BEFORE THE DEPARTMENT OF PUBLIC
HEALTH AND HUMAN SERVICES OF THE
STATE OF MONTANA
In the matter of the amendment of ARM 37.82.101 and 37.82.701 pertaining to Medicaid eligibility
NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT
TO: All Concerned Persons
1. On December 3, 2009, at 11:00 a.m., the Department of Public Health and Human Services will hold a public hearing in the auditorium of the Department of Public Health and Human Services Building, 111 North Sanders, Helena, Montana, to consider the proposed amendment of the above-stated rules.
2. The Department of Public Health and Human Services will make reasonable accommodations for persons with disabilities who wish to participate in this rulemaking process or need an alternative accessible format of this notice. If you require an accommodation, contact Department of Public Health and Human Services no later than 5:00 p.m. on November 24, 2009, to advise us of the nature of the accommodation that you need. Please contact Rhonda Lesofski, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; telephone (406) 444-4094; fax (406) 444-9744; or e-mail email@example.com.
3. The rules as proposed to be amended provide as follows, new matter underlined, deleted matter interlined:
37.82.101 MEDICAL ASSISTANCE, PURPOSE, AND INCORPORATION OF POLICY MANUALS (1) remains the same.
(2) The department adopts and incorporates by reference the state policy manuals, namely the Family Medicaid Manual and the Aged Blind Disabled (ABD) Medicaid Manual governing the administration of the Medicaid program dated
July 1, 2008 January 1, 2010. The Family Medicaid Manual, the ABD Medicaid Manual, and the proposed manual updates are available for public viewing at each local Office of Public Assistance or at the Department of Public Health and Human Services, Human and Community Services Division, 111 N. Jackson Street, Fifth Floor, P.O. Box 202925, Helena, MT 59601-2925. The proposed manual updates are also available on the department's web site at www.dphhs.mt.gov/legalresources/proposedmanualchange.shtml.
AUTH: 53-2-201, 53-6-113, MCA
IMP: 53-6-101, 53-6-131, 53-6-141, MCA
37.82.701 GROUPS COVERED, NONINSTITUTIONALIZED FAMILIES AND CHILDREN (1) Medicaid will be provided to:
(a) remains the same.
(b) individuals who have been receiving assistance in the nonmedically needy family Medicaid program and whose assistance is terminated because of earned income. These individuals may continue to receive Medicaid for any or all of the 12 calendar months immediately following the month in which nonmedically needy family Medicaid is last received, providing:
(i) and (ii) remain the same.
(iii) there continues to be an eligible child in the assistance unit. This coverage group is known as the "
(c) through (d)(i) remain the same.
(e) a pregnant woman whose pregnancy has been verified, whose family income does not exceed
133% 150% of the federal poverty guidelines, and whose countable resources do not exceed $3,000. This coverage group is known as the "pregnancy group";
(i) through (m)(iv) remain the same.
(n) families who, due to receipt of new or increased child or spousal support, lose eligibility for nonmedically needy family Medicaid. To be eligible the family must:
(i) remains the same.
(ii) have received nonmedically needy family Medicaid in Montana for three of six months prior to the closure of nonmedically needy family Medicaid. The coverage will continue for four consecutive months. This program is know as the "
extended child/spousal support family-extended group".
(2) and (3) remain the same.
AUTH: 53-4-212, 53-4-1105, 53-6-113, MCA
IMP: 53-4-231, 53-4-1104, 53-4-1105, 53-6-101, 53-6-131, 53-6-134, MCA
4. The Montana Medicaid program is a joint federal-state program that pays medical expenses for eligible low-income individuals. To qualify for the Montana Medicaid program, an individual must meet the eligibility requirements set forth in ARM Title 37, Chapter 82. Additionally, the Family and the Aged, Blind and Disabled (ABD) Medicaid manuals contain information about the eligibility requirements for Medicaid that is more detailed than that in administrative rules. These state policy manuals are published by the department to provide guidance to employees of the local Offices of Public Assistance who determine Medicaid eligibility.
