WIC Eligibility Road to Success

Transcription

1 WIC Income Eligibility 2017/2018 Presenter: Heather Kahn, MS, RD 2 Purpose The purpose of this training is to review USDA WIC policies and procedures determining WIC eligibility for income, residency & identity. A Medicaid review will be presented, as well. 3 Agenda 1. Policies to be updated 2. Medicaid Review 3. How do we Determine WIC Eligibility? 4. Examples 5. Questions 1

2 4 Policies soon to be updated once approved by USDA 1. Policy 2.02 Residency & 2.03 Identity Updated references: Policy 3.04 Transfers 2. Policy 2.04 Income Eligibility Simplified content & Language Organized & grouped related information Updated references & websites 5 POLICY UPDATE cont 3. Policy 2.06: Adjunct Income Eligibility Content Change: Incorporated MICHILD under the list of Adjunctive eligibility since now it is under the umbrella of Medicaid in Michigan. Simplified content & Language Organized & grouped related information Updated references & websites 6 POLICY UPDATE cont 4. Policy 2.12: Migrant Added the definition of a Migrant Farm Worker at the beginning of policy DEFINITION: Migrant farmworker - An individual whose principal employment is in agriculture on a seasonal basis, who has been so employed within the last 24 months, and who establishes, for the purposes of such employment, a temporary abode. Edited Language Updated References 2

3 7 Medicaid Review How do Medicaid Programs Differ from Each Other? 8 MEDICAID: MA 100% FPL or Federal Poverty Level BENEFIT PLAN ID: MA PLAN NAME: Full Fee-For-Service Medicaid 9 MEDICAID Plan Description Members are generally assigned to this benefit plan upon approval of their eligibility information & remain active even if eventually assigned to Medicaid Managed Care [MA-MC]. Once assigned to a Managed Care Organization, the health plan is the primary payer. 3

4 10 APS: Ambulatory Prenatal Services This program provides presumptive eligibility for pregnant women limited to ambulatory prenatal care services only. Covered services include physician visits for prenatal care, prescription drugs related to pregnancy, and prenatal laboratory tests. 11 HMP: Healthy Michigan Plan 133% FPL Benefit Plan ID: MA-HMP Adults: years 12 HMP Description This plan provides health care benefits to adults 19 through 64 years of age, not covered by or eligible for Medicaid, with family incomes at or below 133% of the federal poverty level (FPL) & who are not eligible for or enrolled in Medicare. Eligibility is determined through the Modified Adjusted Gross Income (MAGI) methodology. 4

5 13 Modified Adjusted Gross Income Generally, your Modified Adjusted Gross Income (MAGI) is the total of your household's Adjusted Gross Income plus any tax-exempt interest income you may have. It does not include assets. 14 CHIP: Children s Health Insurance Program Provides health coverage to eligible children, through both Medicaid & separate CHIP programs. Administered by states, according to federal requirements. Funded jointly by states and the federal government. 15 HK-EXP: Healthy Kids Expansion Full Fee-for-Service Healthy Kids Expansion 160% FPL Children under age 19 Funded by Children s Health Insurance Program (CHIP) Revised 7/1/2016 5

6 16 MOMS: Maternity Outpatient Medical Services 195% FPL Immediate health care For PG Provides immediate health coverage for the unborn child of an undocumented pregnant woman Can be used during a Medicaid pending application Must use Medicaid once it becomes available Also for non-citizens Can cover Entire Pregnancy & 2 Calendar Months after pregnancy ends. 17 MA-MICHILD (CHIP) CHILDREN UNDER AGE % MAGI $10 monthly premium fee Non-emergency Transportation (NEMT) Under Medicaid Umbrella: makes clients adjunctively eligible for WIC 18 ESO: Emergency Services Only Clients who do not meet citizenship requirements, but may be eligible for Emergency Services Only (ESO). 6

7 19 ESO: Emergency Services Only HMP-ESO: HK-EXP-ESO: MA-ESO: MICHILD-ESO: HEALTHY MI PLAN-ESO HEALTHY KIDS-ESO MEDICAID-ESO MICHILD-ESO 20 SSI: Supplemental Security Income Cash benefit to low income adults who are Aged, Disabled or Blind Automatically eligible for Medicaid Contact Social Security Administration (SSA) for Application

8 22 Other Assistance Programs: SNAP (Food Stamps) & FIP/ Cash Assistance SNAP: Supplemental Nutrition Assistance Program Free nutrition education & physical activity promotion program Funding: USDA & FNS Who: children, youth, and adults In Michigan, SNAP is also referred to as the Food Assistance Program (FAP). 8

