No. 40998 (Amendment): Section R414-304-5. MAGI-Based Coverage Groups

(Amendment)

DAR File No.: 40998
Filed: 11/15/2016 08:35:31 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

Based on guidance from the Centers for Medicare and Medicaid Services (CMS), this change clarifies how the Department will treat spouses who separate but file a joint tax return when the Department determines eligibility for the Medicaid program.

Summary of the rule or change:

In accordance with the option that CMS granted the Department concerning Medicaid eligibility, this amendment clarifies that spouses who separate will be treated as separate households. It also makes other technical changes.

Statutory or constitutional authorization for this rule:

• Section 26-1-5
• Pub. L. No. 111-148
• Section 26-18-3

This rule or change incorporates by reference the following material:

• Updates 42 CFR 435.603 , published by Government Printing Office, 10/01/2015

Anticipated cost or savings to:

the state budget:

There is no data to indicate whether there are costs or savings to the state budget. Both options to treat spouses who separate as either a single household or a separate household, may affect household size and countable income depending on individual circumstance.

local governments:

There is no impact to local governments because they neither fund nor make eligibility determinations for the Medicaid program.

small businesses:

There is no data to determine how eligibility outcomes will affect costs or revenue to small businesses, and there are no costs associated with new business requirements.

persons other than small businesses, businesses, or local governmental entities:

There is no data to determine how eligibility outcomes will affect costs or revenue to Medicaid providers. Depending on individual circumstance, household members may see either a positive or negative effect on benefits.

Compliance costs for affected persons:

There is no data to determine how eligibility outcomes will affect costs or revenue to a single Medicaid provider. Depending on individual circumstance, a household member may see either a positive or negative effect on benefits.

Comments by the department head on the fiscal impact the rule may have on businesses:

There is no available data to determine if there is any fiscal impact, either positive or negative, on business at this time.

Joseph K. Miner, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Office of Administrative Rules, or at:

Health
Health Care Financing, Coverage and Reimbursement Policy
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at [e-mail]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

01/03/2017

This rule may become effective on:

01/10/2017

Authorized by:

Joseph Miner, Executive Director

RULE TEXT

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

R414-304. Income and Budgeting.

R414-304-5. MAGI-Based Coverage Groups.

(1) The Department adopts and incorporates by reference 42 CFR 435.603[,] (October 1, 201[2]5)[ed.], which applies to the methodology of determining household composition and income using the Modified Adjusted Gross Income (MAGI)-based methodology.

(a) The eligibility agency shall count in the household size, the number of unborn children that a pregnant household member expects to deliver.

(b) The [eligibility agency]Department elects the option in 42 CFR 435.603(f)(3)(iv)(B).

(c) The eligibility agency will treat separated spouses, who are not living together, as separate households.

(2) The eligibility agency may not count as income any payments from sources that federal law specifically prohibits from being counted as income to determine eligibility for federally-funded programs.

(3) The eligibility agency may not count as income any payments that an individual receives pursuant to the Individual Indian Money Account Litigation Settlement under the Claims Resettlement Act of 2010, Pub. L. No. 111 291, 124 Stat. 3064.

(4) The eligibility agency shall count as income cash support received by an individual when:

(a) it is received from the tax filer who claims a tax exemption for the individual;

(b) the individual is not a spouse or child of the tax filer; and

(c) the cash support exceeds a nominal amount set by the Department.

(5) To determine eligibility for MAGI-based coverage groups, the eligibility agency deducts an amount equal to 5% of the federal poverty guideline for the applicable household size from the MAGI-based household income determined for the individual. This deduction is allowed only to determine eligibility for the eligibility group with the highest income standard for which the individual may qualify.

 

KEY: financial disclosures, income, budgeting

Date of Enactment or Last Substantive Amendment: [July 1, 2016]2017

Notice of Continuation: January 23, 2013

Authorizing, and Implemented or Interpreted Law: 26-18-3

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