GIS 14 MA/08:2014 Federal Poverty Levels

To: Local District Commissioners, Medicaid Directors

From: Judith Arnold, Director - Director, Division of Eligibility and Marketplace Integration

Subject:2014 Federal Poverty Levels

Effective Date: January 1, 2014

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 inform local departments of social services (LDSS) of the revised federal poverty levels (FPLs). The revised FPLs are effective January 1, 2014, and are the actual poverty levels published in the Federal Register on January 22, 2014.

The new FPLs are effective for cases with a budget "From" date of January 1, 2014 or later. The revised figures will be available on MBL March 16, 2014. For all new and pending applications, income must be compared to the revised FPLs. Budgets with a "From" date of 2013 or earlier that utilize an FPL will be mass re-budgeted and overlaid with a budget "From" date of April 1, 2014. Upstate budgets types 04 - 10 will be mass re-budgeted and stored on March 16, 2014. Budget types 07 - 10 with a Medicare Savings Program (MSP) indicator will be recalculated without a Cost of Living Adjustment (COLA) increase, because the COLA was applied during Mass Re-budgeting (MRB) Phase One. Cases with a budget store date prior to November 28, 2013 will include the 2014 COLA increase. Cases with a budget "From" date less than or equal to April 1, 2014 and a budget store date of November 28, 2013 or greater will be recalculated, but no COLA will be applied.

Districts should review cases with a budget store date of November 28, 2013 or greater and recalculate the budget using the 2014 Social Security income amount.

If a district determines that a previously budgeted case with a "From" date of November 28, 2013 or greater, has been negatively affected due to use of 2013 FPL, or a case is brought to the district's attention, the case should be re-budgeted using the revised FPLs. If eligible, covered medical expenses paid by an individual as a result of an improper calculation must be reimbursed pursuant to 10 OHIP/ADM-9, "Reimbursement of Paid Medical Expenses Under 18 NYCRR §360-7.5(a)."

New York City MRB, Phase Two will occur April 12, 2014.

As a result of the increase in the FPLs, the amount used in the Family Member Allowance (FMA) formula increased to $1,967. The maximum monthly FMA increased to $656. All spousal impoverishment cases involving a family member entitled to the family member allowance, which were active on or after January 1, 2014, and which were budgeted using the 2013 family member allowance, must be re-budgeted using the new family member allowance. In addition, the increased family member allowance must be used effective January 1, 2014, in determining any requested contribution of income from a community spouse or from a spouse living apart from an SSI-related applicant/recipient. Budget adjustments should be made at next contact or renewal.

A chart with the new FPLs is attached to this GIS.

Due to expansion of the Medicaid program related to the Affordable Care Act (ACA), a chart with the new FPL's relating to the Modified Adjusted Gross Income (MAGI) population is also attached. Please see the previously issued GIS, "2014 Medicaid Only Income and Resource Levels," for other pertinent eligibility determination information.