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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsJanuary 2014

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Delaware Health and Social Services (“Department”) / Division of Medicaid and Medical Assistance (DMMA) initiated proceedings to amend the Division of Social Services Manual (DSSM) regarding the Modified Adjusted Gross Income (MAGI) provisions related to eligibility determinations for certain medical assistance programs (Medicaid and Children’s Health Insurance Program), specifically, Reasonable Classifications of Individuals under Age 21 and MAGI Household Composition. The Department’s proceedings to amend its regulations were initiated pursuant to 29 Delaware Code Section 10114 and its authority as prescribed by 31 Delaware Code Section 512.
The Department published its notice of proposed regulation changes pursuant to 29 Delaware Code Section 10115 in the November 2013 Delaware Register of Regulations, requiring written materials and suggestions from the public concerning the proposed regulations to be produced by November 30, 2013 at which time the Department would receive information, factual evidence and public comment to the said proposed changes to the regulations.
The purpose of this notice is to advise the public that the Division of Medicaid and Medical Assistance (DMMA) is proposing to amend rules in Division of Social Services Manual (DSSM) regarding the Modified Adjusted Gross Income (MAGI) provisions related to eligibility determinations for certain medical assistance programs (Medicaid and Children’s Health Insurance Program), specifically, Reasonable Classifications of Individuals under Age 21 and MAGI Household Composition. The Patient Protection and Affordable Care Act of 2010 mandates significant changes in how eligibility is determined for medical assistance programs for children, parent/caretaker relatives and pregnant women beginning January 1, 2014.
42 CFR 431 Subpart G, Section 1115 Demonstrations (Family Planning)
42 CFR 435.603, Application of modified adjusted gross income (MAGI)
42 CFR 435.912, Timely determination of eligibility
42 CFR 435.916, Periodic renewal of Medicaid eligibility
42 CFR 457.315, Application of modified adjusted gross income and household definition
The ACA includes many provisions related to eligibility determinations for both Medicaid and the Children’s Health Insurance Program (CHIP). To provide coordinated guidance on the eligibility determination process, the Centers for Medicare and Medicaid Services (CMS) published a final/interim final rule “Medicaid Program: Eligibility Changes under the Affordable Care Act of 2010” incorporating significant changes on March 23, 2012 at http://www.gpo.gov/fdsys/pkg/FR-2012-03-23/pdf/2012-6560.pdf. Additional guidance on the eligibility determination process was issued by CMS in a final rule “Medicaid and Children’s Health Insurance Programs: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment” on July 15, 2013 at http://www.gpo.gov/fdsys/pkg/FR-2013-07-15/pdf/2013-16271.pdf.
This rule, Timely Determination of Eligibility, is revised to clarify the time standards for a determination of eligibility when an application is submitted via the Federally Facilitated Marketplace (FFM). The timeliness standard begins on the date the application is transferred from the FFM to the agency.
This rule is renamed Annual Renewal of Eligibility with new content to describe the streamlined renewal process in accordance with the requirements under the Affordable Care Act. The agency will redetermine eligibility without requiring information from the individual if able to do so based on electronic data sources. When the agency cannot renew eligibility using electronic data sources, a pre-populated renewal form will be sent to the individual. If the individual loses eligibility for failure to respond to the renewal form, eligibility can be reconsidered without a new application if the individual responds within four months after the date of termination.
This rule, Verifications of Factors of Eligibility, is revised to clarify the post-enrollment verification process and time frames.
This rule, Foster Children Group, becomes obsolete and is deleted and repealed. Children in foster homes or private institutions will be eligible under 15300 Children Group effective January 1, 2014. This is required because financial eligibility under the optional Foster Children Group has a lower income limit than financial eligibility under the mandatory Children Group.
This rule, Foster Children Group General Eligibility Requirements, becomes obsolete and is deleted and repealed. Children in foster homes or private institutions will be eligible under 15300 Children Group.
This rule, Technical Eligibility, becomes obsolete and is deleted and repealed. Children in foster homes or private institutions will be eligible under 15300 Children Group.
This rule, Financial Eligibility, becomes obsolete and is deleted and repealed. Children in foster homes or private institutions will be eligible under 15300 Children Group.
This rule, Effective Date of Coverage, becomes obsolete and is deleted and repealed. Children in foster homes or private institutions will be eligible under 15300 Children Group.
