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Issue Alert - 04-04-08

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Date:

Apr 02, 2004

Issue Summary:

Income limits for Medicaid and MIChild are increased slightly, based on the federal poverty levels published in February 2004

Persons Affected:

Medicaid and MIChild applicants and recipients

For More Information:

Michigan Poverty Law Program 611 Church Street, Suite 4A Ann Arbor, MI 48104-3000(734) 998-6100(734) 998-9125 Fax


Background

Medicaid and MIChild

What's Happening?

FIA has now issued updated -- and increased -- income limits and allowances for some Medicaid categories and for MIChild, based on the actual federal poverty guidelines for 2004 that were published in the Federal Register in February 2004. The updated income limits and allowances are not yet available in the FIA manuals online. However, FIA workers have access to the updated limits and allowances at their desks. Advocates can access a table of the monthly amounts for various percentages of the federal poverty level at http://www.cms.hhs.gov/medicaid/eligibility/pov0104.pdf.Under FIA policy, the updated income limits are effective retroactively to February 2004 or April 2004, depending on the Medicaid category and the recipient's income source. (For some Social Security recipients seeking ADCare or Medicare buy-in eligibility, the income limits are not increased until April). However, policy does not require workers to identify and correct cases in which the individual was wrongfully denied due to the estimates of poverty levels.Medicaid categories that have income limits that that are based on federal poverty levels are: Healthy Kids for Pregnant Women (185% of poverty)Healthy Kids for Children under age 1 (185% of poverty)Healthy Kids for other children (150% of poverty)ADCare (100% of poverty)QMB Medicare cost sharing (100% of poverty)SLMB Medicare cost sharing (100-120% of poverty)ALMB Medicare cost sharing (120 - 135% of poverty)(Note: Medicare cost sharing categories do not provide full Medicad coverage.)MIChild eligibility requires income below 200% of poverty

What Should Advocates Do?

Use the new, correct limits in advising clients about possible Medicaid eligibility. Encourage clients to re-apply and/or to request a Medicaid hearing if they were denied Medicaid or Medicare cost sharing under categories that are based on federal poverty levels -- or were denied MIChild -- because their income was slightly higher than the income limit, if their income is below the new income limits. Clients who were denied eligibility for a month in which the new guidelines apply (after February 1 or April 1, 2004, depending on individual circumstances) may want to request a hearing to protect their right to retroactive coverage. Those who were denied previously may simply wish to re-apply.

What Should Clients Do?

Request a hearing and/or re-apply for Medicaid or MIChild if you were denied Medicaid or MIChild -- or were assigned a Medicaid spend-down -- because your income was only a few dollars over the income limit for Healthy Kids or ADCare Medicaid, or for MIChild. Seek legal help if you are not sure whether to request a hearing or re-apply, or if you are not sure whether you would qualify under the new limits. Clients who were denied eligibility for a month in which the new guidelines apply (after February 1 or April 1, 2004, depending on individual circumstances) may want to request a hearing to protect their right to retroactive coverage. Those who were denied previously may simply wish to re-apply.

Finding Help

Most legal aid and legal services office handle these type of cases, and they do not charge a fee. You can locate the "free" legal services or legal aid office that serves your county on the Michigan LawHelp web site (http://MI.LawHelp.org) or look in the yellow pages under "attorneys" or call the toll-free lawyer referral number, (800) 968-0738.