GIS 11 MA/030: Mass Re-Budgeting Changes and the Auto-Renewal Processs

To: Local District Commissioners, Medicaid Directors

From: Judith Arnold, Director - Division of Coverage and Enrollment

Subject: OSC Audit – Reminder of Correct Procedures for NAMI Adjustments

Effective Date: Immediately

Contact Person: Local District Support Unit - Upstate (518)474-8887, NYC (212)417-4500

The purpose of this General Information System (GIS) message is to provide local departments of social services (LDSS) with information regarding the Mass Re-Budgeting (MRB) changes that affect the Automated Renewal Process (see 11 OHIP/ADM-09) that will begin in 2012.

Upstate Districts

After mass re-budgeting, if worker action is required on a case, the case must be excluded from automated renewal until the worker completes the necessary transaction. In order to exclude these cases from automated renewal, a new indicator field, Auto Renewal Indicator (ARI), has been created on screen 1 in WMS that is automatically filled at MRB with the system-generated code 1-Case Excluded from Automated Renewal. Cases with this code are excluded from auto-renewal until the worker action is completed and code 1 is removed by the system. This will occur when a worker enters a subsequent 06 (renewal), 07 or 08 (closing) transaction. System edits will prevent a worker from entering a 1 in this WMS field.

The new WMS ARI code of 1-Case Excluded from Automated Renewal is system-generated at MRB for cases: that are exceptioned from MRB; that change from no excess income to excess income; that have a decrease in the excess income amount; or that have a change in categorical eligibility for the Medicare Savings Program (MSP), e.g., a change from Qualified Medicare Beneficiary (QMB) to Specified Low Income Medicare Beneficiary (SLIMB). For these cases, local districts will follow current MRB procedures for advising recipients of any changes to the case. Cases excluded from automated renewal will follow the current mail renewal process until the ARI code 1 is systematically removed from the case.

Cases that have an increase in the excess income amount after MRB are not excluded from the Automated Renewal Process with a system-generated ARI code 1 and require immediate worker intervention. Currently, spenddown cases are not included in the Automated Renewal Process; however, in 2012, Phase III (Automated Renewal of Spenddown Cases) will take place. To prepare the case for Automated Renewal, it is essential that districts send a notice as soon as possible for any case that has been mass re-budgeted and the budget shows an increase in the excess income amount.

New York City

There will be no significant changes in NYC 2011 MRB except as listed below.

MABEL will generate a fourth pending budget "only" when there are three existing Pending Budgets. It will be system-generated, and the worker will have the ability to move this fourth stored pending budget to current.

MSP QI1 cases with excess income after the 2011 MRB will be processed for closing using a new system generated closing code 567 – Disc-Excess Income Due to COLA for QI1 Individuals.

The information in this GIS message pertains only to changes in the MRB process that affect auto-renewal cases.