Expanding Foundations: Non-MAGI. Overview. Updated 04/2018

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1 Expanding Foundations: Non-MAGI Overview

2 Group Expectations Stay Present Respect each individual s right to learn Critique ideas, not individuals Own your own learning Challenge yourself Take care of yourself Page 4

3 Housekeeping Location of bathrooms Breaks and lunches Safety Computer use Food and drink Clean-up Training materials

4 Non-MAGI Overview Goal: To gain further understanding of Medical Assistance programs, Social Security programs and how they relate. Objectives: After this module, Participants will be able to: Identify eligibility differences between MAGI and Non-MAGI. Associate SSI, SSDI and SSA with Medicaid or Medicare appropriately. Recognize how CBMS applies the hierarchy for eligibility determinations for MA programs

5 MAGI vs. Non-MAGI What do we remember from EF: MAGI? 5 Programs Tax Filing Status and relationship No Resource Check Client Statement

6 MAGI vs. Non-MAGI Non-MAGI Household is now Marital Status and in the Home Introduction or Resource limits Aged, Blind, and Disabled populations Programs were not part of ACA

7 Social Security Administration (SSA) Social Security Retirement Social Security Disability Insurance SSDI Medicare Supplemental Security Income SSI

8 SSDI and SSA retirement Title II Work Quarters No Income and Resource Checks Funded by payroll tax Medicare Disabled or Retired (62+)

9 SSI Title XVI Not enough work quarters Or not insured Income and Resource Checks Discretionary Federal funding Medicaid Disabled or 65+ Maximum benefit $750

10 Non-MAGI Programs SSI related programs SSI Disabled Adult Child (DAC) Qualified Disabled Widow(er) (QDW) Pickle

11 Non-MAGI Programs Medicare related programs Qualified Medicare Beneficiary (QMB) Special Low-income Medicare Beneficiary (SLMB) Qualified Individual-1 (QI-1) Qualified Disabled Working Individual (QDWI) Low Income Subsidy (LIS)

12 Non-MAGI Programs Working Adults with Disabilities (WAwD) Children s Buy-in with Disabilities (CBwD) Old Age Pension (OAP) Old Age Pension Health Care Plan (OAP-HCP) LTC programs Another class Page 8

13 Benefit Categories 1 through 7 Ranks groups of MA categories by overall benefit. 1 is highest benefit

14 Benefit Categories 1 for LTC 2 State plan Medicaid programs 3 Buy-in programs 4 QMB 5 Other MSP 6 HCP 7 LIS Page 9

15 MA Assistance Hierarchy CBMS assessed eligibility for the highest benefit categories first. SLMB is #40, 39 other categories are evaluated first. Page 10,11

16 MA Assistance Hierarchy Which category is last program in on the hierarchy? LIS Page 10,11

17 Review Which SSA programs come with Medicare? Retirement and SSDI

18 Review Which SSA program comes with Medicaid? SSI

19 Non-MAGI? What is different about these programs?

20 Non-MAGI Overview Re-Visit Objectives: Can you? Goal: To gain further understanding of Medical Assistance programs, Social Security programs and how they relate. Identify eligibility differences between MAGI and Non-MAGI. Associate SSI, SSDI and SSA with Medicaid or Medicare appropriately. Recognize how CBMS applies the hierarchy for eligibility determinations for MA programs

21 Resources Expanding Foundations: Non-MAGI

22 Types of Resources and Data Entry Objectives: After this module participants will: Data enter different types of resources. Identify exempt resources. Goal: To understand resource eligibility rules and processes List references to aid in data entry.

23 Estates Home Annuities Life insurance policies Accounts

24 Inheritance Home Annuities Accounts

25 Inheritance Medicaid is not in the business of protecting inheritances!

26 Estate Recovery Estate Recovery allows Medicaid to recoup expenses from an estate prior to any inheritance disbursements.

