1. The Affordable Care Act (ACA) and the HUSKY Redetermination Process
Department of Social Services
September 12, 2014

2. The ACA and the HUSKY Redetermination Process
ACA Eligibility Changes
Classic Medicaid to MAGI Medicaid Redeterminations
MAGI-to-MAGI Redeterminations

3. MAGI (Modified Adjusted Gross Income)
New methodology mandated by the ACA
Changes the way we determine eligibility for
HUSKY A
HUSKY B
HUSKY D
Changes the way we count income, and whose income is counted
Based on federal income tax rules
Used by Access Health CT to determine tax subsidies and cost-sharing amounts
Not used for HUSKY C or the Medicare Savings Programs

4. Income Included as Income for Classic Medicaid
Included as Income for MAGI Medicaid
Type of Income
Wages, Salaries, Tips
Child Support Received
Veterans Benefits
Workers Compensation
Social Security Benefits (retirement, survivor, disability)
Supplemental Security Income (SSI)
Taxable amount of Pension, Annuity, Dividends or IRA distributions
Unemployment Compensation
Business Income
Rental Real Estate, Partnerships, Royalties, S Corps, trusts, etc.
Taxable Interest
Alimony Received
Scholarships, Grants, Awards used for Educational purposes
Gifts and Inheritances
Lump Sums
Yes (Gross Wages)
Yes No
Income in month recv’d
Yes (Federal Taxable Gross) No
Yes
Income in month recv’d

5. Income Deductions Income Disregard (5% of FPL) Child Care Expenses
Deduction for Classic Medicaid
Deduction for MAGI Medicaid
Type of Deduction
Income Disregard (5% of FPL)
Child Care Expenses
Work Expense Disregard
Child Support Received Disregard
Certain Self-employment expenses
Student loan interest
Tuition and fees
Educator Expenses
IRA deduction
Moving expenses
Penalty on early withdrawal of savings
Health Savings Account deduction
Alimony Paid
Step-Parent’s income No
Yes
Yes No
No (not countable income)
Yes (includes depreciation)

6. Household Composition
Determine the household for each person requesting assistance:
A. Does the individual expect to file taxes?
i. If no – continue to step B
ii. If yes – does the individual expect to be claimed as a tax dependent by anyone else?
1. If no - the household consists of the taxpayer, a spouse living with the taxpayer, and all persons whom the taxpayer expects to claim as a tax dependent
2. If yes – continue to step B

7. Household Composition (continued)
B. Does the individual expect to be claimed as a tax dependent?
i. If no – continue to step C
ii. If yes – does the individual meet any of the following exceptions?
The individual expects to be claimed as a tax dependent of someone other than a spouse or a biological, adopted, or step parent
The individual is a child living with both parents, but the parents do not expect to file a joint tax return.
The individual is a child who expects to be claimed by a non-custodial parent
1. If no – the household is the household of the taxpayer claiming her/him as a tax dependent
Is the individual married? If yes - the household also includes the individual’s spouse
2. If yes – continue to step C

8. Household Composition (continued)
C. For individuals who neither expect to file a tax return nor expect to be claimed as a tax dependent, as well as tax dependents who meet one of the exceptions in B.ii., the household consists of the individual and, if living with the individual—
The individual's spouse;
The individual's natural, adopted and step children under the age 19; and
In the case of individuals under age 19, the individual's natural, adopted and step parents and natural, adoptive and step siblings under age 19.

9. Income Limits
The Center for Medicare and Medicaid Services (CMS) converted classic income limits to MAGI-based income limits
Reflects the changes to countable income, deductions and household composition
The conversion is intended to be population-neutral

10. MAGI Income Limits

11. Classic Medicaid vs. MAGI
Example:
Marie, 20-years old, requests Medicaid
Marie lives with her mother
Her mother claims her as a tax dependent
Her mother earns $4,500 per month
Marie has no income

12. Classic Medicaid
Marie’s category of coverage is HUSKY D (Medicaid for Low Income Adults)
The household consists solely of Marie
Marie qualifies for HUSKY D as her income ($0) is less than the HUSKY D income limit (54% FPL)