ARM 37.82.101 adopts and incorporates by reference the Medicaid policy manuals. By incorporating these manuals into the administrative rules, the department gives interested parties and the public notice and an opportunity to comment on policies governing Medicaid eligibility. Additionally, as a result of the incorporation of the manuals into the administrative rules, the policies contained in the Family Medicaid manual and the ABD Medicaid manual have the force of law in case of litigation between the department and a Medicaid applicant or recipient concerning the applicant or recipient's Medicaid eligibility.
ARM 37.82.101 currently adopts and incorporates by reference the Medicaid policy manuals effective January 1, 2008. The department proposes to make some revisions to these manuals that will take effect on January 1, 2010. The amendment of ARM 37.82.101 is therefore necessary in order to incorporate into the Administrative Rules of Montana the revised versions of the policy manuals and to permit all interested parties to comment on the department's policies and to offer suggested changes. Manuals and draft manual material are available for review in each local Office of Public Assistance and on the department's web site at www.dphhs.mt.gov. Following is a brief overview of the changes being made to each manual section for the Family Medicaid manual and the ABD Medicaid manual.
ABD Medicaid Manual
MA 404-2 Penalty Periods for Asset Transfers -- The average cost of nursing home care in Montana is used to calculate penalty periods for uncompensated asset transfers made by nursing home and home and community-based Waiver applicants and/or recipients. The federal Medicaid statute at 42 USC 1396p(c) mandates that the penalty period for a disqualifying transfer of assets be computed by dividing the value of the assets transferred without adequate compensation by the average monthly cost to a private patient of nursing facility services at the time of application in the state where the person is applying for or receiving Medicaid. The average private pay cost is recalculated annually. The average is now being changed to reflect the results of the most recent survey of private nursing home rates in Montana, as conducted by the department's Senior and Long Term Care Division. The updated average is $5,376.50 per month, increased from the 2008 average of $5,125.50 per month.
The department estimates this change will affect approximately 50 recipients per year. The higher the average private pay cost of care is, the shorter the penalty period will be, resulting in an increase in department costs. The reduced penalty would be approximately 11 days shorter for a $40,000 transfer, $40,000 being the average value of a disqualifying transfer. The average daily Medicaid costs for an institutionalized individual is approximately $100.90 per day, so the total estimated fiscal impact of this change is $55,495.00 annually, of which approximately $12,686.16 is general fund.
Family Medicaid Manual
FMA 201-9 Family Transitional -- Certain households are eligible to receive Family Transitional Medicaid for up to 12 months. A household qualifies for Family Transitional Medicaid if (1) the household became ineligible for nonmedically needy Family Medicaid due to earned income or an increase in earned income or went from being eligible for nonmedically needy Family Medicaid to being eligible for medically needy Family Medicaid due to earned income or an increase in earned income; (2) the household received nonmedically needy Family Medicaid in Montana for three of the six months immediately prior to the closing of its nonmedically needy Medicaid or becoming eligible for medically needy Medicaid; and (3) there continues to be at least one qualifying child in the home. Previously eligibility for Family Transitional Medicaid was divided into two six-month periods. During the initial six months there was no income limit and households were not required to file quarterly reports providing information about their income. During the second six-month period there was an income limit and households were required to file quarterly reports. This section has been amended to remove the income limit and the requirement to file a quarterly report during the second six months.
This change was made because Section 5400 of the American Recovery and Reinvestment Act of 2009 gives the states the option to extend the initial eligibility period for Transitional Medicaid from six months to 12 months. Under federal Medicaid law there is no income limit during the initial eligibility period, so the extension of the initial period from six months to 12 months eliminates the need for an income limit and reporting requirement during the second six months of Transitional Medicaid. The department therefore chose the option of extending the initial period of Transitional Medicaid from six months to 12 months because this simplifies administration of Transitional Medicaid by removing the income limit and reporting requirement. It is estimated that 171 adults and 292 children per year will receive Family Transitional Medicaid for an additional six months as a result of eliminating the income limit and reporting requirement. This will result in an increase in Medicaid expenditures of $833,400 per year, of which $635,800 will be federal funds and $197,600 will be state general fund match.
