Expanding Foundations: Non-MAGI SSI Based Programs Expanding Foundations: Non-MAGI

SSI Related Programs Objectives: Goal: To understand a group of Non-MAGI programs, and their eligibility rules. Objectives: After this module, Participants will be able to: Data Enter an SSI mandatory case Identify program resource limits Identify Household requirements and data entry for SSI related Non-MAGI programs Page 65

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

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

Commonalities Income limits (except OAP) Income Disregards $733 Individual $1100 Couple Income Disregards $20 Unearned Income $65+ ½ (total earned income) -Earned income

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.

Household Living in the Home Case Individual And Married Page 67

Married Individual Demographics Household Relationships Both sections must be complete and consistent. Married, Common Law, and Common Law Registered are considered Married. Domestic Partner and Civil Union are not Household relationships must be entered and consistent with the Individual Demographics data entry (husband/wife, husband/husband, wife/wife). Again client statement is acceptable unless questionable.

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

Let’s enter a case! You receive notification that an unmarried member has been receiving $733 in SSI benefits since April 18th 2016. This is verified through SDX

Let’s enter a case! AI a case from 4/18/2016. Individual is born between 1955 and 1975 Make up a name an SSN Assume you have an SSN card and Birth Certificate. Page 68

SSI Details Individual Demographics – SSI tab

SSI Income Unearned Income

SSI Income Income Received

Run EDBC

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! Page 72

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

The Pre-Pickle Program Problem Jimmy initially received a $752 SSDI benefit in 2016. He was also under the SSI resource limit, so SSA calculated a SSI benefit.

The Pre-Pickle Program Problem $752 SSDI - $20 (unearned income disregard) = $732. The SSI limit is $733. Jimmy qualified for a $1 SSI benefit as well, which entitled him to Medicaid Page 72

The Pre-Pickle Program Problem In January 2017 there is a COLA for SSA of 5 percent! The SSI limit would increase by 5 % ($733 x 1.05 = $769.65) rounded to $770! Jimmy’s SSDI benefit would increase by 5% ($752 x 1.05 = $789.60) rounded to $790!

The Pre-Pickle Program Problem SSA re-checks Jimmy’s SSI eligibility. $790 SSDI -$20 = $770. The SSI limit is $770. Jimmy no longer qualifies for the $1 SSI benefit

The Pre-Pickle Program Problem Jimmy loses Medicaid…

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

The Pickle Person Procedure CBMS will check to ensure they 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.

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

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.

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.

DAC Benefit Problem In 2016 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.

DAC Benefit Problem Terra loses SSI and SSI Mandatory Medicaid.

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 Page 78

DAC Medicaid This is also a rare population. CBMS will read the DAC benefit from the SSA interface and run income/resource calculations. Page 78

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

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

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

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

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

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.

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.

SSI Related Programs Objectives: Can you? Goal: To understand a group of Non-MAGI programs, and their eligibility rules. Objectives: Can you? Data Enter an SSI mandatory case Identify program resource limits Identify Household requirements and data entry for SSI related Non-MAGI programs Page 81

Expanding Foundations Non-MAGI Buy-in Programs Expanding Foundations Non-MAGI

Buy-In Programs Re-visit Objectives: Goal: To understand a group of Non-MAGI programs, and their eligibility rules. Re-visit Objectives: After this module participants will: Data Enter a WAwD case. Explain the coverage difference between Buy-in Programs and State plan Medicaid. Identify acceptable sources of disability determination for buy-in programs. Page 82

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.

Working Adults with Disabilities Benefit Category 3 State-Plan with premium Page 83

Working Adults with Disabilities Household Individual only Requirements Disabled and working Age 16-64 Page 83

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 Page 83

Working Adults with Disabilities No resource limit Income limit 450% FPL ($4455/mo.) after disregards $20 unearned disregard. $65 + ½ (earned income) disregard applies. Page 83

Premiums Members on WAwD pay a premium from approval month forward. Can have Retro Med, no premium is required for retro months. Page 84

Premiums Premiums based on countable income Page 84 WAwD premiums 2016 FPL 0%-40% 41%-133% 134%-200% 201%-300% 301%-450% After Disregards $ $0-$396 $396.01-$1320 $1320.01-$1980 $1980.01-$2970 $2970.01-$4455 Monthly Premium $0 $25 $90 $130 $200 Page 84

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

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 Page 85

Children’s Buy-in Under the age of 18 300% FPL after disregards 33% of total income is disregarded An additional $90 earned income disregard No resource limit

Oddities HH composition still uses MAGI rules Tax filer status Everything else is Non-MAGI rules Ineligible for 16-18 year olds who are working They should be on the WaWD Program

Smaller Premiums CBwD Premiums 2016 FPL 0-133% 134-185% 186-250% 251-300% Premium $0 $70 $90 $120

Buy-In Programs Re-visit Objectives: Can you? Data Enter a WAwD case. Goal: To understand a group of Non-MAGI programs, and their eligibility rules. Re-visit Objectives: Can you? Data Enter a WAwD case. Explain the coverage difference between Buy-in Programs and State plan Medicaid. Identify acceptable sources of disability determination for buy-in programs. Page 87

Medicare Saving Programs Expanding Foundations: Non-MAGI

Medicare Based Programs Goal: To understand a group of Non-MAGI programs, and their eligibility rules. Objectives: 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. Page 88

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.

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

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

Medicare Part A Part B Part D Hospital/emergency coverage Typically free Part B Primary Care Has a premium $104.90+ based on income Part D Prescription Coverage Variable premium based on plan

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

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

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

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.

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.

But Wait… You’ll likely never see it happen…

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

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’.

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

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

Medicare Data Entry Expenses- Medicare

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.

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.

Medicare expenses Part D tab Billing and Payment tabs Complete if the client has a Part D premium Billing and Payment tabs Complete for cases with FA or LTC-NF. FA will view this as a medical expense until the state pays the buy-in. Entering for LTC will add the expense to the Patient Payment section of wrap-up.

Fun with MA categories AI a case 60yo with $1100 SSDI –Verified by Bendex Part A eligibility Part B premium of $121.80 Which Category displays in wrap-up?

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

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

Fun with MA categories Add $1250 earned income Run EDBC

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

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

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

Medicare Based Programs Goal: To understand a group of Non-MAGI programs, and their eligibility rules. Re-visit Objectives: Can you? Perform accurate data entry on the Medicare Expense Page. Explain the coverage difference between MSP programs and State-plan Medicaid. Page 94

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