9 25 SNAP: Where Education is provided: child care sites, pre-schools, schools, summer meal sites, worksites, faith faith-based organizations, senior centers, farmer's markets, retail food stores, and emergency food distribution sites. MDHHS partners with: Michigan Fitness Foundation (MFF) Michigan State University Extension (MSUE). 26 SNAP: Most FAP interviews are held by telephone. However, you may request an in-person interview. If you are also re-applying for cash assistance, you may be scheduled for an in-person interview. 27 FIP: FAMILY INDEPENDENCE PROGRAM o Provides FINANCIAL ASSISTANCE to families with children (Cash Assistance). o Helps maintain and strengthen family life for children and the parent(s) or other caretaker(s) with whom they are living, and to help the family attain or retain capability for maximum self support & personal independence 9

10 28 Cash Assistance: Who Qualifies Children must be a part of your family and meet age requirements: under 18 or 18 years old & attending high school The family or legal guardians of that child are also evaluated as part of the eligibility process. Pregnant women Parents of a child in foster care who is expected to return home within one year 29 Tools to Verify Adjunctive Eligibility 1. CHAMPS: Medicaid - MILogin 2. BRIDGES: Medicaid, FAP, FIP 3. Healthcare4mi.gov: Medicaid 4. Mihealth: 30 USING CHAMPS Community Health Automated Medicaid Processing System Is Medicaid Current? 10

11 31 CHAMPS Search Methods Member ID/CIN (client Identification #)/ RID (Pending Eligibility Recipient ID) If only 8 #s, Add 2 ZEROES before Medicaid # (00-MA ID) Last name, first name, DOB Last name, first name, SSN (Social Security #) SSN & DOB 32 CHAMPS: Client SEARCH 33 Member ID & First Name (Name change: client married/divorced) 11

12 MA-MC: MEDICAID MANAGED CARE 34 Medicaid EXPIRES: 12/31/ For more client info: SELECT SHOW 12

13 SELECT MEMBER DISPLAY BASE 37 Provides updated address for client 38 Upon Medicaid Approval, CHAMPS provides a mihealth card The mihealth card ("myhealth") is a permanent plastic health ID card. Beneficiaries with Michigan Medicaid including Emergency Medicaid), CSHCS, MIChild & Healthy Michigan Plan (HMP) coverage will get a mihealth card. 39 Benefits Approved The mihealth card is mailed to new beneficiaries when benefits are approved. Upon Medicaid renewal, beneficiaries that already have a card will not receive a new card. 13

14 Upon Medicaid approval, a health plan is chosen & will vary by county Health Plan Guidelines Enrollment period usually covers 12 consecutive months. Health plans can be changed within 90 days after joining or during open enrollment in May of each year, unless you live in a "rural exception county." Call Michigan ENROLLS at to make changes. If you voluntarily join a health plan you can change plans or dis-enroll at anytime. 42 Health Plan ID Card Will also be mailed Name of health plan Primary Care Provider (PCP) PCP's phone # AND: Member handbook Questions about Medicaid health plans, call Michigan ENROLLS at or

15 43 RESOURCE INFORMATION 1. Current beneficiaries can find out which health plan they are enrolled in by calling the Beneficiairy Help Line at (TTY ). 2. OR, Log into their myhealth Portal account online at 44 Lost Card Call the Beneficiary Help Line at to request a card replacement Or request a replacement card using the myhealthbutton (app for cell phones) or myhealthportal 45 Health Care Phone # Resources 15

16 HOW TO APPLY for Assistance programs: MIBridges includes Applications for: Health Care Coverage Food Assistance Cash Assistance Child Care Emergency Services 48 Paper Application DCH-1426 Application for Health Coverage & Help Paying Costs, is the paper application 16

17 49 Healthcare4mi.com 50 FAP & FIP: Call for Eligibility (Benefits are on same EBT card) Dial WITH PROMPTS: 1. Select #1 for English 2. Select #1 for Food or Cash assistance (#2 for WIC) -enter 16 digit account Number: ( ####-####) FAP & FIP: Call for Eligibility cont (Benefits are on same EBT card) 3. System provides food stamp cash amount & Cash assistance amount available on card. 4. Select choice #5: provides last 10 transactions: -Provides purchase information in the cash amount -Provides Load amount in cash value on a specific date (must be within the past 30 days)