This rule, Infants Awaiting Adoption Group, becomes obsolete and is deleted and repealed. The infants will be eligible under 15300 Children Group effective January 1, 2014. This is required because financial eligibility under the optional Infants Awaiting Adoption Group has a lower income limit than financial eligibility under the mandatory Children Group.
This rule, Infants Awaiting Adoption Group General Eligibility Requirements, becomes obsolete and is deleted and repealed. The infants will be eligible under 15300 Children Group.
This rule, Technical Eligibility, becomes obsolete and is deleted and repealed. The infants will be eligible under 15300 Children Group.
This rule, Financial Eligibility, becomes obsolete and is deleted and repealed. The infants will be eligible under 15300 Children Group.
This rule, Effective Date of Coverage, becomes obsolete and is deleted and repealed. The infants will be eligible under 15300 Children Group.
This rule, Termination of Eligibility, becomes obsolete and is deleted and repealed. The infants will be eligible under 15300 Children Group.
This rule, Family Planning Group, becomes obsolete and is deleted and repealed. Women with household income that does not exceed 133% of the federal poverty level (FPL) will be eligible under 15400 Adult Group effective January 1, 2014, with full Medicaid benefits. Women with household income that exceeds 133% FPL will be terminated from Medicaid effective January 1, 2014, and referred to the Federally Facilitated Marketplace (FFM) to obtain health care coverage. Women will receive advance notice of termination from Medicaid that allows adequate time to obtain health care coverage via the FFM.
This rule, Family Planning Group General Eligibility Requirements, becomes obsolete and is deleted and repealed.
This rule, Technical Eligibility, becomes obsolete and is deleted and repealed.
This rule, Financial Eligibility, becomes obsolete and is deleted and repealed.
This rule, Benefits, becomes obsolete and is deleted and repealed.
This rule, Termination of Eligibility, becomes obsolete and is deleted and repealed.
This rule, Definitions, is revised to add a definition of spouse.
This rule, Rule for Married Couples, is revised to clarify when married couples are included in the modified adjusted gross income household together.
The proposed regulation imposes no increase in costs on the General Fund.
a. Ninety days (90) for applicants who apply for Medicaid on the basis of disability. This includes long term care and the Children’s Community Alternative Disability Program.
b. Forty-five (45) days for all other applicants.
The standards cover the period from the date of application with the agency or the date the application is submitted transferred via the Federally Facilitated Marketplace (FFM) to the date the agency notifies the applicant of its decision.
14100.6 Redetermination Of Eligibility Annual Renewal of Eligibility
Post-enrollment verification will be completed in accordance with the agency’s verification plan approved by the Centers for Medicare & Medicaid Services (CMS). Post-enrollment verification of income and Medicare will be completed within thirty (30) days of the date of enrollment. When additional information is needed to complete the eligibility determination, the agency will request such additional information from the individual. The individual will be provided thirty (30) days to respond to the request for additional information. If the additional information requested is not provided, eligibility will be terminated.
Child” means a natural or biological, adopted, or step-child.
Family size” means the number of persons counted as members of an individual’s household. When determining the family size of a pregnant woman, the pregnant woman is counted as herself plus the number of children she is expected to deliver. When determining the family size of other individuals who have a pregnant woman in their household, the pregnant woman is counted as herself plus the number of children she is expected to deliver.
Federal Poverty Level” means the Federal poverty level updated periodically in the Federal Register by the Secretary of the United States Department of Health and Human Services that is in effect for the budget period used to determine an individual’s eligibility in accordance with this section.
Household income” means the sum of the MAGI-based income of every individual included in the individual’s household.
Modified adjusted gross income (MAGI)” means the adjusted gross income reported on the Internal Revenue Service (IRS) Form 1040 with the addition of:
MAGI-based income” means income calculated using the same financial methodologies used to determine modified adjusted gross income as defined in section 36B(d)(2)(B) of the Internal Revenue Service Code, with the following exceptions:
Parent” means a natural or biological, adopted, or step-parent.
Sibling” means a natural or biological, adopted, half, or step-sibling.
Spouse” means a person who is legally married to another person regardless of their genders.
Tax dependent” means an individual for whom another individual claims a deduction for a personal exemption under section 151 of the Internal Revenue Service Code for a taxable year.
For married couples living together, each spouse will be included in the household of the other spouse regardless of whether they expect to file a joint tax return or whether one spouse expects to be claimed as a tax dependent by the other spouse.
For married couples, each spouse will be included in the household of the other spouse if they are living together or if they expect to file a joint tax return.
Last Updated: December 31 1969 19:00:00.
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