DAR File No. 39483

Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-302-8

Application for Other Possible Benefits

Notice of Proposed Rule

(Amendment)

DAR File No.: 39483
Filed: 06/30/2015 04:43:12 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to clarify that a Medicaid applicant or recipient who may be eligible for a Veterans Assistance (VA) apportionment payment must apply for those benefits.

Summary of the rule or change:

This amendment clarifies that all non-modified adjusted gross income (MAGI) Medicaid applicants or recipients who may be eligible for a VA apportionment payment must apply for those benefits.

State statutory or constitutional authorization for this rule:

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

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget because this amendment only clarifies when an individual must apply for a VA apportionment payment. It does not affect current appropriations for Medicaid services.

local governments:

There is no impact to local governments because this amendment only clarifies when an individual must apply for a VA apportionment payment.

small businesses:

There is no impact to small businesses because this amendment only clarifies when an individual must apply for a VA apportionment payment. It neither affects current appropriations for Medicaid services nor imposes new business requirements.

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

There is no impact to Medicaid providers and to Medicaid recipients because this amendment only clarifies when an individual must apply for a VA apportionment payment. It does not affect current appropriations for Medicaid services, impose new provider requirements, or create out-of-pocket expenses.

Compliance costs for affected persons:

There is no impact to a single Medicaid provider or to a Medicaid recipient because this amendment only clarifies when an individual must apply for a VA apportionment payment. It does not affect current appropriations for Medicaid services, impose new provider requirements, or create out-of-pocket expenses.

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

There is no fiscal impact on business because the amendment clarifies requirements for Medicaid recipients and has no impact on providers or other payees of Medicaid funds.

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:

08/14/2015

This rule may become effective on:

09/01/2015

Authorized by:

David Patton, Executive Director

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

R414-302. Eligibility Requirements.

R414-302-8. Application for Other Possible Benefits.

(1) The Department adopts and incorporates by reference 42 CFR 435.608, October 1, 2012 ed., which requires applicants for and recipients of medical assistance to apply for and take all reasonable steps to receive other possible benefits.

(2) The Department may not require an applicant for or recipient of medical assistance to apply for an income benefit if the applicant's or recipient's income is not counted for the purpose of determining eligibility for medical assistance for either that individual or any other household member.

(3) Individuals who may be eligible for Medicare Part B benefits must apply for Medicare Part B and, if eligible, become enrolled in Medicare Part B to be eligible for Medicaid. The state pays the applicable monthly premium and cost-sharing expenses for Medicare Part B for individuals who are eligible for both Medicaid and Medicare Part B.

(4) Individuals whose eligibility is determined using non-Modified Adjusted Gross Income (MAGI) methodologies and who may be eligible for a Veterans Administration (VA) apportionment payment of benefits, as defined by the VA, must apply for those benefits.

 

KEY: state residency, citizenship, third party liability, Medicaid

Date of Enactment or Last Substantive Amendment: [January 1, 2014]2015

Notice of Continuation: January 23, 2013

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