18 FYI: FAP and FIP EBT Food Benefit Issue schedule: Benefit_Issuance_Dates_January_through_N ovember_2011_and_ongoing_final_343053_ 7.pdf CASH Assistance Payment Schedule: DHS-1111_262016_7_382139_7.pdf MI-WIC Policy 2.0 Eligibility/Certification Eligibility determination consists of Income eligibility and verification Policy 2.01, 2.04, 2.05, 2.06, 2.08 Adjunct program reporting- Policy 2.06 Identify verification- Policy 2.03 Authorized Person Client Residency verification- Policy Eligibility/Certification Policies 18

19 Eligibility/Certification Policies Eligibility/ Certification of Clients Clients must be PG, BF, NPP, C1-C4 or Infant Must meet residency, income and identity requirements Residency Proof of residency required at: Enrollment Each certification Transfer Short certification if client did not bring proof: 60 days 19

20 Residency Proof Allowed: Michigan ID/Driver s license Voter registration Utility or rent/mortgage receipt Passport/Visa Homeless shelter address Mihealth card Other records that the WIC State Agency considers adequate to establish residency Applicants with NO PROOF of residency shall be fully certified with the completion of an Attestation Form. This may include, but is not limited to: Victim of theft, loss or disaster Homeless individual Migrant Person (transferring to Michigan) holding a VOC card. Person who has recently moved into the service area Residency Applicants who are unable to provide proof of residency during the initial enrollment onto the WIC program shall be required to provide proof at the next certification. 20

21 61 How To Locate Attestation Form: CLINIC MODULE: Miscellaneous => Signature New

22 Identity Proof required: For NEW clients & Authorized Persons at initial enrollment For transfers from Out of State & Overseas Visual personal recognition by WIC staff at issuance of benefits or subsequent certifications is allowed once initial proof of identity has been established. 66 Identity Proof Left Proof at Home Short cert 60 days to bring in proof Schedule next visit within 60 days Immunization Record Birth Certificate Hospital Record/Crib Card Health Insurance Identification Social Security Card Photo Identification Driver s License Student Identification Card State Identification Card Work Identification Card Pay Stubs Voter Registration Card Mihealth card Michigan WIC Bridge Card WIC/WIC Overseas records from other states/jurisdictions 22

23 Applicants with NO PROOF of identity shall be fully certified with the completion of an Attestation Form. This may include, but is not limited to: Victim of theft, loss or disaster Homeless individual Migrant Identity Applicants who are unable to provide proof of identity during the initial enrollment onto the WIC program shall be required to provide proof at the next certification Income Determination Maximum allowable is 185% of poverty unless Adjunctively eligible Migrant, homeless or works for cash (Does not have verification/proof) (No Proof of Income Attestation form) (ie. Has income, but cannot prove) NO income (Client Agreement)-Policy 2.07 (Has absolutely NO INCOME) 23

24 Income Rules If client HAS proof of income, but did not bring it to cert/recert appointment SHORT CERT: 30 days of benefits Migrant families have income determined every 12 months IEVAL/CEVAL DO NOT evaluate income, Unless other family member is certified 71 Definition of Income Income means gross cash income before deductions for income tax, social security, insurance premiums, etc. Includes OVERTIME PAY If self-employed or farm income, net income is used for eligibility determination: 1040 Policy 2.04 Income Determination 72 Ways to Calculate Income Current: The family s current (past 30 days) rate of income 30 days worth of pay stubs: weekly, bi-weekly, semi-monthly, or monthly 24

25 73 Annual: Families who qualify for this category include but are not limited to Construction workers Farmers Seasonal agricultural farmworkers Self-employed persons Persons on extended leave due to illness or childbirth. Income over the past twelve months (can use year to date income annualized) Income as stated on the most current IRS 1040 tax form filed 74 Temporary Low Income: Income for the NEXT 30 DAYS Income that is below a family s normal level due to infrequency or irregularity of employment (income available to the family in the NEXT 30 days), ie. Laid off Families who qualify for this category include but are not limited to Workers on strike Temporary or seasonal workers Unemployed workers 75 Year to Date Income (YTD) Check stub has Year to date information MI-WIC feature calculates YTD based on date of check stub and total amount YTD Will provide an annual income to be entered into system. 25