27 Estate Recovery To Medicaid Home Annuities Accounts

28 Estate Recovery Allows for less harsh rules upfront Homes, vehicles etc.

29 Types of Resources Liquid Assets Vehicles Real Property Burials Life Insurance

30 Liquid Assets Bank Accounts Retirement Accounts Cash Items held as an investment Etc. Page 39

31 Liquid Asset-Data Entry

32 Liquid Asset-Data Entry

33 Encumbrances

34 Vehicle Exempt one if used for transportation Regardless of value Use FMV Bluebooks are guideline

35 Equity Equity is the Fair Market Value minus any loans against the asset. $10,000 car - $8,000 loan= $2,000 equity

36 Vehicle

37 Vehicle Page 18

38 Intent to Sell Exemption for vehicles and property Must be listed Client must accept reasonable offers Request updates/verification every 3 months

39 Example Jane owns 2 cars, the first is exempt. The 2 nd is worth $10,000, but Jane is trying to sell that car.

40 Example If Jane provides the listing and is willing to accept a reasonable offer, that car can be exempted as well. When it sells, the cash received is countable.

41 Real Property Primary Home Secondary properties Mineral rights Other income producing property

42 Primary Home Exempt up to $560,000 in equity Must be living in home or Intend to Return Exempt if Spouse or dependent relative live in home (no limit) FMV

43 Secondary Property Equity is countable Intent to sell can be applied Appraisals as guideline

44 Mineral Rights Land appraisal if land is owned Mineral rights only appraisal if not Often low due to extraction costs Income producing property exemption

45 Income Producing Property Exempt up to $6000 Business property must also produce a 6% return on the excluded value Income is countable income

46 Real Property Data Entry

47 Real Property Data Entry

48 Burial Assets Burial plots, and irrevocable policies are exempt Additional $1500 set aside per person as revocable Saves Medicaid burial costs later HCPF must be remainder beneficiary

49 Burial Asset

50 Life insurance Per Person (Applicant and Spouse) If total face value of all policies are over $1500, all are countable. If total face value of all policies are $1500 or less, all are not countable.

51 Life Insurance Face value: Death benefit Cash Value: Investment component Cash Surrender Value: Amount received to cash out the policy

52 Term Life Insurance Premium payments keep death benefit active (face value) No cash value No cash surrender value

53 Whole Life Insurance Also includes Universal or Variable Premium goes to death benefit and an investment fund The investment fund is the cash value The cash surrender value is a separate amount

54 Life Insurance

55 AF vs. Medicaid Countable for Both Counts for Medicaid only Exempt for both Face Value over $100,000 and Purchased within 48 months Face Value greater than $1500 but less than $100,000 Or >$100,000 and purchased more than 48 months ago Total Face Value $1500 or less

56 Data Entry Practice

57 Spouse s Income and Resources

58 Knowledge Check What Resources are exempt? 1 vehicle Primary Home Personal Property Some Life Insurance Irrevocable Burials Some Revocable Burials

59 Types of Resources and Data Entry Re-Visit Objectives: Can you? Data enter different types of resources. Identify exempt resources. Goal: To understand resource eligibility rules and processes List references to aid in data entry.

60 SSI Based Programs Expanding Foundations: Non-MAGI

61 SSI Related Programs Objectives: Goal: To understand a group of Non-MAGI programs, and their eligibility rules. After this module, Participants will be able to: Identify program resource limits Identify Household requirements and data entry for SSI related Non-MAGI programs Data Enter an SSI mandatory case

62 Program List SSI - Supplemental Security Income OAP - Old Age Pension PICKLE DAC - Disabled Adult Child QDW - Qualified Disabled Widow(er)

63 Commonalities Benefit Category 2. State-plan Medicaid Resource Limits $2000 Individual $3000 Couple 45 days to process, 90 days if disability determination is needed.

64 Commonalities Income limits (except OAP) $750 Individual $1125Couple Income Disregards $20 Unearned Income $65+ ½ (remaining earned income) -Earned income

65 Earned Income Disregard Jimmy has $1065/mo. in earned income. $1065-$65= $1000. ½ ($1000) = $500 ($65 + $500) = $565 is disregarded $500 is countable towards Non-MAGI.

66 Household Living in the Home Case Individual And Marital Status

67 Marital Status Individual Demographics Household Relationships

68 SSI Mandatory All individuals receiving an SSI cash benefit are eligible for Medicaid. Benefit can be backdated to the day they 1 st received SSI.

69 Let s enter a case! You receive notification that an unmarried member has been receiving $300 in SSI benefits since April 18th This is verified through SDX

70 Let s enter a case! AI a case from 12/18/2017. Individual is born between 1955 and 1975 Make up a name and SSN Assume you have an SSN card and Birth Certificate.

