Expanding Foundations: Non-MAGI - Traincolorado

Expanding Foundations: Non-MAGI

Facilitator Guide

7800 E Orchard Road, Suite 280 Greenwood Village, CO 80111

Expanding Foundations Release

Date: March 2020


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Acknowledgements The Health Care and Economic Security Staff Development (SDC) would like to thank all the individuals and agencies that provided assistance during the Expanding Foundations development and continue providing feedback to update material as needed.

The SDC would also like to thank staff from the Colorado Department of Human Services (CDHS), the Colorado Department of Health Care Policy and Financing (HCPF), and the Governor’s Office of Information Technology (OIT). Their willingness to share their program and systems knowledge with the SDC has been invaluable.

Introduction

The Health Care and Economic Security Staff Development Center (SDC) presents this guide as a framework for the precision delivery of Expanding Foundations curriculum. Expanding Foundations will prepare health and human service professionals to use the Colorado Benefits Management System (CBMS) to determine eligibility for Food, Medical and Cash Assistance.

In the spirit of the SDC’s vision, which is to provide an efficient, non-duplicative, and responsive training array for staff that promotes an integrated and holistic service delivery system, we are offering this guide to standardize and formalize across Colorado the way county staff are trained. Standardization of Expanding Foundations and precision delivery of the curriculum will assure that all staff receives and attains the same high standard of competency through training.

Trainer Resources The Trainer’s Territory drop down in TrainColorado.com will give you access to information you need as a Certified Trainer. The drop down will give you access to:

• Ask the Trainer• CBMS_TRN Issues Reporting• Foundations Course Material Access Request Form• Expanding Foundations Case Copy Request Form• Report Course Changes• Report Course Changes for WBTs• Trainer Network


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Case Copy Tool Expanding Foundations courses may include pre-made case copies available in CBMS-TRN. The cases include unique case numbers for each of your participants that have pre-filled demographics, attributes, application initiation etc. This allows you to focus your time on specific windows or areas of need rather than case creation. To request case copies, contact the SDC at [email protected]

Report Course Changes

As part of our ongoing partnership with statewide public assistance sites, we invite you to aid in our continuing development and improvement of SDC courses. Using the Report Course Changes and Report Course Changes for WBTs, dropdown link allows you to add change requests to a specific course. These can be as simple as wording changes to larger topic additions. Courses are revised multiple times per year and all reported course changes are addressed.


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Curriculum Abstract The Health Care and Economic Security Staff Development Center (SDC) is tasked with designing and delivering a standardized, competency-based training for new eligibility workers stationed at County Departments of Human Services and Medical Assistance (MA) sites throughout Colorado.

Revisit Content Take time to revisit the main ideas from the training as frequently as time allows to ensure that the participants comprehend the information presented during training. Revisiting content can occur after finishing a module, upon return from breaks or lunch, or at the start of new days. Content revisits can take the form of participants offering teach-backs, small group discussions, or independent note review.


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Activity and Material Adaptations Within the Expanding Foundations Facilitator Guide, there are many activities incorporated into each module to promote active learning for participants and enhance the transfer of learning. On occasion, an adaptation of an activity may be required due to the number of participants, availability of materials, or other unforeseen circumstances. The activity itself can be modified to meet the needs of your learners, but the content must remain intact and delivered within the same context. Examples of this are as follows:

If an activity calls for a Flip Chart or Flip Chart paper, it would be acceptable to utilize a whiteboard or chalk board or other similar material you have available

If an activity calls for paddles (hand-held whiteboards), you could use a piece of paper and write on either side, or the activity could be modified to be a “call-out” type of answer as opposed to having it written on an instrument

If an activity calls for 3x5 cards, any type of paper could be used in place of an index card

If needed, adapt the group sizes or your delivery of the activity itself. Most importantly, use your creativity to enhance the activities to maximize participants’ learning!

Adaptations can make curriculum more suitable for an organization’s business process without compromising or deleting core components. There are three types of adaptations: Green, Yellow, and Red-light adaptations. Facilitators can make Green and some Yellow light adaptations. Green light adaptations can be made without informing any stakeholder, although it is best practice to inform the Staff Development Center; Yellow light adaptations require contacting the Staff Development Center and must follow a 6-step adaptation process; Red light adaptations cannot be made by facilitators. If desired, Red light adaptations must be requested of the Staff Development Center. More guidance regarding adaptations is available through the Trainer Certification Process and on the SDC website, http://traincolorado.com. Green – Safe to make changes:

Ordering modules to fit your business process Tailor activities to your audience Make activities more interactive Customize activities to be more relevant to participants

Yellow – Investigate more and ask the SDC: Change sequence of modules Add activities to reinforce learning Add activities to address additional factors Modify activities for timeliness Replace or include supplemental resources

Red – Must be avoided because changes may weaken outcomes: Altering policy Changing the sequence within a module Incorporating activities that contradict, compete with, or dilute the objectives Not repeating/reinforcing key messages Cutting key skill-building activities

http://traincolorado.com/


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Planning and Set-Up Planning and preparation for this course will vary by trainer. It is recommended that you read through ll the material and get any questions you have answered before the first time you train the course. Practicing in front of a group will also be beneficial. If you have any questions or would like assistance, contact the SDC at [email protected].

The first day, setup will take between 30 minutes to 1 hour. Each day thereafter should take 15-30 minutes if the room setup is left in the same.

In general, planning and set up will include preparing for all activities, ensuring the materials are available and displayed properly, assuring the room is clean and in order, and preparing technology. Minimum recommended materials are: Facilitator’s computer Computer for each participant (for CBMS data entry) Projection screen or white wall Writing utensils (pens/pencils and markers) Flip-chart paper with an easel, or a white board Facilitator guide Participant guide for each participant “Parking Lot” for questions that cannot be answered immediately Note: Activity templates will be available on the SDC website (traincolorado.com) for download

separate from the Expanding Foundations Guides.

Clearing the Cache Additionally, as part of the planning and setup Facilitators should follow the below steps before and after each course. Walking through these steps with participants is encouraged. It is a learning opportunity, as these steps may resolve or prevent the need for help desk tickets. Clearing the cache will enhance system and application performance and the overall performance of the machine. For additional details refer to the Clearing the Cache Compatibility View Settings Desk Aid on the Trainer’s Territory.

1. On the Internet Explorer Tools menu or on the Settings icon in the top right corner of the page,click on Internet Options.

2. On the General tab, in the Browsing History section, click on the Delete button3. Click Delete to clear the cache.4. Click OK to close the page.