26 Income Sources Wages (including overtime), salary, commissions, tribal per capita payments, can be electronic pay stub Military Pay (see 2.04A) Net income from Farm or Self Employment (IRS 1040 schedule F, C) Social Security benefits (SSI) Dividends, interest on savings or bonds, income from trusts or real estate Income Sources cont Public Assistance DO NOT INCLUDE Food Stamp/SNAP benefits Government civilian or military retirement, pensions or veterans payments Pensions or annuities Alimony or child support payments Regular contributions from persons not living in the household Net royalties Other CASH income-can be on a regular basis (baby sitting) or one-time (lottery winnings) A Military Pay What DOES count: Base pay Basic Allowance for Subsistence (BAS) Foreign Language Pay (FLPP) Family Separation Allowance (FSA) Jump Pay, Dive Pay, Sea Pay, Flight Pay Continental United States Cost of Living Allowance (CONUS COLA) Allowed to Income Average over the year: Clothing Maintenance Allowance (CMA) Bonus Pay (Bonus) Special Pay 26

27 79 Military Pay: What DOES NOT count: Basic Allowance for Housing (BAH or BAQ) Family Separation Housing (FSH) Family Subsistence Supplemental Allowance (FSSA) Overseas Housing Allowance (OHA) Overseas Continental United States Cost of Living Allowance (OCONUS COLA or COLA) Combat Duty or Combat Zone Pay Income Exclusions The value of in-kind housing and other in-kind benefits. Loans Payments or benefits from Federal Programs or Acts: - See list 14e i-xxxv (page 4-7) - ie. VISTA, Foster grandparents payments, Payments through Job training Partnership Act Income Exclusions cont School lunch benefits/child care feeding programs Payments from Low Income Home Energy Assistance Act Student financial assistance funded by Title IV, including Pell grants Value of child care payments under the Child Care and Development Block Grant National Flood Insurance payments 27

28 Income Guidelines 83 MI-WIC POP UP Adjunct Income Eligibility Medicaid: Healthy Kid s Program Healthy Michigan Plan (HMP) MICHILD MOMS/Presumptive Eligibility FIP (Cash Assistance) 28

29 Member of a family that: Receives SNAP (Food Stamps) Receives FIP (Family Independence Program) Includes a Pregnant Woman or Infant receiving Medicaid: Will Make ENTIRE FAMILY Adjunctively Eligible. 86 Upon approval of adjunct income eligibility, applicants can verbally declare their income. 87 When do I verify Income? Income Determination Certification Recertification No Income Determination Infant Evaluation Child Evaluation Transfer with current VOC 29

30 88 No Proof of Income No proof brought to certification, but available Short cert Document no proof of income on the income verification screen 30 day certification, bring proof at next visit 89 HAS INCOME, but NO PROOF Works for CASH Attestation form required unless adjunctively eligible Full certification period Migrant, Works for cash, Homeless 90 cash Attestation Form 30

31 91 Attestation Form: No proof of income (paid in cash) 92 NO INCOME whatsoever Declaration of No Income Client Agreement Staff must ask client questions from no income pop-up screen To determine if member of another household Make needed referrals Homeless 93 NO INCOME: Client Agreement By signing this form I also understand and agree: The information I have given to the WIC Program is TRUE. WIC staff may check any of this information. 31

32 Declaration of NO INCOME Client states they have NO INCOME Source = no income FURTHER screening Describe how they are supported with food, shelter, medical care 95 Proofs - How Do I Know What I Need to Do? Family Size Income eligibility based on Total Family Size Include: Unborn child(ren) Adopted child(ren) Deployed Husband Special Considerations Resident of Institution or group home Family living in homeless shelter, group residence Foster child: Family of one 32

33 97 Pregnant woman & Expected # infants Pregnant woman Family size counts EXPECTED # of INFANTS Woman pregnant with twins Pregnant woman 1 Twins 2 Family size 3 98 Policy 2.08 Definition of Family A group of related or nonrelated individuals who are living together as ONE ECONOMIC UNIT (except that residents of a homeless facility or an institution are not considered as members of a single family). 99 Family or Household Size WIC Policy 2.08 Family members share income, goods & services More than one family can live in a house => Shares apartment with sister, pays rent, has own income Must have its own source of income 33

34 Foster Child Eligibility ONE PERSON FAMILY where DHHS is legally responsible for child Payments made by DHHS or from any other source for the care of the foster child shall be considered the income for the child. If adopted, the child becomes & is counted as a member of the family and WIC eligibility shall be based on the income of the adoptive family Foster Child Eligibility If custody changes, VOID Foster child s benefits Do Not Terminate Foster Child Child will still be able to transfer to another family & receive benefits without having to be recertified Foster child income process P-Cert Screen: Check Foster