71 SSI Details Individual Demographics SSI tab

72 SSI Income Unearned Income

73 SSI Income Income Received

74 Run EDBC

75 OAP Covered in Expanding Foundations: Adult Financial Individuals eligible for OAP AF will receive a MA benefit, Could be OAP-Med, OAP-HCP, QMB, WAwD or even a MAGI program!

76 Pickle Intended to protect SSI s Medicaid benefit from SSDI initial entitlements or COLAs pushing an individual over the income limit.

77 The Pre-Pickle Program Problem Jimmy initially received a $769 SSDI benefit in He was also under the SSI resource limit, so SSA calculated a SSI benefit.

78 The Pre-Pickle Program Problem $769 SSDI - $20 (unearned income disregard) = $749. The SSI limit is $750. Jimmy qualified for a $1 SSI benefit as well, which entitled him to Medicaid

79 The Pre-Pickle Program Problem In January 2018 there is a COLA for SSA of 5 percent! The SSI limit would increase by 5 % ($750 x 1.05 = $788.55) rounded to $789! Jimmy s SSDI benefit would increase by 5% ($754 x 1.05 = $791.70) rounded to $792!

80 The Pre-Pickle Program Problem SSA re-checks Jimmy s SSI eligibility. $792 SSDI -$20 = $772. The SSI limit is $772. Jimmy no longer qualifies for the $1 SSI benefit

81 The Pre-Pickle Program Problem Jimmy loses Medicaid

82 The Pickle Person Procedure The Pickle Program keeps this population on Medicaid if they: Are eligible for and receiving a Title II benefit Have countable income and assets below current SSI limits ($2000/$3000) Submit an application

83 The Pickle Person Procedure CBMS will check to ensure the client is only over-income because of the Title 2 increase. These are rare occurrences to keep an eye out for around COLAs. A data entry guide is in the book.

84 Disabled Adult Child (DAC) Protect SSI s Medicaid benefit from a SSA Disabled Adult Child entitlement pushing an individual over the income limit.

85 Disabled Adult Child (DAC) A DAC SSA entitlement is for individuals who suffered a childhood disability (prior to age 22). Because they were unable to collect work credits of their own, they can draw on their parent s claim when their parent retires or becomes disabled.

86 DAC Benefit Problem Terra suffered a childhood disability and was found disabled by SSA at age 14 Terra was unable to work as a result. At age 18 Terra started receiving an SSI benefit and Medicaid.

87 DAC Benefit Problem In 2017 Terra s parents retire, Terra qualifies for a DAC payment of $800 based on her parent work history. SSA automatically uses this income change to re-evaluate SSI eligibility. $800-$20 disregard= $780 which is over income for SSI.

88 DAC Benefit Problem Terra loses SSI and SSI Mandatory Medicaid.

89 DAC Medicaid DAC Medicaid keeps this population on Medicaid if they: Meet the $2000/$3000 resource limit Would be income eligible for SSI if they did not receive the DAC benefit

90 DAC Medicaid This is also a rare population. CBMS will read the DAC benefit from the SSA interface and run income/resource calculations.

91 Qualified Disabled Widow(er) Protect SSI s Medicaid benefit from a SSA Widow(er) entitlement pushing an individual over the income limit.

92 Qualified Disabled Widow(er) s Burden Valerie is 52yo and disabled. She is married to Rob who is working and provides for the household.

93 Qualified Disabled Widow(er) s Burden Rob dies.

94 Qualified Disabled Widow(er) s Burden Valerie would be eligible for SSI and Medicaid but

95 Qualified Disabled Widow(er) s Burden The widow benefit she received from Rob s work quarters totals $920/mo. SSA points out she isn t SSI eligible due to this income, Valerie can t qualify for SSI Medicaid

96 Qualified Disabled Widow(er) s Burden QDW extends Medicaid to this population if they: Meet the $2000 resource limit Apply Would be income eligible for SSI if not for the QDW benefit.

97 Qualified Disabled Widow(er) s Burden Again the survivor s benefit is an income type and is a rare population. CBMS will check for the income type, Medicare eligibility (disabled), and calculate financial eligibility.

98 SSI Related Programs Objectives: Can you? Goal: To understand a group of Non-MAGI programs, and their eligibility rules. Identify program resource limits Identify Household requirements and data entry for SSI related Non-MAGI programs Data Enter an SSI mandatory case

99 Buy-in Programs Expanding Foundations Non-MAGI

100 Buy-In Programs Re-visit Objectives: Goal: To understand a group of Non-MAGI programs, and their eligibility rules. After this module participants will: Explain the coverage difference between Buy-in Programs and State plan Medicaid. Identify acceptable sources of disability determination for buy-in programs.

