Authorized Signature Issue Date: 12/3/2012

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1 Aging and People with Disabilities Policy Transmittal Mike McCormick Number: APD-PT Authorized Signature Issue Date: 12/3/2012 Topic: Medical Benefits Transmitting (check the box that best applies): New policy Policy change Policy clarification Executive letter Administrative Rule Manual update Other: Applies to (check all that apply): All DHS employees Area Agencies on Aging Aging and People with Disabilities Children, Adults and Families County DD Program Managers County Mental Health Directors Health Services Other (please specify): SSP and OHA workers who determine eligibility for OSIPM and Medicare Savings Programs Policy/rule title: Income and Payment Standards, OSIPM Policy/rule number(s): , , , , , , , and Release no: Effective date: January 1, 2013 Expiration: References: Web Address: Discussion/interpretation: This Policy Transmittal explains the impact of SSA Cost of Living Adjustments (COLAs) on OSIPM and Medicare Savings Programs (QMB/SMB/SMF) eligibility for Implementation/transition instructions: Effective January 1, 2013, the Social Security Administration (SSA) will implement a 1.7% COLA for Social Security recipients. This includes Social Security payments under Title II of the Social Security Act (both SSB and SSDI) and Supplemental Security Income (SSI) under Title XVI of the Social Security Act. This COLA will have the following program impacts:

2 SSI/OSIPM standards changes: The full SSI standard (known as the Federal Benefit Rate or FBR) for one person will increase from $698 to $710. SSI clients may receive less than that amount, but the maximum amount for a single person would be $710 per month. $710 per month will also be the adjusted income standard for all standard living arrangement (non-services) OSIPM clients, regardless of the basis of need (aged/blind/disabled). This means that the separate one-person OSIPM-AB standard (of $700.70) will be eliminated. APD had planned to eliminate the separate blind standard when SSA COLAs made the SSI standard larger than the OSIPM blind standard, and the 2013 COLA makes that happen. There will now only be one standard for a one person need group for OSIPM, and that will be $710. Two-Person SSI/OSIPM Adjusted Income Standard: The full SSI/OSIPM two-person adjusted income standard will increase from $1048 to $1066. System Updates: The CM system is scheduled to automatically update SSI and SSB amounts at EOM processing near the end of December. Staff will receive more information about this update in a separate transmittal later in December. Please do not manually update SSI and SSB amounts for on-going clients in December. Doing so will create system inaccuracies when the automatic conversion happens. Allocating and Deeming: The maximum allocation rate for non-applying children in OSIPM will increase from $350 to $356 per month. Substantial Gainful Activity (SGA): The SGA standard for one person will increase from $1010 to $1040 per month for individuals who are not blind, and from $1690 to $1740 for individuals who are blind. Trial Work Period (TWP): The TWP standard for working SSDI recipients will increase from $720 to $750 per month. Countable Income Standard for LTC and Waivered Service clients: The countable income standard for individuals receiving long-term care and waivered services under OSIPM (300% of SSI) will increase from $2094 to $2130 per month. Room and Board and PIF: For CBC cases other than MH residential treatment, $10 of the COLA increase will go to residential providers (new R&B rate $552.70), and $2 will go to the PIF (new rate $157.30). Residential MH Treatment: For clients in 24-hour residential MH treatment, the R&B rate will be $552.70, and the PIF will be $ CIP Housing: DHS will raise the allowable monthly rental charges related to DD CIP housing to $

3 Resource Assessment: The maximum Community Spouse monthly income allowance in OAR (3)(d)(A) will be $2,898. The Community Spouse s maximum share of the couple s combined countable resources in OAR (2)(c)(A) and (2)(f)(A) will be $115,920. The Community Spouse s minimum share of the couple s combined countable resources in OAR (2)(c)(B) and (2)(f)(B) will be $23,184. Medicare Savings Programs (MSPs): Effective January 1, 2013, the Medicare Part B monthly premium will increase from $99.90 to $ Clients who are enrolled and receiving benefits in MSPs have protected eligibility in the current program until March 1 st, For clients already receiving QMB, SMB, or SMF, the CM system will be programmed effective January 1 to have income standards approximately 1.7% higher than they are now, so as to not cause current clients to go over the income standard between January 1 and February 28. This is because the FPL will change in January and federal statute protects MSP recipients until the month after the month in which the new FPL standards are published, usually in January. Staff must, however, use the income standards in the OARs when calculating eligibility for new applicants in January and February, and NOT the amounts in the CMS system. In February, 2013, Central Office will send a list of clients whose eligibility will change and explain notice requirements at that time. MSP reports related to individuals who may have gone over income for MSPs will be updated on View Direct with the same standards that are used in the CM system. SBI/CBI: The CBI amount for 2013 will be $ The Need/Resource edit and the N/R amounts on CMS will be changed automatically during the end-of-year computer update. All clients with the CBI N/R will have it changed automatically. For service cases, at redetermination, please review your cases with SBI and determine if they would not be eligible for CBI coding. EPD Participant Fee changes: So as to not disrupt EPD Participant Fee calculations pending the implementation of new FPL standards for 2013, Central Office is adding a 2% increase to the Participant Fee calculation standards. Effective January 1, the new income ranges will be as follows: Under $713: $0 $713 - $ $50 $940 - $ $100 $2375 and above $150 Pickle Eligibility: Clients eligible for OSIPM under the Pickle Amendment will have their income evaluated based on the new table, found in OAR :

4 If SSI was Last Received During Multiply Current SSB by January 2012-December January 2009-December January December January December January December January December January December January December January December January December January December January December January December January December January December January December January December January December January December January December January December January December January December January December January December January December January December July December July June July June July June July 1978 June July 1977 June May or June SNAP: Only SNAP cases in CRS (change reporting) will get the automatic COLA update on January 1: SRS and TBA cases are excluded. The update will occur only if the correct CAN is coded in the Ben# field on the SSB, SSD or SSI income line on page 2 of FSMIS. For SNAP actions effective January 1 or later, use the 2013 SSA

5 benefit amount. If you are processing an action with a December 1 effective date, use the SSA benefit amount the client will receive in December. Update FSMIS with the increased benefit amount when you process the next Interim Change Report (852) or recertification. MAA/MAF, OHP, HKC, and TANF: For MAA, MAF, and TANF cases, clients are required to report when unearned income changes by $50 or more. For OHP and HKC cases, clients are not required to report changes in income. Training/communication plan: APD policy manuals, training material (such as the Pickle tutorial in WG 9), forms (including the 3510 and 3511 forms on the Form Server), and systems will be updated. Local/branch action required: Please review this memorandum with staff who determine eligibility for OSIPM, QMB, SNAP, MAA, MAF, OHP, HKC, and TANF. Central office action required: and systems. Update policy manuals, training materials, forms, Field/stakeholder review: Yes No If yes, reviewed by: APD Policy Workgroup; SSP SNAP and TANF Program Analysts, OHA Medicaid Analysts Filing Instructions: If you have any questions about this policy, contact: Contact(s): OSIPM and Medicare Savings Programs: Jeff Stell SNAP: Policy, SNAP MAA/MAF/OHP: SSP-POLICY, Medical Phone: Jeff Stell (503) Fax: (503) Jeff.stell@state.or.us