35 103 Income Tab: Select Foster Child & hit GO 104 Enter rest of income data

36 106 Client Info Screen: Migrant Farmworker An individual whose principal employment is in agriculture on a seasonal basis, who has been so employed within the last 24 months, and who establishes, for the purposes of such employment, a temporary abode Migrant Family Eligibility Designate as migrant upon enrollment, verify migrant status at each certification Give Priority appointments (within 10 days) Do not need proof of ID or residency Sign no proof of ID or Residency Attestation Form Income completed every 12 months Self-declaration allowed-no Proof of Income Attestation form 36

37 Migrant Family Eligibility VOC/Verification of Certification Accept VOC for migrant family Income eligible if verified in last 12 months Provide VOC to migrant families so they have proof of WIC enrollment Certification Periods PG: Estimated date of delivery + 42 days BF: one year past delivery date NPP: 6 months past delivery or pregnancy end date Certification Periods Infants under 6 months of age: one year past birth date Infants 6 months of age & over shall be certified at the time of entrance into the Program for six (6) months. C1-C4: 12 months past certification date 37

38 Certification Periods Time Variations for Recertification of Infants and Children: In cases where there is difficulty in appointment scheduling due to illness or to synchronize appointments with other family members, a time variation of +/- 30 days from the certification due date is permissible Notification of Client Rights and Responsibilities The Michigan WIC Client Agreement shall be used to inform clients/authorized persons of their WIC Program rights and responsibilities. Read by or read to the client/authorized person at each cert/recert in an appropriate language Notification of Client Rights and Responsibilities Sign & date the Client Agreement At each cert/recert When Authorized person changes When client transfers into Michigan Copy of Client Agreement At initial certification Upon request at other certification/recerts 38

39 Verification of Certification (VOC) The local agency shall issue a VOC to each client participating in the WIC Program. The VOC shall be issued to the authorized person at the time of each certification Verification of Certification (VOC) Must have Signature & printed name of Local Agency Official Ineligibility Notices Written notice is required when client is: Ineligible at certification Terminated at mid-cert for income ineligibility Sanctioned, suspended or disqualified BF woman who discontinues breastfeeding after 6 months 39

40 Ineligibility Notices Written notification of ineligibility shall contain the following: Date of notice Client s name Reason for ineligibility Client s right to a fair hearing Note: Automatically prints when Ineligibility Notice is printed NE: Nutrition Education Plan Issuance of the NE Plan provides notification of the end of certification for each client/parent/caretaker. Notification of Right to Fair Hearing IS NOT REQUIRED Mid-Cert Income Determination Mid-certification income reassessment must be done when a local agency receives information that a client s income or family size has changed. If less than 90 days are left within the existing certification period, no redetermination of income eligibility is needed. If more than 90 days are left in the existing certification period, determine current income based on the income documentation provided 40

41 : Mid-Cert Income Determination If the client s income is determined to be over income and the client/family does not have adjunct eligibility, the client/family shall be terminated with 15 days notice and benefits shall be issued during that period. If client is no longer eligible, use the term reason of No Longer Eligible to end the certification period in MI-WIC. Remember to give the client a notice of ineligibility. 122 Special Cases Is a Deployed Husband counted in family size? Yes Parent is paying child support and is applying for WIC. Are they allowed to exclude their child support payments from their Gross Income? No Mom receives child support. Must mom count child support in her income? Yes 123 FAQ: Are they allowed to use NO INCOME AGAIN if they had stated NO INCOME for their last certification period? Currently, there is no Federal Guidance for this situation 41

42 124 Answer: Questions to Assess current income status: o How have they been able to support themselves & their family over the past year? o If they are not on Medicaid, why or why not? o Are they participating in any other MDHHS programs? 125 Guidance Technically they could declare NO INCOME again. Be sure they understand the Client Agreement & consequences of fraud. MI-WIC Policy 2.07 Declaration of No Income 126 WIC Policy Manual Michigan.gov/WIC WIC Providers Michigan MI-WIC Policy Manual WIC DuJour WIC-1636 then Press 1 and 1 (MI-WIC) Press 1 and 2 (Policy) 42

43 127 MEDICAID MEDICAID PROVIDER MANUAL pdf 128 Thank you! Heather Kahn, MS, RD Eligibility Program Area Lead (517) Local Agency Questions 43