Questions and Answers from the BadgerCare Plus Phase II Trainings

Transcription

1 Questions and Answers from the BadgerCare Plus Phase II Trainings Significant changes to the BadgerCare Plus (BC+) program, resulting from ACA and changes in state law will be implemented starting January 1, From July through September, the BEPS Training Section conducted face-to-face trainings on these changes for the experienced Income Maintenance workers across the state. The staff conducting the trainings documented questions asked by the workers during the trainings. Those questions and answers are compiled below. This document is being distributed to the IM Consortia Leads and the CARES and Policy Coordinators in the Income Maintenance (IM) Agencies. Tax filing status and tax dependency 1. Q: Will CARES be programmed to ignore a person coded as a tax dependent or co-filer living outside the home (OTX) or a deceased tax dependent (DTX) for FoodShare? A: Tax dependents or co-filers living outside the home and deceased tax dependents will not be counted for any programs of assistance other than BC+. They will not be included for FoodShare, Child Care, Caretaker Supplement, W-2 or any of the Elderly, Blind, or Disabled or Long Term Care Medicaid programs. 2. Q: Will we have a data exchange to verify people's tax filing status? Can we use last year s tax forms to verify the tax filing status? A: No. Because the applicant or member is stating what their tax filing intention is for the income earned in the year you are asking the question and the taxes will not be filed until sometime between January and April 15 th of the next year, there would be no method to verify the person s intent. 3. Q: What do we do if someone does not file taxes? A: Relationship rules will be used. 4. Q: How do we process cases when divorced parents alternate years for claiming the child? A: If both parents are filing taxes, the child will be counted in a given parent s group only for the year he or she is claiming the child. The worker will have to indicate on the Tax Filing Details page in CARES Worker Web (CWW) that the child is only being claimed for that specific tax year. 5. Q: Could a group include a 22-year-old child living with his parents and being claimed as a tax dependent? Would he have to apply separately? A: Yes, if the parents are claiming the 22 year old as a tax dependent, he would be included in the parents assistance groups. Because he is 19 or older, he would have to apply separately if he was requesting BadgerCare Plus for himself. 6. Q: Is it an overpayment if someone's tax status changes? A: No, because we're looking at expected tax status for the income from the current year but the person will not file those taxes until the next year. Their tax status could change by the time they file their taxes. DHS/DHCAA/BEPS Training 1 November 2013

2 7. Q: Can someone be included as a tax dependent even if they live out of state? A: Yes. You could also have a tax dependent who is a resident of Mexico or Canada. 8. Q: Will we prospectively include fetuses as tax dependents before they are born? A: A child has to be born in order to be a tax dependent, but we will increase the group size to reflect the fetus count while the woman is pregnant. You would not prospectively include unborn children as tax dependents. Once the child is born you would add him or her as a tax dependent if the parent states he or she will claim the child as a tax dependent. Individuals are required to report if they have a change in tax status. 9. Q: How do we handle a situation where spouses are living apart, both applying and one spouse says they are filing jointly and the other one says they are filing separately? A: Workers should attempt to gather information from both spouses that is consistent. However, if they insist that they are both answering correctly use the statement from each one. 10. Q: When will we update a case with a child or tax dependent on an application submitted toward the end of the year, who reports that they will not be above the expected to be required to file threshold for that year, but continues the job in the next year? A: At the next renewal. If a worker sees via the State Wage Information Collection Agency (SWICA) match or other data source that someone has already exceeded the threshold for that year, the worker should question the no response and issue a verification request. If the child s tax dependency changes from one parent to the other, the questions regarding the expectation to be required to file taxes should be asked at the time the child tax dependency changes. 11. Q: If someone applies in 2013 and we are gathering the tax filing and dependency information, we will be asking about tax filing and dependency information for 2013 income but testing for eligibility in Is that correct? A: That is correct. However, people are required to report if they have a change in tax status. 12. Q: What if we determine someone is ineligible based on the tax filing information they reported and they call to change their expected tax filing status or tax dependency information? A: We must go with what they tell us unless we have information that contradicts what they tell us they re going to do. 13. Q: For ongoing tax deductions, when a change in the deduction amount is reported but not verified, do we use the old information or no longer allow the deduction? A: If they do not verify the reported change they do not get the deduction. The Questionable not Verified or QV code should be entered in the verification field. 14. Q: If someone is only filing homestead are they considered a tax filer? A: No. This person would not be considered a tax filer. When we say filing taxes we mean filing a federal tax return. DHS/DHCAA/BEPS Training 2 November 2013