Assembling Groups A significant part of this training involves participation in groups of various sizes. Participation is important for learning but recognize that participants will have varying degrees of comfort with group activities. Encourage participants to interact and engage while allowing those who are not comfortable doing so to participate at their own level.

mailto:[email protected]


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There are numerous ways to divide participants into groups. Use your creativity to come up with novel methods. A few suggestions:

Number off (1,2,3,4,5…). Matching numbers will form a group Number off and pair more than one set (1,2,3,4,5,6,7,8,9,10; 1s and 6s form a group) Give each participant a piece of paper with a number (as many as there are people), then draw from

a bag with a duplicate set of numbers. Example: If there are 20 participants, have each choose numbers from 1-20 from a bag. Then pick 4 random numbers at a time from another set of 20 to create 5 groups of 4

Playing cards using color, suit, number, odds/evens Gum balls/candy Months of the year Same color shirt Brand of toothpaste Randomly assign a few people to each group, without accounting for strict size requirements Put different things in a container, the same number of each item as you want in the group. Give

each participant one, ask them to shake it, then tell them to find others with the same sound Cut pictures into as many pieces as you want in the group. Distribute one piece to each student. The

participants will fit the puzzle pieces together to compose their group. Example: group of 12, 3 small groups of 4: Cut 3 different pictures into 4 pieces and distribute

Common Terms and Phrases There are terms and phrases found throughout this Guide that have other common names associated with them. These terms and phrases are used based on accuracy, appropriateness, and general understanding to provide consistency. They are listed below with other associated common names. Cash Assistance: Colorado Works (CW) and Adult Financial (AF) Client: applicant, customer, recipient, household, member Colorado Works: Temporary Assistance for Needy Families (TANF) is the federal program Eligibility Worker or Public Assistance Professional: user, eligibility technician, program specialist,

eligibility professional, worker Food Assistance: Supplemental Nutrition Assistance Program (SNAP) is the federal program, food

stamps Medical Assistance: Medicaid and Child Health Plan Plus (CHP+); not Medicare Public Assistance: Food, Medical, and Cash Assistance programs; human services, social services


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Helpful Symbols


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Facilitator Notes

The Participant guide for Non-MAGI contains more printed information than typical Expanding Foundations courses. The Participant guide aligns with the structure of the PowerPoint material, but you are not expected to read through the entirety of the document as a class. The guide is intended to include all desk aids, data entry walkthroughs as well as provide supplemental information.

Facilitator Guide Because all the required information is contained in the Participant Guide, your facilitator Guide is structured differently for this course.

On the Left-hand page, you will have a list of talking points, Facilitator Notes and PowerPoint slides to ensure that PPT page numbers and Participant guide page numbers match your copy.

On the Right-hand side, you will have a copy of the actual page from the Participant guide. Use this to supplement the notes and talking points presented on the Facilitator page and Power point.

PowerPoint

The PowerPoint does not contain blocks of text or full paragraphs. It is intended to focus on key points or single ideas. The facilitator should be able to expand on these ideas based on CBMS experience as well as Facilitator and Participant guide notes.

Facilitator Page

• Facilitator Notes• PowerPoint Slides• Talking Points• No page numbers

Facilitator Page

• Facilitator Notes• PowerPoint Slides• Talking Points• No page numbers

Participant Page

• Actual copy of Participant Guide• Actual Page number for Participants

and PPT.

Facilitator PageParticipant Page

• Actual copy of Participant Guide• Actual Page number for Participants

and PPT.


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Facilitator

Notes – Welcome

Introduce the course and local facility information to the class. This should include:

An overview of the course structure/modules. Non-MAGI overview Disability Resources SSI related programs Buy-in Programs Medicare Related Programs

Local information Bathrooms Plan for lunch/breaks

Your expectations Asking questions Policy on phones, individual breaks etc.

Additionally, provide an icebreaker or chance for individuals to introduce themselves.


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Table of Contents

Acknowledgements ............................................................................................................................................................................... 2 Introduction ........................................................................................................................................................................................... 2 Trainer Resources .................................................................................................................................................................................. 2 Case Copy Tool ...................................................................................................................................................................................... 3 Report Course Changes ......................................................................................................................................................................... 3 Curriculum Abstract ............................................................................................................................................................................... 4 Revisit Content ...................................................................................................................................................................................... 4 Activity and Material Adaptations ......................................................................................................................................................... 5 Planning and Set-Up .............................................................................................................................................................................. 6 Clearing the Cache ................................................................................................................................................................................. 6 Assembling Groups ................................................................................................................................................................................ 6 Common Terms and Phrases ................................................................................................................................................................. 7 Helpful Symbols ..................................................................................................................................................................................... 8 Facilitator Guide .................................................................................................................................................................................... 9

Participant Page ................................................................................................................................................................................ 9

Facilitator PageParticipant Page ........................................................................................................................................................ 9

Facilitator Page .................................................................................................................................................................................. 9

Facilitator Page .................................................................................................................................................................................. 9 Welcome.............................................................................................................................................................................................. 14 Course Modules ................................................................................................................................................................................... 14

Group Expectations/Housekeeping ................................................................................................................................................. 14

Introductions ................................................................................................................................................................................... 14 Facilitator Notes – Non-MAGI Overview ............................................................................................................................................. 15 Non-MAGI Overview............................................................................................................................................................................ 16 Objectives: ........................................................................................................................................................................................... 16 MAGI vs. Non-MAGI ............................................................................................................................................................................ 17 SSI vs. SSDI ........................................................................................................................................................................................... 19

Non-MAGI Programs ....................................................................................................................................................................... 21

Benefit Categories ........................................................................................................................................................................... 23 CHP+ is separate ................................................................................................................................................................................ 24 Review ................................................................................................................................................................................................. 29 Non-MAGI Overview............................................................................................................................................................................ 30 Non-MAGI Overview............................................................................................................................................................................ 31 Re-Visit Objectives: .............................................................................................................................................................................. 31 Types of Resources and Data Entry ..................................................................................................................................................... 32 Types of Resources and Data Entry ..................................................................................................................................................... 33 Objectives: ........................................................................................................................................................................................... 33 Estate Recovery ................................................................................................................................................................................... 34


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............................................................................................................................................................................................................. 34

Note on Estate Recovery ................................................................................................................................................................. 35 Estate Recovery ................................................................................................................................................................................... 35

Liquid Assets ................................................................................................................................................................................... 37

Liquid Assets Page ........................................................................................................................................................................... 39

Vehicles ........................................................................................................................................................................................... 42

Real Property .................................................................................................................................................................................. 44

Burials ............................................................................................................................................................................................. 49

Life Insurance Policies ..................................................................................................................................................................... 50

Life Insurance Policies ..................................................................................................................................................................... 51 Adult Financial vs. Medicaid ................................................................................................................................................................ 53 Adult Financial vs. Medicaid ................................................................................................................................................................ 54 Practice Time! ...................................................................................................................................................................................... 55 Types of Resources and Data Entry ..................................................................................................................................................... 60 SSI Related Programs ........................................................................................................................................................................... 61 Objectives: ........................................................................................................................................................................................... 61 Program List ......................................................................................................................................................................................... 62 ............................................................................................................................................................................................................. 62 Commonalities among these programs .............................................................................................................................................. 63

Processing guidelines ...................................................................................................................................................................... 64

Household ....................................................................................................................................................................................... 64

Household ....................................................................................................................................................................................... 65

Living in the home ........................................................................................................................................................................... 65

Marital Status .................................................................................................................................................................................. 65

SSI Mandatory ................................................................................................................................................................................. 66 Program eligibility ................................................................................................................................................................................ 66

SSI Mandatory ................................................................................................................................................................................. 66

