tax dependent of Lauren – No income

Complete the chart below:

Medicaid Eligibility For	Income to be counted				FPL % for Group Type	FPL for Household Size ($)	Total Countable MAGI-Based Income of the MAGI AG size	Financial Results
Medicaid Eligibility For	Matilda	Dominic	Lauren	Cameron	FPL % for Group Type	FPL for Household Size ($)	Total Countable MAGI-Based Income of the MAGI AG size	Financial Results
Matilda-mother of Dom
Dominic-son to Matilda
Lauren-Dom’s wife
Cameron-Lauren’s son

Answer:

Medicaid Eligibility For	Eligibility Category	Matilda	Dominic	Lauren	Cameron	MAGI AG Size
Matilda-mother of Dom	Parent/Caretaker	Eligible	Group	Not Counted	Not Counted	2
Dominic-son to Matilda	Children	Counted	Eligible	Counted + 1	Counted	4
Lauren-Dom’s wife	Pregnant Women	Not Counted	Counted	Eligible + 1	Counted	4
Cameron-Lauren’s son	Children	Not Counted	Counted	Counted + 1	Eligible	4

Scenario 6 – Intact Family with Child Attending College Out of State

Household Descriptions:

Joanne (39 years old), her husband Andrew (41 years old), their daughter Ella (16 years old) and their son Andrew Jr. (21 years old) are all applying for Medicaid. Andrew Jr. is currently attending college out of state.

Joanne is a tax-filer – Gross earned income $1,200 per month no pre-tax deductions

Andrew is a Joint Tax-filer with Joanne – Gross earned income $1,300 per month no pre-tax deductions

Ella is a tax dependent of Joanne and Andrew – No income

Andrew Jr. is a tax dependent of Joanne and Andrew – Gross earned income of $300 per month

Complete the chart below:

Medicaid Eligibility For	Income to be counted				FPL % for Group Type	FPL for Household Size ($)	Total Countable MAGI-Based Income of the MAGI AG size	Financial Results
Medicaid Eligibility For	Joanne	Andrew Sr.	Ella	Andrew Jr.	FPL % for Group Type	FPL for Household Size ($)	Total Countable MAGI-Based Income of the MAGI AG size	Financial Results
Joanne-wife
Andrew Sr.-husband
Ella-daughter
Andrew Jr.-son College Student

Answer:

Medicaid Eligibility For	Eligibility Category	Joanne	Andrew Sr.	Ella	Andrew Jr.	MAGI AG Size
Joanne-wife	Parent/Caretaker	Eligible	Counted	Group	Not Counted	3
Andrew Sr.-husband	Parent/Caretaker	Counted	Eligible	Group	Not Counted	3
Ella-daughter	Children	Counted	Counted	Eligible	Counted	3
Andrew Jr.-son College Student	None	N/A	N/A	N/A	Not Counted	4

Section Two: New HEIGHTS

Section Two will provide screen prints and further explanations to the changes in New HEIGHTS.

Section 2.1

Client Registration

There is a new question on the Client Registration screen stating PL/MAGI. This field has been added to this screen to indicate whether the applicant would like to pursue a PL or MAGI Only MA path for Medicaid. This field will be defaulted to “No” when the screen is displayed for the first time.

PL/MAGI will say yes when the clients apply through the Federal Market Place or through NH EASY as PL/MAGI. If there are other categories of Medicaid that the client could be potentially eligible for then it will come over as Medicaid not MAGI.

Also workers should set switch to “Yes” if Form 800M (Application for Health Coverage & Help Paying Costs) or the Federal Streamlined Medicaid Application is received.

Individual Demographics

Race/Ethnicity (Check all that apply) is no longer a mandatory field

Program of Assistance

If the PL/MAGI only field on this screen is checked then pay periods prior to 1/1/2014 in New HEIGHTS will build PL only categories, payment periods on and after 1/1/14 will build MAGI categories.

The PL/MAGI Only field can be populated by any of the following sources:

· Family Service Specialist

· NH EASY, Federally Facilitated Marketplace (FFM) for MAGI eligibility, information is imported from the Marketplace

· Community Applications, the field will be automatically checked and locked

This means that the client wishes to pursue a MAGI MA category only. The client can pursue other non-MA programs of assistance while leaving the PL/MAGI checked off (like the previous PLC only). This cannot be done through Client Registration; it can be done on the Program of Assistance screen only.

Household Relationship Screen

Joint Filer? Will default to “No” if there is no spouse in the household that the client could be a Joint Filer with, but is to be updated according to what the individual states. This answer will affect some of the tax filer questions in the Additional Demographics screen.

This has to do with what the individual plans to do in the current tax year (2013) (the individual may be getting married or in the process of a divorce).

Household Relationship Screen/ Tax Dependent

The purpose of this question is to determine if the Source Name person is the “tax dependent” of the Reference Name.

A child can be a tax dependent of only one person in the case, except where both parents are filing jointly, in which case the child’s response to this question must be ‘Yes’ for both parents.

The Tax Dependent field will be blank and mandatory for all MA cases.

Example: Since Theodore is “No” to being a tax dependent to Sophie, he is most likely claimed as a tax dependent of a non-custodial parent or relative.

Note: Not all children are tax dependents, example: if the parent(s) don’t file taxes.

Individual meets MAGI verification requirements

Household Relationship Screen

This is the first screen that this question appears on “Individual meets MAGI verification requirements”. This question will also be on other screens such as employment, self-employment, and unearned income.

Example:

· If this question is checked and marked “not yet verified”, MAGI will pass and will open and other AG’s will pend.

· If this questions is checked and marked “refused failed to verify”, MAGI will pass other AG’s will fail.

· If unchecked, works as usual “not yet verified” will pend and “refused failed to verify” will fail all categories.

Additional Demographics /Marital Status

If you check that the clients Marital Status as Never Married, Widowed, and Legally separated or divorced the “Plans to file Jointly will be set to “No”

If Marital Status is Married or Informally Separated the “Joint File question is Mandatory.

Additional Demographics / Tax Information

There are new fields on the Additional Demographics screen at the bottom in regards to the Tax Information. The purpose is to collect whether or not the individual expects to and/or is required to file a tax return, and if filing jointly is the other joint filer living outside of the home, which is all necessary to determine household composition based on the new MAGI rules.

Plans to file a return?” This will indicate the potential tax filers in the household to the system and be used to determine the MAGI-based AG size.