101 Buy-in programs 2 MA categories allow individuals who are disabled, but ineligible for a state plan Medicaid program, to buy-in to Medicaid via a premium.

102 Disability Definition Medically Determinable Impairment, Lasting 12 months or more, Adults Children Resulting in an Inability to perform substantial gainful activity Resulting in multiple markedly or at least one severely limited functional domain

103 Disability Criteria SSA Determination State Contractor Determination Page 58

104 Working Adults with Disabilities Benefit Category 3 State-Plan with premium

105 Working Adults with Disabilities Household Individual only Requirements Disabled and working Age 16-64

106 Working Adults with Disabilities Disability Can be full or limited from ARG or SSA. Working Earned income Self-employment income Job attached Take client statement

107 Working Adults with Disabilities No resource limit Income limit 450% FPL ($4455/mo.) after disregards $20 unearned disregard. $65 + ½ (earned income) disregard applies.

108 Premiums Members on WAwD pay a premium from approval month forward. Can have Retro Med, no premium is required for retro months.

109 Premiums Premiums based on countable income FPL WAwD premiums %-40% 41%-133% 134%-200% 201%-300% 301%-450% After Disregards $ $0-$402 $403-$1337 $1338-$2010 $2011-$3015 $3016-$4550 Monthly Premium $0 $25 $90 $130 $200

110 Children s Buy-in Children s Buy-in with Disabilities (CBwD) Category for children with disabilities whose families are over-income for other Medical Assistance programs Benefit Category 3

111 Children s Buy-in Under the age of % FPL after disregards 33% of total income is disregarded An additional $90 earned income disregard No resource limit

112 Oddities HH composition still uses MAGI rules Tax filer status Everything else is Non-MAGI rules Ineligible for year olds who are working They should be on the WAwD Program

113 Smaller Premiums FPL CBwD Premiums % % % % Premium $0 $70 $90 $120

114 Buy-In Programs Re-visit Objectives: Can you? Goal: To understand a group of Non-MAGI programs, and their eligibility rules. Explain the coverage difference between Buy-in Programs and State plan Medicaid. Identify acceptable sources of disability determination for buy-in programs.

115 Disability Expanding Foundations: Non-MAGI

116 Disability Objectives: Goal: To gain further understanding of Disability, and the associated business processes to meet this requirement After this module, participants will be able to: Perform data entry on the Disability Determination screen in CBMS Identify when the disability requirement is met, and when the disability app is necessary Gather, complete and submit a disability application

117 Disability Definition Medically Determinable Impairment, Lasting 12 months or more, Adults Children Resulting in an Inability to perform substantial gainful activity Resulting in multiple markedly or at least one severely limited functional domain

118 Disability Criteria Age 65+ SSA Determination State Contractor Determination Page 65

119 Disability Determination Process Check for age then SSA disability determination: State Verification and Exchange System (SVES) for SSDI State Data Exchange (SDX) for SSI Award letter from SSA verifying SSI, SSDI or future diary date

120 Title XVI Page 66

121 Title II

122 Disability Determination Process If there is no disability determination from SSA: State Disability Contractor Complete Disability application and Medical Release Form

123 Disability Application

124 Comments Page Page 19

125 Release Form

126 ARG Contact Information Mailing Address: Arbor E&T, Action Review Group P.O. Box 340 Olyphant, PA Application Status (pending, new or in appeal): address: Phone number: (877) Fax number: (877)

127 Auto-Mail CBMS will mail the app for you!

128 Pend for Disability After receipt, send to ARG

129 Determination Notice

130 Disability Criteria Full vs. Limited Disability Full Disability (All programs) Meets the SSA disability criteria All LTC waivers Limited Disability (WAwD) Meets the SSA disability criteria without consideration of substantial gainful activity WAwD clients: CMHS and EBD waivers only

131 Full or Limited FULL Limited

132 Data Entry Info

133 Disability Data Entry

134 Medical Conditions Screen

135 Disability Determination Screen EBD: Retro date Onset date: Retro date for ARG, Onset date for SSA. Status date: Date status was last changed Result date: Date the last decision on disability was made. Diary Date: Date case will be re-reviewed for ongoing disability.