OAP ................................................................................................................................................................................................. 69

Pickle ............................................................................................................................................................................................... 70 Applicable Disregards ....................................................................................................................................................................... 71 Other Income ..................................................................................................................................................................................... 71 Title II Frozen Amount ..................................................................................................................................................................... 71 SSI or OAP Limit ................................................................................................................................................................................ 71

Disabled Adult Child (DAC) .............................................................................................................................................................. 73


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Disabled Adult Child (DAC) .............................................................................................................................................................. 73

Qualified Disabled Widow(er) QDW ................................................................................................................................................ 76 SSI Related Programs ........................................................................................................................................................................... 77 Objectives: ........................................................................................................................................................................................... 78

WAwD ............................................................................................................................................................................................. 79 Buy-In Programs .................................................................................................................................................................................. 85 Disability Overview .............................................................................................................................................................................. 86 Disability Definition ............................................................................................................................................................................. 86 Disability Overview .............................................................................................................................................................................. 87 Objectives: ........................................................................................................................................................................................... 87

SSA Determinations ......................................................................................................................................................................... 90

State Contractor Determination ...................................................................................................................................................... 92 Data Entry Practice .............................................................................................................................................................................. 105 Case Data Entry ................................................................................................................................................................................. 107 Case Data Entry ................................................................................................................................................................................. 107 Medicare Based Programs ................................................................................................................................................................. 108 Medicare Savings Programs .............................................................................................................................................................. 108 Program list ....................................................................................................................................................................................... 109

QMB SLMB .................................................................................................................................................................................... 109 Medicare Savings Programs .............................................................................................................................................................. 109 Program list ....................................................................................................................................................................................... 110

QMB .............................................................................................................................................................................................. 110

SLMB and QI-1 ............................................................................................................................................................................... 110

QDWI ............................................................................................................................................................................................ 111

MSP Income Deeming ................................................................................................................................................................... 112 Medicare Data Entry .......................................................................................................................................................................... 113


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Facilitator Notes – Non-MAGI Overview

State Objectives for this module.

Participants should understand that they are expected to be able to perform these objectives by the end of the module.

This will be re-visited at the end of each module. The re-visit is accountability “now that you have completed the module, can you perform these tasks?”


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Non-MAGI Overview

Objectives: After this module, Participants will be able to:

Identify eligibility differences between MAGI and Non-MAGI. Associate SSI, SSDI and SSA with Medicaid or Medicare appropriately. Recognize how CBMS applies the hierarchy for eligibility determinations for MA programs

Goal: To gain further understanding of Medical Assistance programs, Social Security programs and how they relate.


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MAGI vs. Non-MAGI

A chance to review what was learned in the MAGI course. Hopefully students can recall HH, eligibility and age groups.

(Write on board as students identify what they remember)

Transition to introducing a few ways that NON-MAGI is different

Primary MAGI and Non-MAGI differences:

Household is determined by marital status and in the home.

Tax status is not relevant (except CBWD) Resource limits Aged, Blind, and Disabled populations Different Income rules

Non-MAGI programs exist to extend Medicaid coverage to individuals who are Aged, Blind and/or Disabled. While Citizenship, Identity, and Residency procedures still apply, all other criteria vary by program.

Specific criteria will be addressed throughout the course, but it is important to note the population group, household composition, and the introduction of resource limits require actions above and beyond that of MAGI case processing.


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Note: When an individual loses their SSI eligibility, regardless of their current benefit category, additional information is needed. A new SSI packet requesting additional information will be created and a packet will be sent to the member.

MAGI

Tax Filing Status

Income

Age 0-64

Non-MAGI

Marital Status and in

the home

Income and Resources

Aged (65+) Blind or Disabled

Household

Financial

Target Population


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SSI vs. SSDI

Non-MAGI programs are based on SSI and SSDI rules. Medicaid or the existence of Medicare coverage defines which category they will fit into. Explain the difference in the programs as listed on the slides.

*Highly recommend Integrating interface trainingwith this section for local trainings.

The chart on the participant guide is a compare of Title 16 vs Title 2 benefits. An applicant’s relationship with SSI, SSDI or SSA retirement plays a significant role in determining the Non-MAGI program they are eligible for.

If you draw this on a board or print, you will be able to reference the ideas throughout this course. The Income limits (SSI), Medicaid vs Medicare, and disability.

The point is partially to illustrate that not all people on SSI ‘never worked’ or ‘didn’t work enough’.


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Being that aged and/or disabled is the primary criteria for Non-MAGI, most Non-MAGI Medicaid members may qualify for an SSA (Social Security Administration) benefit. This may be SSI (Supplemental Security Income), SSDI (Social Security Disability Insurance), or SSA retirement. Non-MAGI Medicaid program rules build off the benefit(s) associated with SSA. (No Slide for this)

SSI

Not enough work quarters or

expired coverage.

Income and Resource limits

Medicaid

Max benefit $783 in 2020

65+ or Disabled

SSDI/SSA

Typically, at least 40 work quarters.

No Income and Resource Limit

Medicare

Benefit based on work history

Disabled or Retired (62+)

Some Widows and Survivors

Work History

Financial

Medical Coverage

Cash Benefit

Population


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Non-MAGI Programs

These connect MA categories to their association with SSI or Medicare. This also is how the course will be organized as it related towards benefit category/MA execution order which is discussed next.

Benefit Categories rank programs from most benefit 1-LTC to least benefit 7-LIS.

The course presents programs in this order as it is the same order CBMS determines eligibility.

Note on how to identify an LTC case based on the application. This may require a check-in with the applicant. Some people indicate yes when they have a baby in the home.


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*** The application question: ‘Does this person Need Help with Self-Care Activities’ is intended to filter Long Term Care cases. Applications marked yes should be re-directed to a Long-Term Care worker.

SSI eligibility •Disabled Adult Child (DAC)

•Qualified Disabled Widow(er) (QDW)•Pickle

Medicare (SSDI or SSA) eligibility •Qualified Medicare Beneficiary (QMB)

•Special Low-income Medicare Beneficiary(SLMB)

•Qualified Individual-1 (QI-1)•Qualified Disabled Working Individual (QDWI)

•Low Income Subsidy (LIS)

Qualification Based on:

Any Disability Determination

•Working Adults with Disabilities (WAwD)•Children’s Buy-in with Disabilities

Age •Old Age Pension A and B (OAP-A OAP-B)

•Old Age Pension Health Care Plan A and B(OAP-HCP-A OAP-HCP-B)


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Benefit Categories

Benefit Categories are the driving factor for the CBMS execution order. The course is organized based on

Benefit Category located on the hierarchy. The higher categories provide the most benefits.

1 is highest 7 is lowest.

1 – State plan + LTC services

2 – State Plan Programs

3- State plan with Premium

4 – Medicare + premiums, coinsurance and deductibles

5 – Medicare + premiums

6 – State HCP

7 – Part D subsidy

Talking Points

We would never approve someone for a category 3 (requiring a premium) if they qualified for a category 2 (which has no premium)

All category 2 programs have the same coverage. This includes MAGI Adult, SSI Medicaid and OAP

Medicaid You still need to make sure the correct category is in CBMS, but to the client there is no

difference in coverage


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Medical Assistance categories vary in total coverage or cost to the member. Category 02 is the basic ‘State plan Medicaid’. The higher the program is on the chart, the more beneficial the program is to the member.