3 15. Q: Can a baby that is stillborn be claimed as a tax dependent? A: If a baby was truly a stillborn he or she cannot be claimed as a tax dependent. But if baby was alive, even only if a few minutes, then IRS rules will allow the parents to claim the baby as a tax dependent for that year. 16. Q: Are we going to use the self-employment threshold for expected to be required to file taxes when looking at whether or not we count the income of a tax dependent or child? A: We have received policy clarification since the start of the Phase II trainings and found the $400 self-employment threshold should not be used when determining whether or not the tax dependent or child will be expected to be required to file taxes. We will only use the earned income and unearned income thresholds. The self-employment threshold questions were added to CWW before we received this clarification so the fields will have to be filled out. CARES will not use the information entered for the self-employment threshold. The best practice for workers would be to enter a No on these fields. Income and Deductions 17. Q: Are members going to be notified that we may be counting certain income for children based on whether they are expected to be required to file taxes? A: Yes, applicants and members will continue to receive program information through the Enrollment and Benefits Handbook (E & B). An updated E & B will be sent at the next renewal. 18. Q: Do we have to verify the income of a child who is working but is under the expected to be required to file thresholds? A: No. CARES will know when eligibility is run whether or not the income is counted. If the income is not counted, CARES will not pend for verification of that income. 19. Q: Does maintenance, alimony and spousal support mean the same? A: Yes they mean the same thing and all are counted as income and can be used as a tax deduction. 20. Q: Is family support considered counted unearned income? A: Yes. Even though child support is not counted; alimony, maintenance and spousal support are counted. If the family support includes payment to the ex-spouse, the portion of the family support designated as spousal support would be counted. 21. Q: Are wage and State Wage Information Collection Agency (SWICA) matches in CARES Worker Web (CWW) going to be updated so Income Maintenance (IM) workers can see the earned income for children under 18 years of age? A: We plan to update the SWICA matches later in DHS/DHCAA/BEPS Training 3 November 2013

4 22. Q: When determining whether a child or tax dependent will be expected to be required to file, do we count Social Security income (other than Supplemental Security Income)? A: No. We are only counting taxable income when determining whether a child or tax dependent will be required to file. Even though Social Security income is countable income for the eligibility determination, it is only taxable at high income levels so it will not be used to determine if the child is expected to be required to file taxes. 23. Q: How will we know how much of the pension or retirement payment is taxable? A: This should be on the pension or retirement statement, but if the person cannot verify it, then the gross amount will be counted. 24. Q: Are tax refunds considered Lump Sums? A: No, tax refunds are not considered countable income for BadgerCare Plus. 25. Q: Is there a threshold for counting interest and dividend income? A: No, all interest or dividend income should be reported. 26. Q: How will we look at back pay from Social Security? A: It will be counted as a lump sum. 27. Q: Is educational aid prorated across the semester? A: Yes, the countable educational assistance as well as the expenses are prorated over the semester. The begin date and end date of the semester should be entered on the Educational Aid page in CARES Worker Web (CWW). 28. Q: Are student loans counted? A: No they are not taxable so they are not counted. There will be a complete list of countable and non-countable types of educational aid in the BadgerCare Plus Handbook. 29. Q: Is work study counted? A: Yes. Work study is counted as earned income. 30. Q: If you have an SSI person who is working, (currently a test individual), do you count that income? A: We will disregard the SSI income but other income received by the SSI recipient would not be automatically disregarded. 31. Q: Some Tribal per Capita payments are tax exempt. Are we now going to count them? A: Tribal per Capita payments from gaming revenues are counted. The BadgerCare Plus Handbook lists the disregarded payments to Native Americans. 32. Q: We use the last year s tax return to verify the income for a self-employed individual, so can we use last year s tax return to verify tax deductions for BadgerCare Plus? A: No, the tax deductions that you will be using are for the current year and would need to be verified with current documentation. 33. Q: What are some examples of taxable unearned income for minors? A: Payments from trust funds, annuities, or interest income. DHS/DHCAA/BEPS Training 4 November 2013