13. MAGI Medicaid
Marie’s category of coverage is HUSKY D (ACA Adult Group)
The household consists of Marie and her mother
Marie is not eligible for Medicaid as the household income ($4,500 per month) is more than the HUSKY D income limit ($1,809.18, which is 138% FPL for 2 people)

14. Classic Medicaid vs. MAGI
Example:
Medicaid is requested for the James, age 7
James lives with his mother and stepfather
James’ mother earns $2, per month
James’ stepfather earns $2,500 per month

15. Classic Medicaid James’ category of coverage is HUSKY A
Household consists of James and his mother
James qualifies for HUSKY A as his mother’s income is less than the HUSKY A income limit (185% FPL for 2)

16. MAGI Medicaid James’ category of coverage is HUSKY A
The household consists of James, his mother and his stepfather
James is not eligible for HUSKY A as the monthly household income ($ ) is over the HUSKY A income limit ($3,316.50, which is 201% FPL for a family of 3)
James qualifies for HUSKY B, Band 2

17. Classic Medicaid to MAGI Medicaid Redetermination Process
Redeterminations delayed by three months beginning in January 2014
Rolling delay - January delayed to April, February to May, March to June etc.
Redeterminations resumed for those due in April and May 2014
During this time, CMS approved our request for an additional delay.
Redeterminations delayed by three months beginning in June 2014
Rolling delay – June to September, July to October etc.
Redeterminations resumed for those due in September
HUSKY C and MSP redeterminations have not been delayed

18. Classic Medicaid to MAGI Medicaid Redetermination Process (continued)
Our shared system with Access Health CT (AHCT) supports the new MAGI Medicaid rules
Clients will receive a new form to complete a renewal for MAGI Medicaid (AH3) along with a return envelope
The quickest way to complete the redetermination process and receive an eligibility determination, is to go to Access Health CT (
Individuals can complete their redetermination by phone by calling Access Health CT at

19. Classic Medicaid to MAGI Medicaid Redetermination Process (continued)
On-line and Phone redeterminations are the most expedient and result in an immediate eligibility decision.
Some post-eligibility verifications may be needed if information is not matched against the federal data services hub or other sources
90 days of coverage is provided while verification documentation is requested and reviewed
Paper applications are mailed to AHCT via Scan
Optics where they are later accessed by Xerox State
Health Care workers who data enter the information
from the paper into the AHCT/DSS share eligibility system

20. Classic Medicaid to MAGI Medicaid Redetermination Process (continued)
Clients may mail paper forms to AHCT via Scan Optics
Xerox data enters the information into the AHCT/DSS eligibility system
Xerox enters the final eligibility decision into EMS (HUSKY A and HUSKY D) and into ConneXion (HUSKY B)
Currently, there is no electronic interface between the AHCT and EMS or ConneXion.
This manual data entry may have to continue until 2016 when the new EMS system (ImpaCT) is completed.
Once the determination is made, READ ABOVE…

21. Classic Medicaid to MAGI Medicaid Redetermination Process (continued)
MAGI rules do not apply to HUSKY C or the Medicare Savings Program (MSP)
HUSKY C and MSP continue to follow the traditional redetermination process
Non-MAGI redeterminations are processed through our ConneCT system

22. MAGI-to-MAGI Redeterminations
MAGI-to-MAGI redeterminations will be processed in the AHCT/DSS shared system
administrative renewal procedures used to lessen burden on families
System will check electronic data sources before taking action
Clients remain enrolled for another 12 months so long as data matches
Clients may need to provide additional information if there are changes (e.g. income)
There is a new 90 day “reconsideration period” provision for applicants who renew after closure. No new application is required.

23. Reconsideration Period
The Reconsideration Period is a 90 day grace period to complete redeterminations after the case has been closed
The Reconsideration Period begins when Medicaid stops due to an incomplete redetermination
Client will automatically receive retroactive coverage back to the date of discontinuance once the redetermination is completed (if eligible)
This provides better continuity of coverage

24. Reconsideration Period
The Reconsideration Period is a 90 day grace period to complete redeterminations after the case has been closed
The Reconsideration Period begins when Medicaid stops due to an incomplete redetermination
Client will automatically receive retroactive coverage back to the date of discontinuance once the redetermination is completed (if eligible)
This provides better continuity of coverage