01 LTC programs include additional services, 03 has a premium,

04 has less coverages etc.

CBMS will attempt to place the member in the highest benefit category at each eligibility

determination.

01

NF/300% hospital HCBS programs, PACE

02

SSI Mandatory, FFC, Pickle, DAC, QDW, OAP Med-A, OAP Med-B, OAP-A Med>65, Trans Med, 4-month Extended, Refugee, BCCP MAGI Pregnant, Legal Immigrant Newborn, Psych <21, Eligible Needy Newborn, MAGI Child, MAGI Parent/Caretaker, MAGI Adult

03

WAwD CBwD

QMB 04

SLIMB, QI-1, QDWI 05

OAP HCP-A, OAP HCP-B 06

LIS 07

CHP+ Children, CHP+ Newborn, CHP+ Prenatal 08

Benefit decreases with each benefit category downgrade

CHP+ is separate


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Reference Hierarchy printed in Participants guide. Explain how CBMS uses this, (notice the benefit category is listed). Question slides for knowledge checks follow.

Highest Benefit category programs are determined 1st (LTC). CBMS will not look as the later programs until a determination is made for those above. CBMS wrap-up will display the primary aid code and a secondary aid code it it applies

An SSI mandatory approval will not display denial for LTC programs. You should realize this means an SSI approval was found ineligible for LTC.

Talking Points

Benefits category is the 4th column, the hierarchy attempts to place all the 1’s before 2’s etc.

If someone was approved for #31 MAGI Parent/Caretaker, it means CBMS did not find them eligible for #15 SSI Mandatory.

A case that has been approved for #40 SLMB, has already been denied for programs 1-39. CBMS uses this order to ensure the highest benefit category the member is eligible for.

MA Assistance Hierarchy The MA assistance hierarchy shows the order that CBMS will an eligibility approval in CBMS.


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Medical Assistance Hierarchy, Benefit Category, Coverage and Execution Order


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Continued from last page


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Which category is the last program listed on the hierarchy and what are the benefits associated with this

category?

Answer: LIS – Medicare Part D premium + co-pays and deductibles

Which two main SSA programs come with Medicare?

Answer: SSDI and Retirement are Medicare. Remember that customer who are 65 and receiving SSA retirement will receive Medicare on their 65th birthday. Customers who are receiving SSDI may have to wait two years before being eligible.

Review information on screen Review information on screen


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Review What category is the last program listed on the hierarchy and what are the benefits associated with this category?

LIS – Medicare Part D premium + co-pays and deductibles

Which two main SSA programs come with Medicare?

Which SSA program comes with Medicaid?

What are three eligibility differences between Magi and Non-MAGI programs. Resource limits, Aged/Blind/disabled population, no MBU for Non-MAGI

Which SSA program comes with Medicaid? A. SSI is Medicaid

What are three eligibility differences between MAGI and Non-MAGI programs. A. Resource limits, Aged

blind/disabled, income limits, noMBU for Non-MAGI

SSDI and Retirement

SSI


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Non-MAGI Overview

Revisit the objectives. Participants should be able to perform these, if they can’t they should ask questions now. You can view this slide as a test, having them perform the objective.

There are checkboxes in the Participant guide. Have them honestly answer with themselves. Those that are unsure should ask questions and recognize they should seek additional help.


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Non-MAGI Overview

Re-Visit Objectives: Can you?

Identify eligibility differences between MAGI and Non-MAGI. Associate SSI, SSDI and SSA with Medicaid or Medicare appropriately. Recognize what approval for a MA program means in regard to other MA programs.

Goal: To gain further understanding of Medical Assistance programs, Social Security programs and how they relate.


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Types of Resources and Data Entry

Visit Objectives. There will be another Data Entry practice section.


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Objectives: After the module participants will be able to:

Data enter diverse types of resources. Identify exempt resources. List references to aid in data entry.

Goal: To understand resource eligibility rules and processes


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Estate Recovery

Look at these slides ahead of time. They are animated to explain Estate recovery:

• Estates refer to your net worth, all your assets and debts• When you die, an executor of your estate is appointed who liquidates your assets to

pay off your debts• The rest becomes an inheritance divided up as decided by the will• Medicaid doesn’t want to be paying $100,000/yr. to protect an inheritance• Estate Recovery is the solution to this, it removes the protected inheritance scenario

• In the new scenario, assets are liquidated and paid to Medicaid prior to aninheritance disbursement.

• Eligibility workers need to explain this to applicants when asked and send outnotification to anyone over 55. It is an easier conversation if you approach it fromthe standpoint of house exemptions. (Outlined in the FAQ in the back of the book).

• The alternative was that we make everyone sell all their belongings prior to beingaccepted to Medicaid.


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Note on Estate Recovery

This primarily affect LTC cases, but ‘could’ apply to any individual on state-plan Medicaid who is over 55. Eligibility workers must send this Estate Recovery paperwork to individuals 55 or older that are on a State-plan program.

Estate Recovery Medicaid Estate Recovery became a federal requirement for states as part of the Omnibus Budget Reconciliation Act of 1993. The goal of the program is to help cover the cost of providing services to Medicaid beneficiaries from the estates of medical assistance recipients. [email protected] is the unit email.

The Department may recover payments made for all medical assistance paid on behalf of an individual who was institutionalized at the time he/she received medical assistance; OR,

For persons age 55 at the time they received medical assistance, the Department may recover medical assistance provided for nursing facility care, home and community-based services, and related hospital and prescription drug services. 10 C.C.R. 2505-10, Section 8.063

Estate recovery applies to clients regardless of their category of eligibility and may apply to “MAGI clients” under the circumstances noted above.

This also sets up the ‘whys’ of some resource rules.



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Liquid Assets

Bank accounts, retirement accounts etc. are rather straight forward and, in most cases, can be verified through AVP. We are not going to go into specific details on AVP today but there is a web-based training on CoLearn that you are urged to take to learn about this process. For our training and data entry we

will demonstrate how to manually enter resources. Items held for investment may not be as clear. Personal property is exempt, so workers may need to establish intent. An antique passed down as a family heirloom would be personal property and exempt if one intends to keep it as a family heirloom. If someone intends to sell that item one day, it would be an item held for investment and countable.

Any personal property that has been declared by the customer should be entered in CBMS as ‘other personal property’ on the liquid assets page.

Note on bank accounts: Entering the last 4 digits of the account number and the name of the bank is recommended so that the resource can be easily identified

Important for the name of the resource to be the bank name.


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FYI - The Achieving Better Life Experience (ABLE) Act has created a tax free saving account for members

with disabilities. One of the resource types will be ABLE Account. This asset is exempt for all Medical

Assistance programs. The Source and the verification must read ABLE Account. An original verification

must be received by the Eligibility Site.