ARM 37.82.701 lists and describes the Family Medicaid coverage groups. The department proposes to make several changes to ARM 37.82.701. In ARM 37.82.701(1)(b)(iii) the name "family-transitional" is replacing "family-extended" to identify the coverage group receiving Medicaid for up to 12 months after the family's nonmedically needy Medicaid eligibility would otherwise end due to receipt of new or increased earned income. This new name was chosen because this coverage group is referred to as "transitional Medicaid" in federal law, and also to avoid confusion with the coverage group described in ARM 37.82.701(1)(o)(ii), which is currently called "extended child/spousal support". In ARM 37.82.701(1)(o)(ii) the name "family-extended" is replacing "extended child/spousal support" to identify the coverage group receiving Medicaid for four months after the family's nonmedically needy Medicaid eligibility would otherwise end due to receipt of new or increased child or spousal support. This new name was chosen because "family-extended" is less cumbersome than the name "extended child/spousal support". The names are being changed in the rules to the new names used to identify the coverage groups in the Combined HealthCare Information and Montana Eligibility System (CHIMES), the new Medicaid eligibility system which was implemented on October 1, 2009. There is no change in the policies governing these coverage groups. Only the names of the groups are being changed.
Additionally, in ARM 37.82.701(1)(e) the income limit for receipt of Medicaid under the pregnancy coverage group is being changed from 133% to 150% of the federal poverty guidelines. The department has been using the higher income limit since 2007 when the Legislature appropriated additional Medicaid funds so that women with income of up to 150% of poverty could receive Medicaid, but the rule was never amended to reflect the new income limit for this group. It is now necessary to amend the rule so that it will accurately reflect the income policy currently in effect.
It is estimated that an additional 248 women will receive Medicaid during the biennium as a result of raising the income limit from 133% to 150% of the federal poverty guidelines. Additionally, there will be an increase in the number of infants eligible to receive Medicaid as a result of the increased income limits, because a newborn child whose mother was eligible for and receiving Medicaid at the time of the infant's birth is automatically eligible for Medicaid through the infant's first birthday as long as the child continues to reside in Montana. It is estimated that 199 infants will receive child-newborn coverage due to the increased income limit for pregnant women. The total increase in expenditures for both pregnant women and newborn infants will be approximately $1,222,000 in federal funds per year and approximately $550,000 in state funds per year. The state share is funded through state special revenue.
5. The department intends the proposed rule amendments to be effective January 1, 2010.
6. Concerned persons may submit their data, views, or arguments either orally or in writing at the hearing. Written data, views, or arguments may also be submitted to: Rhonda Lesofski, Department of Public Health and Human Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana, 59604-4210; fax (406) 444-9744; or e-mail firstname.lastname@example.org, and must be received no later than 5:00 p.m., December 11, 2009.
7. The Office of Legal Affairs, Department of Public Health and Human Services, has been designated to preside over and conduct this hearing.
8. The department maintains a list of interested persons who wish to receive notices of rulemaking actions proposed by this agency. Persons who wish to have their name added to the list shall make a written request that includes the name, e-mail, and mailing address of the person to receive notices and specifies for which program the person wishes to receive notices. Notices will be sent by e-mail unless a mailing preference is noted in the request. Such written request may be mailed or delivered to the contact person in 6 above or may be made by completing a request form at any rules hearing held by the department.
9. An electronic copy of this Proposal Notice is available through the Secretary of State's web site at http://sos.mt.gov/ARM/Register. The Secretary of State strives to make the electronic copy of the Notice conform to the official version of the Notice, as printed in the Montana Administrative Register, but advises all concerned persons that in the event of a discrepancy between the official printed text of the Notice and the electronic version of the Notice, only the official printed text will be considered. In addition, although the Secretary of State works to keep its web site accessible at all times, concerned persons should be aware that the web site may be unavailable during some periods, due to system maintenance or technical problems.
10. The bill sponsor contact requirements of 2-4-302, MCA, apply and have been fulfilled. The primary bill sponsor was contacted by letter on October 27, 2009, sent postage prepaid via USPS, and by telephone and e-mail on October 27, 2009.
/s/ Barbara Hoffmann /s/ Anna Whiting Sorrell
Rule Reviewer Anna Whiting Sorrell, Director
Public Health and Human Services
Certified to the Secretary of State November 2, 2009.