136 Data Entry Practice Page 83-86

137 Disability Wrap-up Re-visit Objectives: Can you? Goal: To gain further understanding of Disability, and the associated business processes to meet this requirement Perform data entry on the Disability Determination screen in CBMS Identify when the disability requirement is met, and when the disability app is necessary Gather, complete and submit a disability application

138 Remember your SSI Case What must happen to change that person to the WAwD program? Enter those changes effective today and Run EDBC

139 Medicare Saving Programs Expanding Foundations: Non-MAGI

140 Medicare Based Programs Objectives: Goal: To understand a group of Non-MAGI programs, and their eligibility rules. After this module participants will: Perform accurate data entry on the Medicare Expense Page. Explain the coverage difference between MSP programs and State-plan Medicaid.

141 MSP Programs Benefit Categories 4 and 5 State contribution to Medicare costs. May pay for Medicare premiums, coinsurances and deductibles. Health Insurance coverage remains Medicare.

142 MSP Categories QMB SLIMB QI-1 QDWI LIS* - Benefit Category 7

143 MSP Categories Eligibility Eligible for Medicare Part A Income and Resource limits

144 Medicare Part A Hospital/emergency coverage Typically free Part B Primary Care Has a premium $134+ based on income Part D Prescription Coverage Variable premium based on plan

145 QMB Benefit Category 4 QMB individuals have their Medicare premiums, deductibles, co-pays, and coinsurance covered by the state.

146 SLMB and QI-1 Benefit Category 5 SLMB and QI-1 individuals only have their Medicare B premiums covered by the state.

147 SLMB and QI-1 What s the difference? QI-1 is an expanded income bracket that requires active renewal each year by Congress.

148 QDWI Benefit Category 5 QDWI individuals don t have a free part A. They have lost their SSDI and Free Part A because they have too much earned income and are under 65. QDWI will pay for Part A.

149 But Wait This population is covered by WAwD. The program is close to obsolete because of the WAwD category. If a working disabled individuals opts out of WAwD or fails to pay a premium, they might fall into the QDWI category if SSA has identified them as a QDWI eligible.

150 But Wait You ll likely never see it happen

151 Income and Resource limits QMB SLMB QI-1 QDWI Income $1,010 Individual $1,355 Couple Income $1,208 Individual $1,622 Couple Income $1,357 Individual $1,823 Couple Income $2,000 Individual $2,690 Couple Resources $8,780 Individual $13,930 Couple Resources $8,780 Individual $13,930 Couple Resources $8,780 Individual $13,930 Couple Resources $4,000 Individual $6,000 Couple

152 LIS Low Income Subsidy. Benefit category 7. Managed by SSA. Provides a partial subsidy for Part D costs and eases the Prescription drug donut hole.

153 LIS Approvals for LIS have their info sent to SSA to provide the subsidy.

154 LIS Because it s the last program on the hierarchy, it will display denied when applicants are not eligible for any program.

155 Medicare Data Entry Expenses- Medicare

156 Medicare expenses Interfaces for existing cases. Data entry required for new cases. Part A section Usually Payment method Other and Free Part A Include approval date- Part A eligibility is required for many programs. Find this info in BENDEX or SVES.

157 Medicare expenses Part B Section Enter the actual premium and approval date. Mnthly Deduc and paid by beneficiary if client pays. State payment and paid by state buy-in if state is already paying.

158 Fun with MA categories AI a case 60yo with $1100 SSDI Verified by Bendex Part A eligibility Part B premium of $ Which Category displays in wrap-up?

159 Fun with MA categories Reduce their income to $900/mo Which Category displays in wrap-up?

160 Fun with MA categories Add any countable resource worth $10000 Which Category displays in wrap-up?

161 Fun with MA categories Add $1250 earned income Run EDBC

162 Fun with MA categories Delete the Earned income and add $1250 unearned income. Run EDBC

163 Fun with MA categories You ve received a case with active AF- OAP only 60yo No income or Resources Add MA and run EDBC

164 Fun with MA categories Add a whole life insurance to your OAP case. $30,000 face value $5,000 CSV Run EDBC

165 Medicare Based Programs Re-visit Objectives: Can you? Goal: To understand a group of Non-MAGI programs, and their eligibility rules. Perform accurate data entry on the Medicare Expense Page. Explain the coverage difference between MSP programs and State-plan Medicaid.

166 Course Evals Traincolorado.com

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