Good Faith

When creating a verification checklist, customers will receive 1 calendar day+10 business day+5 calendar days to provide the information. In some instances, they may be given a Good Faith Extension to provide the documentation if they are not able to obtain the verification within that timeframe. This is typically for Citizenship but can be for resources etc. as well. Once you run EDBC and the VCL is generated, the Good Faith Screen will be enabled at the bottom half of the wrap up screen. You must now enter an EED no longer than six months. Discuss with class that you do not have to always give 6 months, have a conversation with the client and determine how long they think it may take to get the information. If the verification is not provided by the EED, batch will run and discontinue/deny the case. There is a report that was created to manage these cases and can be found in Cognos. It is they MA Good Faith Report

Timely Dis-enrollments When a customer provides verification or a change, County users/MA sites will have 15

calendar days to process the change and re-determine eligibility based on the information provided. There are also two reports that have been created to monitor this within Cognos.

They are the MA Dis-enrollment Processing Times Report and the MA Timely Dis-enrollment report.


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Liquid Assets Page

Cash, bank accounts, retirement accounts, investments accounts, etc. are countable.

Log into CBMS and walk through EACH type of Resource.


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Once a Liquid Asset has been entered, several Related Lists are displayed. The Liquid Asset Ownership list tracks information about ownership. All the fields in this list with a red asterisk AND the ‘Amount of Balance Considered Current Income’ are ALL required fields.

It is important to complete the percent owned field so that the calculation of total resources is accurate.

Example: If a customer co-owns a bank account with his daughter and the total available in the account is $15,000 CBMS will calculate that the customer owns 100% of this resource instead of 50%. The total $15,000 will be attributed to the customer instead of $7,500 potentially putting the customer over the resource limit

The Amount of Balance Considered Current Income should be completed if income is deposited into the account. You should total income deposited for all owners.

Example: A couple each receive $1200 in income (total $2400) and it is deposited into a shared account. You would enter 2 ownership records on the bank account each with 50 percent owned.


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Encumbrances

Used for loans and liabilities against an asset.

Examples of this would be auto loans or mortgages, but this theoretically could be a bona-fide loan against any asset. It should be completed any time a loan against an asset is relevant.

The encumbrance entry should be case commented and reviewed/updated at each RRR. This isn’t a regularly used field and may be skipped over by future workers when updating.


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Vehicles

One vehicle (regardless of the value) is exempt if it used for the transportation of the individual or household member (8.100.5.M2c). CBMS will automatically exempt the vehicle with the greater value. All other

vehicles will be a countable resource. Fair market value is obtained by requesting NADA/KBB etc.

If the customer has a loan against any of the vehicles you would enter this into the encumbrances field (as we reviewed a few moments ago)

Intent to Sell 8.100.5.M2b

Excess properties (vehicles, homes, land etc.) may be exempted if there is an ongoing reasonable effort to sell.


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Verification of reasonable efforts are required every 3 months until the property sells. At that time those funds are countable, and the client is ineligible until they are below the resource limit.

Excess properties (vehicles, homes, land etc.) may be exempted if there is an ongoing reasonable effort to sell.

Talking Points

Temporary exemption requirement if vehicle (or any resource) is listed for sale The cash received is countable when the asset is sold, eligibility

must bere- reviewed at that time Letting the client know ahead of time that they need to report the sale

timely as claims could occur if it is not The Radio buttons will trigger this exemption Verification of reasonable efforts are required every 3

months until the property sells. At that time those funds are countable, and the client is ineligible until they are below the resource limit.

Reasonable effort means:

•Listed at current market value•Reasonable offers must be accepted•Reasonable offers are defined as at least two-thirds of thecurrent market value


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Real Property Policy slides followed by data entry explanations.

Primary home

Value can be pulled from websites like Zillow.com, trulia.com, redfin.com, As a guideline.

Assessor as last resort but follow your current business process in your County.

Equity exemptions are related to estate recovery exemptions.

Secondary Property

Equity is countable.

Check for loans as well as FMV.

When using real estate websites for FMV it is advised you to check a few. The estimates are computer algorithms and can be overly-sensitive to recent sales.


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Real Property

Equity (Value – total amount owed on loans) is countable. Formal appraisals, E-appraisals can be used as a guideline. Verify loans against the property for encumbrances. Conditional exemptions for intent to sell can be applied:

Primary home 8.100.5.M2

Is exempt so long as:

The home is in Colorado and,

Equity is $595,000or less (2020) and,

The individual lives in the home or is institutionalized but intends to return to the home.

Or

A spouse or dependent relative lives in the home.

-No limit on equity

Secondary Property

Equity is countable. Intent to sell can be applied. Use appraisals as guideline. For e-appraisals check multiple sites due to volatility and use best

judgement. Applicant can dispute with a 3rd party appraisal.


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Mineral Rights

Rights to a resource on a piece of land, but not the land itself (i.e. the oil in the ground). Get an appraisal from a reputable and knowledgeable source. This may be a resource and income.

Mineral Rights

Mineral Rights are the ownership interest in natural resources that can be extracted from the ground (i.e. oil, natural gas, coal, precious metals, gemstones etc.). These rights are generally leased to an extraction company for a percentage of the profits. The value of the Mineral rights are a countable resource.

If the applicant owns the land, the value is generally included in the assessed land value If the applicant does not own the land an estimate of the value can be

obtained by a knowledgeable source (extraction company, Bureau of Land Management, US Geological survey)

This may be low or even $0 if the land has not been prospected Income from mineral rights are countable as income

If income producing, the value may be exemptible as a resource Evaluate under 8.100.5. J2,3

Example: I own the oil under the land, but not the land. The oil or mineral rights would be entered in CBMS and would be included as part of the countable resource limit.


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Income Producing Property

Very Rare. $6000 exemption can be applied in a specific scenario. No current CBMS functionality for this, but it rarely can be applied in a meaningful way. The reason this can be rarely applied is because anything that is income producing is likely worth well over $6000, so the reduction won’t fully exempt the value.

Income Producing Property 8.100.5.J2,3

Exempt up to $6000 of value for:

Non-business producing income, goods or services essential to self-support Business property as long as it produces a 6% return (per year) on the excluded value Can apply to any property

Mineral Rights, Land, rental property, vehicles etc. Income is countable Income

Example:

A second car worth $10,000 is being rented to the neighbor.

Since the car is now income producing we can exempt $6,000 from the value, the countable amount is now $4,000.

Business Example:

Client owns an S-Corp. The S-Corp rents the car to the neighbor.

We can still exempt the $6,000, but only on the condition that there is a 6% return on Investment (on the $6000). This would require at least $360/yr. in car rental income.


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Data Entry

Overview of basic data entry. Required fields + Percent Owned.

The drop-down menu has ‘home-primary’ as a type which will provide the exemption.

These screens are very similar to the Liquid Assets screen where we entered the bank account. It is important that the resource name is identified especially if the customer owns several properties. It could be entered as “home on Colorado Blvd” for the primary residence with the type matching the resource name. If there was an additional property, the resource name could house in Grand Junction etc. and secondary property as the type.

The Radio button “listed for sale” must be completed if the customer has the intent to sell so that CBMS can properly exempt the property.


