DEPARTMENT OF SOCIAL SERVICESSEPTEMBER 12 , 2014

The Affordable Care Act (ACA)and the

HUSKY Redetermination Process

The ACA and the HUSKY Redetermination Process

ACA Eligibility Changes

Classic Medicaid to MAGI Medicaid Redeterminations

MAGI-to-MAGI Redeterminations

MAGI (Modified Adjusted Gross Income)

New methodology mandated by the ACAChanges 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 rulesUsed by Access Health CT to determine tax

subsidies and cost-sharing amountsNot used for HUSKY C or the Medicare Savings

Programs

Income

Type of Income Included as Income for Classic Medicaid

Included as Income for MAGI Medicaid

• 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• Yes• Yes• Yes

• No• Yes

• Yes• Yes• Yes• Yes• Yes• Yes• No

• Income in month recv’d

• Income in month recv’d

• Yes (Federal Taxable Gross)• No• No• No• Yes

• No• Yes

• Yes• Yes• Yes• Yes• Yes• Yes• No

• Income in month recv’d• Income in month recv’d

Income Deductions

Type of Deduction Deduction for Classic Medicaid

Deduction for MAGI Medicaid

• 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• Yes• Yes• No• No• No• No• No• No

• No• No• No

• Yes• No• No• No (not countable income)• Yes (includes depreciation)• Yes• Yes• Yes• Yes• Yes• Yes• Yes• Yes• Yes• Yes

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

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

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.

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

MAGI Income Limits

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

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)

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)

Classic Medicaid vs. MAGI

Example:

• Medicaid is requested for the James, age 7

• James lives with his mother and stepfather

• James’ mother earns $2,000.00 per month

• James’ stepfather earns $2,500 per month

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)

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 ($4500.00) 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

Classic Medicaid to MAGI MedicaidRedetermination 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 SeptemberHUSKY C and MSP redeterminations have not been delayed

Classic Medicaid to MAGI MedicaidRedetermination 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 (www.accesshealthct.Com)

Individuals can complete their redetermination by phone by calling Access Health CT at 1-855-805-4325

Classic Medicaid to MAGI MedicaidRedetermination 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

Classic Medicaid to MAGI MedicaidRedetermination 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.

Classic Medicaid to MAGI MedicaidRedetermination 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

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.

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

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