5 34. Q: We have a Specified Low-Income Medicare Beneficiary (SLMB) case with a man eligible for SLMB because we are deducting the $50.00 for his child support obligation. We will no longer allow this deduction with the Modified Adjusted Gross Income (MAGI) rules. Will the child support income and expense rules change with the MAGI implementation? A: Rules for counting income and expenses for Elderly, Blind or Disabled (EBD) Medicaid cases (including Long Term Care (LTC) cases) are not changing with the MAGI implementation. Child support income will continue to be counted for these eligibility determinations and we will continue to allow child support obligations as an expense. 35. Q: What is the relationship between current monthly income and annual income threshold? A: The current monthly income can be used to help answer the expected to be required to file questions, but these annual income threshold questions will be asked separately of all tax dependents. There are going to be situations in which the current monthly income is not a good predictor of annual income. Extensions 36. Q: If a parent declines an extension, what happens with the kids? A: If the kids are still eligible for BadgerCare Plus, then they would stay eligible under regular BadgerCare Plus, but they won t get put into an extension if the parent quits or declines prior to the start of the extension. 37. Q: What about situations in which parents are both in the Adults in Extension who Owe a Premium (MAGM) assistance group? Could they have premiums that are more than 9.5% of their income? A: If they are married and not filing taxes or married filing jointly, we will determine a single premium amount. In those situations, premiums would never exceed 9.5% of the joint income. If they are Married Filing Separately or Non-Marital Co-Parents, then we look at their financial eligibility separately and their income and premium amounts would be treated separately. 38. Q: Will we keep someone in an extension even past March 31, 2014? A: Yes; we will honor existing extensions, assuming the person remains non-financially eligible, into If someone goes into an extension starting in December 2013, it could last all the way to the end of November If there is another individual eligible for a BCP AG with an earlier renewal date, the members in the extension will transition to MAGI rules at the earlier renewal date. 39. Q: Is there a limit to the number of times someone can go into an extension? A: There is no limit for the number of times a person can be eligible for an extension. However, a child cannot start a new extension while he or she is in an existing extension. 40. Q: When a member is in an extension are we required to verify their income? A: A member in an extension will only be required to verify his or her income if a premium is required. This is so the premium calculation is completed using verified income. DHS/DHCAA/BEPS Training 5 November 2013

6 41. Q: If you are doing a late renewal and go back to the 1 st month and in the 3 rd month in the late renewal the income increases, would they get an extension? A: If the adults meet the criteria for an extension (eligible for 3 of the past 6 months with income at or below 100% of the FPL) they would be eligible for an extension. Pregnancy Verification 42. Q: Is pregnancy verification no longer required? A: According to the federal rules, pregnancy, due date and number of fetuses are no longer required to be verified for BadgerCare Plus and/or Medicaid. 43. Q: What do we do if someone calls and says she took an at-home pregnancy test? A: We must accept the self-declared pregnancy. 44. Q: If a minor is pregnant, is she considered a child or pregnant woman? A: Pregnant woman. 45. Q: Will we be able to backdate eligibility for the BadgerCare Plus Prenatal Program now that we do not have to wait for verification? A: We will not be able to backdate eligibility for the BadgerCare Plus Prenatal Program, but we will be able to start the benefits the first day of the month of application. 46. Q: How many times can someone report a pregnancy and subsequent miscarriage? A: This depends on the situation; in general, the information should be accepted unless you have information that contradicts what the person is saying. 47. Q: If a pregnant woman has a baby that is stillborn, when exactly does her group size drop? A: She will remain eligible for 60 days after the child is born. Keep in mind that while she is eligible as a pregnant woman, including the 60 day extensions, group size does not matter because her eligibility is frozen through the extension period. Her assistance group size will drop once she is tested as a parent or caretaker. The assistance groups of any other individuals that the pregnant woman is included in as a counted individual will change in the month after the birth is reported, allowing for Adverse Action Notice. Restrictive Re-enrollment 48. Q: If a child remains ineligible for the 3 month restricted re-enrollment period (RRP) and the arrears are forgiven, can the child be eligible for backdated months at application? A: To become eligible in the 3 months of the RRP, the request has to be made during those 3 months and all premiums owed would have to be paid. If the re-request is made after the 3 month RRP, the child cannot be made eligible for any of those months. DHS/DHCAA/BEPS Training 6 November 2013