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This is a good opportunity to explain irrevocable vs revocable.

Revocable can be cancelled Irrevocable cannot be cancelled.

Burials

Pre-paying burial/cremation expenses ensures Medicaid will not need to pick up the cost and therefore are looked upon favorably. Burial plots and irrevocable policies are exempt as are revocable policies with a face value up to $1500 (per person).

Irrevocable means that the policy cannot be cashed in/cancelled. It also will not count toward the countable resource limit

Revocable means that the policy can be cashed in/cancelled and will count toward the resource limit. If the policy is revocable many funeral homes or other companies that issue burial policies can convert the policy to irrevocable and/or assign the policy to HCPF if the customer makes this request.

HCPF must be the remainder beneficiary on all pre-paid policies. Funeral homes should be sending excess funds to:

HCPF- Recoveries

1570 Grant St.

Denver, CO 80203

[email protected]



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Life Insurance Policies

2 Steps

1. Do we count this? ($1500 facevalue slide.)

2. What do we count? (CSV)

The Cash Surrender value is the amount the person would receive if they cancel the policy.


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Life Insurance Policies

Treatment of life insurance policies varies by the type of policy. Terms you will need to know:

Face Value: The amount of the death benefit

Cash Value: The amount of the investment component of a policy.

Cash Surrender Value: The amount of money that a beneficiary would receive to terminate or “cash out” their policy. This amount may increase as a client gets older to mitigate risk from the life insurance company. The amount also decreases if clients borrow from the cash value of the policy.

Term Life: These policies have a face value (benefit) that only pays out upon death. The client pays a monthly premium to provide coverage, the premium price is usually based upon age.

Whole Life: May be called Universal life or Variable life depending on the exact details. These policies contain an investment component. Part of the monthly premium is contributed towards the investment component and earns a return. The policy will contain a face, cash and cash surrender value.

Eligibility rules

If the total face value of all policies is $1500 or less (per person), then all policies are exempt. If the total combined face value is over $1500 (per person) then all policies are countable using the cash surrender value.

Term life insurance policies have no cash surrender value so will ultimately not count against the resource limit in any event.

If total face value of all policies are over $1500, all are countable.

If total face value of all policies are under $1500, all are countable.


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Policy and Data Entry Review for Life Insurance.

Required fields, ownership, date acquired, Face value, CSV.

Of note:

Leaving the Face value blank will cause the policy not to count. ‘Cost of liquidating policy’ is for any fees associated with

cashing out. This would be deducted from the countable value. Policy # and the name of the provider should also be entered for identification. If the policy has a cash surrender value remember that this could

potentially count as a resource if the face value is more than $1,500 and that a customer could take a “loan” against the policy so this must be re-verified and updated at each RRR

It is important to review the policy carefully. The owner, the insured and the beneficiary are

very different things. The owner is the person who is paying the premiums and owns the policy. The insured is the person who is covered by the policy and the beneficiary is the

person who will receive a payout when the customer passes away. The owner and the insured

are most often the same person. Ensure that the radio button “is the insured person different form the owner is selected with yes or no. Your customer may own the policy but is not the insured and if there is a cash surrender value this could potentially count toward the resource

limit. The cash surrender value is the countable value on a life insurance policy.


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Adult Financial vs. Medicaid

Countable for • Face Value over $100,000 for MA and $250,000 for AF•Purchase within 48months

Both

• Face Value greater than $1500 but less than $100,000Counts for • Or >$100,000 and purchased more than 48 months ago

Medicaid only

Exempt for both

• Total Face Value $1500 or less


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Adult Financial vs. Medicaid Adult Financial and Medicaid have different rules for counting Life insurance policies. This sometimes leads to situations in which an individual meets the AF resource limit but is over the Medicaid Resource limit (even when it is the same limit!)

This is one reason an individual may end up on OAP-HCP.

This is discussed further in the Adult Financial Expanding Foundations course

Practice Time!

You can use the same case copy cases that you previously assigned to student. Participants are given a resource verification, they can data enter it and check their answer on the next page.

This usually takes ~20 mins.


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Practice Time! Example: Client provides the below Checking Account Verification.


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Example: Client states ownership of a 2012 Chevy Malibu LT. NADA or KBB is used and printout is below. Customer owes $2,000

Example: Client has a Primary Home. Client still owes $200k.


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Example: Client provides verification of a Term Life Insurance Policy


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Example: Client provides verification of a Whole Life Insurance Policy.


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Knowledge Check:

Depending on the size of the class, you may opt to call specific people, or have everyone name 1.

CBMS will request a spouse’s income and resources for some of the Non-MAGI categories. If the spouse’s income and/or resources are not received the case will deny.

Members will be given 1 calendar day + 10 business days + 5 business days to provide verifications. Keep in mind the notice will not show the extra 5 days, this is behind the scenes

Revisit objectives.

Participants have performed data entry.


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SSI Related Programs

This module covers the programs related to SSI. Visit objectives.


Identify program resource limits Identify Household requirements and data entry for SSI related Non-MAGI programs Data Enter an SSI mandatory case

Goal: To understand a group of Non-MAGI programs, and their eligibility rules.


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Program List

List the programs that will be discussed. Review the Commonalities from the PPT and Participant guide.


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Commonalities among these programs

Benefit Category 2

State-Plan Medicaid

Countable Resource limits

$2000 for an individual

$3000 for a couple (consistent with SSI)

General Income Disregards

$20 off unearned income

$65 + ½ of remaining earned income.

(Review example on slide 70)

Coverage begins

1st of the month of application, 90- day retro can be applied.

Pickle OAP (MA) SSI Mandatory

DAC QDW

The $20 disregard will always s be applied to unearned income first.

If there is any reminder from the General Income Disregard, it will be applied to earned income and referenced as the Excess General Income Disregard.

The Excess General Disregard is first applied to earned income before the $65 and ½ deduction.

The General Disregard will not be applied to:

Individuals with SSI Income only, exempt income, CBwD, LTC, HCBS and MSP.


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**OAP is the exception as it begins the day OAP AF begins (day of application).

Processing guidelines

45 days, 90 if disability determination is needed.

Household

A household consists of an applicant and spouse if they are living in the home and married.

The PPT slides identify the data entry related to living in the home and Married. Applicants must meet both requirements to be considered the same household.


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Household A household consists of an applicant and spouse if they are living in the home and married.

Living in the home

Case Individual – Living in the home

This is a required field asking if each individual is residing in the head of household’s home

Marital Status

CBMS determines if a couple is married based on 2 pieces of data entry. Individual Demographics

Marital information must be entered. Client statement is acceptable unless questionable. Married,

Common Law, and Common Law Registered are considered Married.

AND

Household Relationships Details

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.


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SSI Mandatory

CBMS bases this decision on whether the individual is in SSI pay status.

Program eligibility

SSI Mandatory

Individuals receiving SSI are automatically Medicaid eligible. They do not need to submit a separate application. The application date is the date they were first eligible for SSI. This could be years in the past! Many times, these individuals don’t know to apply for the program or assume they already have coverage. The population is typically discovered when medical coverage is needed.

