GIS 15 MA/03: 2015 Federal Poverty Levels - Mass Re-budgeting Phase 2

To: Local District Commissioners, Medicaid Directors

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

Subject: 2015 Federal Poverty Levels - Mass Re-budgeting Phase 2

Effective Date: January 1, 2015

Contact Person: Local District Support Unit - Upstate (518) 474-8887, New York City (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, 2015, and are the actual poverty levels published in the Federal Register on January 22, 2015.

The new FPLs are effective for cases with a budget "From" date of January 1, 2015 or later. The revised figures will be available on MBL March 16, 2015. For all new and pending applications, income must be compared to the 2015 FPLs. The 2015 FPLs will be applied to upstate budgets for existing cases per the bullets below.

  • Budget types 01 and 04 - 10 with a "From" date of April 1, 2015 or earlier that utilize FPL levels will be mass re-budgeted. These budgets will be overlaid with a budget "From" date of April 1, 2015 and a budget store date of March 14, 2015.
  • 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 December 12, 2014 will include the 2015 COLA increase.
  • Cases with a budget "From" date of April 1, 2015 or earlier, and a budget store date of December 12, 2014 or greater, will be recalculated, but no COLA will be applied.
  • Cases with a Budget Type 04 that have Office equal to "MSP" or "QI1", Unit as "Recert" and Worker ID of "NYDOH," will have a COLA applied to the case regardless of the store date (these are cases that administratively renewed).

Districts should review cases with a budget store date of December 12, 2014 or greater and recalculate the budget using the 2015 Social Security income amount.

If a district determines that a previously budgeted case with a "From" date of December 12, 2014 or greater, has been negatively affected due to use of 2014 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 March 21, 2015.

As a result of the increase in the FPLs, the amount used in the Family Member Allowance (FMA) formula increased to $1,992. The maximum monthly FMA increased to $664. All spousal impoverishment cases involving a family member entitled to the family member allowance, which were active on or after January 1, 2015, and which were budgeted using the 2014 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, 2015, 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.