7 49. Q: What happens if someone reports a change in income that occurred during the RRP? Would we adjust the premium retroactively? A: Yes. Changes that are verified and result in a decrease in the premium amount are to be acted on for the months the change occurred. 50. Q: If an adult is in a RRP and their income goes under 100% will they stay in the RRP? A: They are still in the RRP however, since they are now under the 100% of the Federal Poverty Level (FPL) they would be eligible for BadgerCare Plus. Should their income again increase over 100% of the FPL while they are in the RRP, they would not be eligible for an extension. Renewals 51. Q: Is the 90 day renewal period for all Medicaid? A: This is only for renewals for BadgerCare Plus cases under Modified Adjusted Gross Income (MAGI) methodology. 52. Q: When doing a late renewal are we looking at all income in the past months just like we do now for a back date? A: Income for all past months must be reported and verified when processing a late renewal. 53. Q: When we are processing those late renewals, what date do we use? A: The first day of the month after the renewal was due. Transition to MAGI Rules 54. Q: Will BadgerCare Plus members eligible under the BadgerCare Plus Core Plan (BCLA) transition before their next review in 2014? A: No, but any Core Plan members that have a review in January or February will have their eligibility determined using MAGI methodology. We will not wait until March 31 to convert them to MAGI rules. All Core Plan members who have income at or below 100% of the Federal Poverty Level will transition to the BadgerCare Plus Standard Plan starting January 1 st, even though they will still eligible under the BCLA assistance group. 55. Q: When are the mass changes related to these updates scheduled? A: On November 23 rd, all BadgerCare Plus cases will run through a batch run to apply the new income limits. The only other mass change related to the BadgerCare Plus 2014 changes will be on February 22, 2014 to transition cases with non-blca and non-family Planning Only Services (FPOS) assistance groups that completed a review in January or February to MAGI rules. 56. Q: If an application filed December 31, 2013 or earlier is not processed until January 2014, will the members be considered ongoing beneficiaries under BC+ old rules for January? A: Yes. We will test them for December eligibility under old rules, and assuming they are eligible in December and continue to meet the income limits in January, we will keep them on as an ongoing beneficiary. DHS/DHCAA/BEPS Training 7 November 2013