Case eligibility is whether the individual is receiving SSI. Social Security Administration has already verified citizenship, identity, income, and resources. These individuals also receive financial RRRs through SSA. Because of this no Medicaid application or RRR is needed. Eligibility will continue via the interface until the member is no longer eligible for an SSI benefit.


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Data Entry

Walkthrough of data entry. Have Participants AI and enter their own case info. Address SSI details and Income as a group.

Data Entry

This is the walkthrough for the 2 screens that would not have been covered in EF: MAGI.

Data Entry CBMS will determine SSI MA eligibility based on data that has been entered on the SSI details page and

the unearned income page.

This may interface, but if you are entering a new client, you will need to fill out the just a few fields.

Effective Begin Date: The date the SSI benefit was approved.

Receiving: Yes, if they were/are receiving benefits for this time period. Verification: Received, SSA

statement.

Guidance for entering SSI income. The individual must be in pay status, so entering income is required. This would typically come from the SDX interface but if it doesn’t you will have to request the information from SDX/Bendex.

Be sure to back date the income to the application date in this scenario.

Because CBMS also looks for active Income, you will need to enter an income record back to the date

of approval (even if the received a lump sum later).

This will also apply to the Income Received Details page. Run EDBC and take a look!

Wrap-up view of SSI mandatory.

This will run back to the date that SSI income is first received. Identify the Program type of SSI Mandatory.


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OAP is covered in depth in EF: Adult Financial. There is a flow chart in the Participant’s guide explaining how other Med categories can be involved. The time you spend on this is your discretion. OAP-Med and HCP should be recognized as Medical assistance, but the eligibility is tied to and covered in EF: AF.


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OAP

Old Age Pension is primarily covered in Expanding Foundations Adult Financial. Whenever an individual is approved for AF OAP they will receive a Medical assistance benefit (Must be AI’ed separately). This is likely OAP Medicaid or OAP HCP, but could be other categories. This is because HCP is a very low benefit category, only covering limited services. CBMS will place the member in the highest benefit medical assistance category they are eligible for.

Coverage for OAP Medicaid and OAP-HCP will begin the same day the AF benefit begins.


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with any other income and resources is within the

Pickle

PPT slides exist to explain how these occur… click and read through the story.

Example

The Pickle Amendment

The Pickle amendment got its name from its congressional sponsor.

It protects people who were eligible for both SSI and some other type of Social Security benefits and/or OAP but lost their benefit (and their SSI Medicaid) due to a Cost of Living Adjustment (COLA).

income/resource limits for SSI, the person can continue to receive SSI for Medicaid purposes only.

Example:

You retired at age 65 in March 2017 and began collecting Social Security payments. You had very limited resources and almost no other income, so you were also eligible for SSI with Medicaid. In January 2018, there was a 5.8% COLA increase to your Social Security payment. This increase made your income too high for SSI eligibility, and consequently Medicaid. By using the Pickle Amendment, you can use your original Social Security payment amount

(identified in March 2017) without any subsequent COLA increases, for your income. Provided

your other income and resources do not disqualify you, you will be able to re-qualify for SSI for Medicaid purposes only. You can do this any time after you lost coverage in January2018.

The amendment states that those who would have been eligible for SSI/Medicaid if not for the COLA raises, don’t have to include the COLA for Medicaid eligibility. If the original SSA payment amount, along


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Data Entry

A guide exists in the Participant guide. This isn’t in the PPT as it is so rare. A case is not going to be created.

These individuals also have annual RRRs. Because a resource check is required, you should not allow these cases to auto-reenroll!

CBMS will collect information to verify that the member is over the income only because of COLAs. It tracks this by identifying the amount of the initial entitlement and year. It the initial entitlement was frozen; would they still be eligible? The initial entitlement is often called the ‘frozen amount’ to represent this question.

The Title 2 Frozen amount + Other income must be less than the SSI or OAP amount (after disregards).

Title II Frozen Amount

Other Income

Applicable Disregards

SSI or OAP Limit

Equal or less than


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Data Entry Continued

(The individual will not be receiving SSI)

Pickle Details

Collect Pickle Information: Yes, will open the other fields.

1. Was SSI or OAP Med lost? Check Med Spans or SVES to identify the date for new cases.2. Was it for COLA (Cost of Living Adjustmenr) or Initial Entitlement (new)3. Was the Initial Title II payment under their own SSN? Enter initial (frozen) amount.4. Was this Initial Title II payment under another person’s SSN? This would be a DAC or QDW

amount.5. Likely Yes

Verification: Received Source: SSA

1

2

3

4

5


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Disabled Adult Child (DAC)

PPT slides exist to explain how these occur… click and read through the story.

Example

Eligibility

Click through the example of how these occur.

Disabled Adult Child (DAC)

A DAC benefit is an SSA benefit for individuals who became disabled prior to age 22. These individuals often had no opportunity to earn significant work quarters because of their disability. The DAC benefit allows them to draw based on their parent’s benefit when their parent retires or becomes disabled.


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Example

At age 18 Terra started receiving an SSI benefit and Medicaid.

Because the individual may be well into adulthood when their parents retire, the sudden receipt of the DAC benefit may jeopardize their SSI Medicaid eligibility.

Terra was diagnosed with a childhood disability and was found disabled by SSA at age 14 Terra

was unable to work as a result but was ineligible to collect SSI due to her parent’s income.


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In 2018 Terra’s parents retire, Terra qualifies for a DAC payment of $820 based on her parent’s work history. SSA uses this income change to re-evaluate SSI eligibility.

$800-$20 disregard= $800 which is over income for SSI. Terra loses SSI and SSI Mandatory Medicaid.

The DAC Medicaid category exists to prevent this loss. Similar to Pickle, the individual would need to be otherwise eligible for SSI. This means checking resources ($2000/$3000), conducting RRRs (do not let them auto re-enroll), and ensuring that the DAC benefit is the only reason the individual is over the SSI income limit.

Eligibility

CBMS will check to see if this individual would have been eligible if they were not receiving the DAC benefit.

Data Entry

DAC benefits are an income type from SSA. This income may interface for existing cases. CBMS uses the income type and BIC number to identify potential DAC eligibility.

If the income does not interface, you will have to request the information form SVES or Bendex and verify the correct BIC code or claim number as it will be different from the customer’s SSN. Income Type: Social Security Disabled Adult Child

Total Income

DAC Benefit

Applicable Disregards SSI Limit

Equal or Less Than


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Qualified Disabled Widow(er) QDW PPT slides exist to explain how these occur… click and read through the story.

Eligibility

Click through the example of how these occur.

Data Entry

Qualified Disabled Widow(er) QDW Similar to the DAC benefit, the QDW Medicaid benefit seeks to maintain Medicaid eligibility to individuals whose SSA widow(er) benefit puts them over the SSI income limit. These individuals are disabled, widowed, and would be otherwise SSI eligible.

Example

Valerie is 52 years old, disabled and receives SSI. She is married to Rob. Rob passes away.

The widow’s benefit she receives from Rob totals $920/month She is no longer eligible for SSI due to being over income

Valerie will be eligible for QDW if she meets all other MA requirements.

