DAR File No. 28680

Health, Health Care Financing, Coverage and Reimbursement Policy

R414-304-11

Income Standards

NOTICE OF PROPOSED RULE

DAR File No.: 28680
Filed: 04/27/2006, 02:23
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

This rulemaking amends the way the Department calculates the premium for the Medicaid Work Incentive program. It changes the Medicaid Work Incentive premium calculation so that clients with income under 120% of the federal poverty guideline will pay a smaller percentage of income for their premium.

Summary of the rule or change:

A new Subsection R414-304-11(1) is added and other subsections are renumbered. Subsection R414-304-11(3) is modified to remove the language that says a person who qualifies for the Medicaid Work Incentive (MWI) program can choose coverage under either the Medicaid Work Incentive program or under a medically needy coverage group depending on whether the spenddown under medically needy is lower than the MWI premium. This must be changed because if a person is eligible under the MWI program, then the person does not have the option of coverage under a medically needy coverage group. Subsection R414-304-11(4) is modified to explain that the premium for the Medicaid Work Incentive program will use three different percentages to calculate the premium depending on how much income a client has. For clients with income over 100% but not over 110% of the federal poverty guideline, the MWI premium will be 5% of the client's income. For clients with income over 110% but not over 120% of the federal poverty guideline, the MWI premium will be 10% of the client's income. For clients with income over 120% of the federal poverty guideline, the MWI premium will be 15% of the client's income. This makes the transition from the spenddown Medicaid program easier because currently a client whose income is between 100% and 120% of the federal poverty guideline would pay a lower spenddown than what the current MWI premium would be at these income levels. Adding these two steps for the lower income levels may increase a client's cost for Medicaid, but it increases it in smaller steps until their income reaches 120% of poverty. At that point, the MWI premium is always lower than a spenddown would be.

State statutory or constitutional authorization for this rule:

Title 26, Chapter 18

Sections 1902(a)(10)(E), 1902(l), 1902(m), 1903(f) and 1905(p) of the Compilation of the Social Security Laws, in effect January 1, 2003

Anticipated cost or savings to:

the state budget:

This change will result in some MWI individuals paying a lower premium, while others will pay a higher premium. The combined cost to the department is about $1608 annually because of reduced net collections from these recipients. The federal match would be about $1,142.

local governments:

This does not impact local governments because Medicaid eligibility is not a local government function.

other persons:

The 34 current recipients will be affected by this change. About 19 will pay less than they are now, while 15 will pay more. The aggregate savings for this group of clients is about $134 per month or about $1,608 annually.

Compliance costs for affected persons:

The increased cost for individual clients who will have to pay more to receive Medicaid ranges between $3 to $37 per month; or $36 to $444 annually. The savings for individual clients who will pay less to receive Medicaid ranges between $2 to $37 per month or $24 to $444 annually.

Comments by the department head on the fiscal impact the rule may have on businesses:

This rule change is necessary to coordinate benefits between the Medicaid Work Incentive program and the medically needy coverage group. A. Richard Melton, Acting Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Direct questions regarding this rule to:

Ross Martin at the above address, by phone at 801-538-6592, by FAX at 801-538-6099, or by Internet E-mail at rmartin@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

06/14/2006

This rule may become effective on:

06/22/2006

Authorized by:

Richard Melton, Deputy Director

RULE TEXT

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

R414-304. Income and Budgeting.

R414-304-11. Income Standards.

(1) This rule sets forth the income standards the Department uses to determine eligibility for Medicaid coverage groups.

([1]2) The Department adopts Sections 1902(a)(10)(E), 1902(l), 1902(m), 1903(f) and 1905(p) of the Compilation of the Social Security Laws, in effect January 1, [2001]2003, which are incorporated by reference.

([2]3) The Department calculates the Aged and Disabled poverty-related Medicaid income standard [shall be calculated ]as 100% of the federal non-farm poverty guideline. If an Aged or Disabled person's income exceeds this amount, the current Medicaid Income Standards (BMS) [shall ]apply unless the disabled individual or a disabled aged individual has earned income. In this case, the income standards of [either the Medically Needy (BMS) program or ]the Medicaid Work Incentive program [may be applied]apply.[ The individual may choose coverage under either program if the individual meets all other eligibility criteria for both programs.]

([3]4) The income standard for the Medicaid Work Incentive Program [shall be](MWI)for disabled individuals with earned income is equal to 250% of the federal poverty guideline for a family of the size involved. If income exceeds this amount, the current Medicaid Income Standards (BMS) [shall ]apply.

(a) The Department [shall ]charges a MWI buy-in premium for the Medicaid Work Incentive Program when the countable income of the eligible individual, or the eligible individual and spouse, when the spouse is also eligible or has deemable income, exceeds 100% of the federal poverty guideline for the Aged and Disabled 100% poverty-related coverage group. When the eligible individual is a minor child, the Department [shall ]charges a MWI buy-in premium when the child's countable income, including income deemed from parents, exceeds 100% of the federal poverty guideline for a one-person household.

(b) The premium [will be calculated as]is equal to 5% of income when income is over 100% but not more than 110% of the federal poverty guideline, 10% of income when income is over 110% but not over 120% of the federal poverty guideline, or 15% of income when income is over 120% of the federal poverty guideline.[percent of] The premium is calculated using only the eligible individual's[,] or eligible couple's[,] countable income multiplied by the applicable percentage.

([4]5) The income limit for pregnant women, and children under one year of age, shall be equal to 133% of the federal poverty guideline for a family of the size involved. If income exceeds this amount, the current Medicaid Income Standards (BMS) [shall ]apply.

([5]6) The current Medicaid Income Standards (BMS) are as follows:

TABLE

Household Size     Medicaid Income Standard (BMS)



   1                       382

   2                       468

   3                       583

   4                       683

   5                       777

   6                       857

   7                       897

   8                       938

   9                       982

  10                     1,023

  11                     1,066

  12                     1,108

  13                     1,150

  14                     1,192

  15                     1,236

  16                     1,277

  17                     1,320

  18                     1,364

KEY: financial disclosures, income, budgeting

Date of Enactment or Last Substantive Amendment: [July 2, 2005]2006

Notice of Continuation: January 31, 2003

Authorizing and Implemented or Interpreted Law: 26-18-1

ADDITIONAL INFORMATION

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For questions regarding the content or application of this rule, please contact Ross Martin at the above address, by phone at 801-538-6592, by FAX at 801-538-6099, or by Internet E-mail at rmartin@utah.gov

For questions about the rulemaking process, please contact the Division of Administrative Rules (801-538-3764). Please Note: The Division of Administrative Rules is NOT able to answer questions about the content or application of these administrative rules.