DAR File No. 41429

Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-303-4

Medicaid for Parents and Caretaker Relatives, Pregnant Women, Children, and Individuals Infected with Tuberculosis Using MAGI Methodology

Notice of Proposed Rule

(Amendment)

DAR File No.: 41429
Filed: 03/31/2017 09:15:58 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this revision is to change the income standard for the Parent and Caretaker Relative (PCR) coverage group to the Federal Poverty Level (FPL), as directed by state law.

Summary of the rule or change:

This amendment changes the income standard for the PCR coverage group to the FPL and sets the new income limit at 55% of the FPL.

Statutory or constitutional authorization for this rule:

• Section 26-1-5
• 42 CFR 435.110
• Section 26-18-3

This rule or change incorporates by reference the following material:

• Removes Section 1902(a)(10)(A)(ii)(XII) of the Social Security Act, published by Government Printing Office, 01/01/2014
• Removes 42 CFR 435.110, 435.116, 435.118, and 435.139, published by Government Printing Office, 10/01/2012

Anticipated cost or savings to:

the state budget:

For FY 2018, the Department of Health estimates a cost of $5,400,000 to the General Fund ($18,200,000 in total funds) with the addition of 4,000 individuals to the PCR coverage group.

local governments:

There is no impact to local governments because they neither fund nor make eligibility determinations for the Medicaid program.

small businesses:

To the extent small businesses provide services to Medicaid members, these businesses may see a portion of $18,200,000 in annual revenue as a result of this change. The exact amount, however, cannot be determined since it will depend on the services needed by Medicaid members.

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

Medicaid providers may see a portion of $18,200,000 in annual revenue as a result of this change while Medicaid members who qualify for PCR coverage will see a portion of this amount in total savings. The exact savings, however, cannot be determined as it will depend on what Medicaid members qualify for and which providers they use.

Compliance costs for affected persons:

There are no compliance costs because this change can only result in increased revenue to a single Medicaid provider and savings to a Medicaid member.

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

This amendment may have a fiscal impact on business in that an increase in eligible recipients will increase the amount of services provided by Medicaid providers.

Joseph K. Miner, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Office 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:

05/15/2017

This rule may become effective on:

07/01/2017

Authorized by:

Joseph Miner, 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, 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, and 42 U.S.C. 1396a(a)(10)(A)(ii)(XII).[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 as required in 42 CFR 435.110, whose countable income is equal to or below 55% of the Federal Poverty Level (FPL).[, 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:

 

TABLE

  

  Family Size           Income Standard
  
     1                       $438
  
     2                       $544
  
     3                       $678
  
     4                       $797
  
     5                       $912
  
     6                     $1,012
  
     7                     $1,072
  
     8                     $1,132
  
     9                     $1,196
  
    10                     $1,257
  
    11                     $1,320
  
    12                     $1,382
  
    13                     $1,443
  
    14                     $1,505
  
    15                     $1,569
  
    16                     $1,630

 

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

([5]4) 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 FPL.[federal poverty level (FPL).]

([6]5) 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]6) The Department provides Medicaid coverage to pregnant women as required in 42 CFR 435.116.

(a) The Department elects the income limit of 139% of the FPL to determine a pregnant woman's eligibility for Medicaid.

(b) An individual, as defined in Subsection R414-302-3(2), may only receive coverage through the end of the month in which the individual turns 19 years old.

([8]7) 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]8) 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.

 

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

Date of Enactment or Last Substantive Amendment: [July 1, 2016]2017

Notice of Continuation: January 23, 2013

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