DAR File No. 38401

Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-303

Coverage Groups

Notice of Proposed Rule

(Amendment)

DAR File No.: 38401
Filed: 04/01/2014 02:57:34 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to comply with a clarification set forth by the Centers for Medicare and Medicaid Services (CMS) for the Tuberculosis Medicaid coverage group, which is subject to Modified Adjusted Gross Income (MAGI) methodology for eligibility determinations.

Summary of the rule or change:

This amendment clarifies that the Tuberculosis Medicaid coverage group is subject to MAGI methodology for eligibility determinations. This change also clarifies that to be eligible for Former Foster Care Youth, an individual must be on Medicaid when aging out of foster care. This change also updates references in the rule text and makes other technical changes.

State statutory or constitutional authorization for this rule:

• Section 26-1-5
• Pub. L. No. 111-148
• Section 26-18-3

This rule or change incorporates by reference the following material:

• Adds Section 1902(a)(10)(A)(ii)(XII) of the Social Security Act, published by Social Security Administration, 01/01/2014

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget because this change does not increase the number of individuals who are eligible for the Tuberculosis Medicaid coverage group, which averages less than one individual each year. In addition, this amendment only clarifies ongoing policy in Former Foster Care Youth and does not affect services for individuals who are eligible for this program.

local governments:

There is no impact to local governments because they neither fund nor provide Medicaid services to Medicaid recipients.

small businesses:

There is no impact to small businesses because this change does not increase the number of individuals who are eligible for the Tuberculosis Medicaid coverage group, which averages less than one individual each year. In addition, this amendment only clarifies ongoing policy in Former Foster Care Youth and does not impose new costs or requirements on business.

persons other than small businesses, businesses, or local governmental entities:

There is no budget impact because this change does not increase the number of individuals who are eligible for the Tuberculosis Medicaid coverage group, which averages less than one individual each year. In addition, this amendment only clarifies ongoing policy in Former Foster Care Youth and does not impose new costs or requirements on Medicaid providers and on Medicaid recipients.

Compliance costs for affected persons:

There is no budget impact because this change does not increase the number of individuals who are eligible for the Tuberculosis Medicaid coverage group, which averages less than one individual each year. In addition, this amendment only clarifies ongoing policy in Former Foster Care Youth and does not impose new costs or requirements on a single Medicaid provider or on a Medicaid recipient.

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

No impact on business as this rule makes no change in current practices.

David Patton, PhD, Executive Director

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

Health
Health Care Financing, Coverage and Reimbursement Policy
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at cdevashrayee@utah.gov

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

05/15/2014

This rule may become effective on:

06/01/2014

Authorized by:

David Patton, Executive Director

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

R414-303. Coverage Groups.

R414-303-4. Medicaid for Parents and Caretaker Relatives, Pregnant Women,[and ]Children, and Individuals Infected with Tuberculosis Using MAGI Methodology.

(1) The Department provides Medicaid coverage to individuals who are eligible as described in 42 CFR 435.110, 435.116, 435.118, and 435.139, October 1, 2012 ed., and Section 1902(a)(10)(A)(ii)(XII) of the Social Security Act, effective January 1, 2014, which are adopted and incorporated by reference.  The Department uses the MAGI methodology defined in Section R414-304-5 to determine household composition and countable income for these individuals.

(2) To qualify for coverage, a parent or other caretaker relative must have a dependent child living with the parent or other caretaker relative.

(3) The Department provides Medicaid coverage to parents and other caretaker relatives, whose countable income determined using the MAGI methodology does not exceed the applicable income standard for the individual's family size. The income standards are as follows:

 

. . . . . . .

 

(4) For a family that exceeds 16 persons, add $62 to the income standard for each additional family member.

(5) The Department provides Medicaid coverage to children who are zero through five years of age as required in 42 CFR 435.118, whose countable income is equal to or below 139% of the federal poverty level (FPL).

(6) The Department provides Medicaid coverage to children who are six through 18 years of age as required in 42 CFR 435.118, whose countable income is equal to or below 133% of the FPL.

(7) The Department provides Medicaid coverage to pregnant women as required in 42 CFR 435.116. The Department elects the income limit of 139% of the FPL to determine a pregnant woman's eligibility for Medicaid.

(8) The Department provides Medicaid coverage to an infant until the infant turns one-year old when born to a woman eligible for Utah Medicaid on the date of the delivery of the infant, in compliance with Sec. 113(b)(1), Children's Health Insurance Program Reauthorization Act of 2009, Pub. L. No. 111 3. The infant does not have to remain in the birth mother's home and the birth mother does not have to continue to be eligible for Medicaid. The infant must continue to be a Utah resident to receive coverage.

(9) The Department provides Medicaid coverage to an individual who is infected with tuberculosis and who does not qualify for a mandatory Medicaid coverage group. The individual's income cannot exceed the amount of earned income an individual, or if married, a couple, can have to qualify for Supplemental Security Income.

 

R414-303-8. Foster Care, Former Foster Care Youth and Independent Foster Care Adolescents.

(1) The Department adopts and incorporates by reference 42 CFR 435.115(e)(2), October 1, 2012 ed., and Section 1902(a)(10)(A)(i)(IX) of the Social Security Act, effective January 1, 2013.

(2) Eligibility for foster children who meet the definition of a dependent child under the State Plan for Aid to Families with Dependent Children in effect on July 16, 1996, is not governed by this rule. The Department of Human Services determines eligibility for foster care Medicaid.

(3) The Department covers individuals who age out of foster care. This coverage is called the Former Foster Care Youth. These individuals must be enrolled in Utah Medicaid at the time they age out of foster care.

(a) Coverage is available through the month in which the individual turns 26 years of age.

(b) There is no income or asset test for eligibility under this group.

(4) The Department elects to cover individuals who age out of foster care, are not eligible under the Former Foster Care Youth coverage group, and who are 18 years old but not yet 21 years old as described in 1902(a)(10)(A)(ii)(XVII) of the Social Security Act. This coverage is the Independent Foster Care Adolescents program. The Department determines eligibility according to the following requirements.

(a) At the time the individual turns 18 years of age, the individual must be in the custody of the Division of Child and Family Services, or the Department of Human Services if the Division of Child and Family Services is the primary case manager, or a federally recognized Indian tribe, but not in the custody of the Division of Youth Corrections.

(b) Income and assets of the child are not counted to determine eligibility under the Independent Foster Care Adolescents program.

(c) When funds are available, an eligible independent foster care adolescent may receive Medicaid under this coverage group until he or she reaches 21 years of age, and through the end of that month.

 

KEY: MAGI-based, coverage groups, former foster care youth, presumptive eligibility

Date of Enactment or Last Substantive Amendment: [January 1, ]2014

Notice of Continuation: January 23, 2013

Authorizing, and Implemented or Interpreted Law: 26-18-3; 26-1-5