QDW Medical assistance will extend the Medicaid benefit if Valerie would have been otherwise SSI eligible. CBMS checks for Medicare eligibility (disabled), the existence of a widow benefit, the SSI resource limit $2000/$3000, and that the Widow’s benefit from SSA is the sole reason she is over the income limit.

Again, an application and RRRs are required. The resource check means auto re-enroll should not be allowed.


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Eligibility

CBMS will verify that the QDW benefit is the reason the individual is over the SSI limit.

Data Entry

Like DAC, this is an income type. CBMS will view the income type and BIC code to identify this population. Additionally, a Medicare benefit is needed.

Income Type: Social Security Survivor Adult , this income should interface but if not, you will have to request from SVES/Bendex and pay attention to the BIC number

SSI Related Programs

Re-visit objectives.

Total Income

QDW Benefit

Applicable Disregards SSI Limit


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Explain the coverage difference between Buy-in Programs and State plan Medicaid. Identify difference between Working Adults with Disabilities (WAwD) and Health First Colorado Buy-

In Medicaid program for Children with Disabilities (CBwD)

Students should now login to their CoLearn Account:Ask them to locate the web-based training (WBT) titled Health First Colorado Buy-In Program

Participants will need to complete the WBT. This will take them about 15-20 minutes. Let them know they can take notes along the way, and then we will be coming back together after everyone has finished to discuss what they learned.

CoLearn


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Buy-In Programs

Once the class has completed the Buy-In Program WBT discuss key take aways:

• What is WAwD?• What is the main eligibility criteria?• What is WAwD with Additional Services?• What is CBwD?• What is the main eligibility criteria?• How can disability be determined?• How are premiums determined?• How can a client pay their premiums?


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Data Entry Practice- Enter an ARG determination


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Case Data Entry

Ask participants what they think needs to change on their SSI case to become a WAwD? They should come up with a plan and see what works. Having them determine the changes is good review and troubleshooting why they were wrong is a job-related skill.

1. SSI must end, or else it will be SSI2. Earned income must exist (and must be over the Adult MAGI limit).3. Disability Entered.

a. Maybe an ARG was submitted.b. Maybe the SSI diary date was verified.c. Maybe the individual is now on SSDI

4. DRA must be met, SSI covered up any missing verifications.

Have them enter these changes and view wrap-up.

If an individual has the wrong category, ask why this happened? The key is to remember the hierarchy, WAwD requirements, DRA, and other MA programs.

Case Data Entry Change your SSI case to WAwD by adding earned income, what steps must you take?


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Medicare Based Programs

Visit Objectives.

Medicare Savings Programs

Benefit Category 4 and 5. These are Medicare with some level of costs paid for by the state. Members should contact

Medicare for coverage questions. Some Individuals will not receive Medicaid Cards.


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Program list

Part A eligible it the primary requirement. Note that receiving Part A satisfies DRA It will be essential to ensure Part A eligibility is entered in CBMS.

QMB SLMB

Review what is on the PPT slides for each program.

Medicare Savings Programs Benefit categories 4, 5 and 7.

The Medicare based programs do not grant state plan Medicaid benefits. Individuals on these programs are Medicare recipients with low income. The programs help pay Medicare costs for individuals based on which income bracket they fall into. All individuals on one of these programs must be entitled to Medicare Part A.


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(Slide 140 – review slide only)

Program list

QMB

Qualified Medicare Beneficiary benefit category 4. The program pays for Medicare premiums, deductibles, co-pays, and coinsurance. It cannot be backdated.

SLMB and QI-1

Special Low-Income Medicare Beneficiary and Qualified Individual 1 are both benefit category 5 programs. They are like QMB, except cover less Medicare expenses (only Part B premiums). The primary difference between the programs is that QI-1 must be re-authorized by Congress every year and will only cover the individual’s Medicare Part B premium. SLMB and QI1 are eligible for up to 90 days retroactive coverage .


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QDWI Qualified Disabled Working Individual also benefit category 5.

Medical Assistance coverage is limited to the monthly payment of Medicare Part A premiums and any other Medicare cost sharing expenses. Some individuals receiving SSDI benefits do attempt to return to work. If their earned income goes

above the Substantial Gainful Activity threshold, they can lose their SSDI benefits.

To be eligible for QDWI the individual must have exhausted the SSA’s allowable extension of “premium free” Medicare coverage, has resources below $6,000 and has income below ($2,044 for an individual or

$2,764 for a couple) Medicare part A is still made available to them, but at a cost. If these individuals meet the income and resource criteria for QDWI, their part A costs can be covered.

Coverage can be backdated 90 days.

Read from PPT slide discussing the difference between QDWI and WAwD


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Income and Resource Limits

*These Income limits include the $20 unearned income disregard.

MSP Income Deeming

In addition to the standard $20 and earned income disregard ($65 + ½), there are also disregards related to children and child support.

The Income of the spouse and children in the household towards the income limits.

Children are defined as:

Under 18 and in the household, or Under 21, in the household, and attending school, college, or technical training.

Child support has a 33% disregard.

Each child allows a disregard equal to ½ SSI.

Disabled children receive disregard = SSI.

Each child’s first $400/mo. Income (up to $1620/yr.) is not countable.

Income from any child receiving SSI or OAP does not count, nor does the disregard apply.


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Medicare Data Entry This interfaces on existing cases but must be entered for new clients. Client pays for Part B must be answered yes at initial application, otherwise the interface won’t occur, and payment will not be picked up by the State.

The key here is matching the payment method to the Buy-in Status.

The likely pairs are:

Payment Method Buy-in Status

Other Free Part A

Monthly Deduction Paid for by beneficiary

State Payment Paid for by State Buy-in


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The Medicare Expense screen will interface for ongoing cases but must be completed for new applications. The page has separate sections for Part A and B.

The Medicare Expense screen will interface for ongoing cases but must be completed for new applications. The page has separate sections for Part A and B.


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LIS

LIS as lowest benefit category as it is merely a Part D cost offset. Talking points about why it displays when all cases are denied (last program considered).


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LIS


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Other Notes Final Case Data Entry runs

The course ends with scenarios that participants can enter and find the answer to by looking in wrap- up. This is intended to be a situation where they take a few existing cases (as well as a new one) and enter info they’ve learned in the past 2 days. They should run the case and look at wrap-up but not authorize. Entering subsequent changes will produce a different MA category.

This stress that single changes can produce different results, but also helps define what causes different MA categories to be determined.

AI a 60-year-old individual with $1100 SSDI income, Part A and Part B expense of $144.60

Reduce income to $900.

Add $1250/mo. earned income.

Notice the Earned income disregard.

Run EDBC (Do not Authorize), which category is displayed?

SLMB


QMB


WAwD

Expanding Foundations Release Date: March 2020


118

Medicare Based Programs

Re-visit Objectives.

You’ve reached the end of the course. Provide a closure activity and congratulate your participants.

Be sure to instruct all participants to complete the evaluation

Expanding Foundations: Non-MAGI - Traincolorado

Documents

Transcript of Expanding Foundations: Non-MAGI - Traincolorado