8 57. Q: Can members request an early BadgerCare Plus renewal to sync up with their FS renewal? A: Yes. However, once the family has requested an early renewal in 2014 they will be transitioned to MAGI rules and will not be able to be tested under the old rules again. 58. Q: What will happen to the case if a member loses eligibility on old BadgerCare Plus rules, but would have qualified under MAGI rules due to depreciation from self-employment? A: If the depreciation is entered in CARES, CARES will allow the deduction when the case is run through the mass change on November 23, If the depreciation is not entered in CARES and the case closes, the worker should update the depreciation amount and rerun eligibility once he or she becomes aware of the closure. If the member applies through the Marketplace, depreciation will be allowed as an expense and the application would be sent back to Wisconsin for enrollment. 59. Q: What if it would benefit the member to qualify for BadgerCare Plus using MAGI rules rather than old BadgerCare PLus rules? A: The member may request an early renewal. CARES will also automatically test under MAGI rules if the member reports a change that would make him or her ineligible under the old rules. Other 60. Q: Are there any changes in the temporary absence policy for BadgerCare Plus? A: No, the temporary absence policy is not changing. 61. Q: How will MAGI impact a child enrolled in Children s Waivers? A: If the child is eligible for Group A Waiver due to his or her eligibility for BadgerCare Plus and the child loses BadgerCare Plus eligibility under MAGI rules, the child would have to be tested as a Group B Waiver participant. The cost share calculation under Group B would be based on EBD/LTC budgeting rules. 62. Q: Because child support will no longer be counted as an income or expense for BadgerCare Plus under MAGI rules, is there still a requirement to cooperate with Child Support? A: There is no change to the policy related to cooperation with Child Support. 63. Q: What is the difference between MAGI relationship rules and tax rules? A: MAGI refers to a method of counting income and forming Assistance Groups (AGs). Tax rules and relationship rules are both subsets of MAGI rules. Tax rules refers to a determination of who is included in an AG based on who is planning to file taxes and who is expected to be claimed as a tax dependent. Relationship rules refer to the method we use to determine who is in an AG when we don t apply the tax rules for example, when someone is not filing taxes or if a tax dependent does not meet the rules to have tax rules applied to them. These relationship rules are similar to but not exactly the same as the relationship-based rules currently used to form BC+ groups. Once transitioned to MAGI rules, all BC+ applicants and members will be tested using either tax or relationship rules. DHS/DHCAA/BEPS Training 8 November 2013

9 64. Q: If a child is not included in a parent's assistance group, will the child have to apply separately? A: No. The rules regarding who can be made eligible on the same case have not changed. A child under 19 will still have his or her eligibility determined on the same case as his or her parents or caretaker relative as long as they reside with that parent or caretaker at least 40% of the time. 65. Q: Will relevance logic be updated? A: Yes. CARES logic will be updated to include tax dependents and co-filers living outside the household as relevant to the BadgerCare Plus request. 66. Q: What is the process for completing an application for someone who is separated from their spouse? How are we supposed to get information from the spouse? A: We only need information from separated spouses if they are married filing jointly and workers should get the best information they can about the spouse and their income. 67. Q: Will the notices show different premium amounts for different kids? A: No, the premium amount will be rolled up to a household premium amount. 68. Q: When you have a child or pregnant woman with income over 300% of the FPL should the worker try to determine if the person would be better off with a deductible or by applying for private coverage through the Marketplace? A: The parents of the child would have to make that determination. Workers should provide the parent with the information on the amount of the deductible, how to meet a deductible, etc. and let the parents make the choice of BadgerCare Plus or Marketplace. The same would be true for a pregnant woman. She would have the option to meet the deductible and have coverage through the pregnancy extension but may then have to purchase insurance through the Marketplace. 69. Q: When do we send the application to the Federally-facilitated Marketplace (FFM)? A: Effective January 1, 2014 most accounts will be automatically transferred to the FFM at denial or termination of BadgerCare Plus. Not all accounts will be automatically transferred. Those that are not automatically transferred will have notice language telling them they can apply at the Marketplace. More information on account transfers will be available in a future Ops Memo. 70. Q: Are we still going to see all the old categories? A: Yes, you will continue to see the BadgerCare Plus (BCP) categories through 2014 as current eligible assistance groups. After 2014 you will be able to view the eligibility under the BadgerCare Plus categories in history. 71. Q: If someone is denied because they are not cooperating with child support and are under an IV-D sanction will the Marketplace kick them back to us when they are under the 100%? A: If their income is at or below 100% of the FPL, the account will be transferred back to Wisconsin for enrollment. However, they will remain ineligible if they continue to refuse to cooperate and do not have good cause. DHS/DHCAA/BEPS Training 9 November 2013

10 72. Q: In the Marketplace will there be an option where a person can choose not to have their case sent to an agency because they do not want BadgerCare Plus? A: A person can choose to just purchase insurance through the Marketplace but if they could be eligible for BadgerCare Plus and choose not to apply, then they would not be eligible for the premium tax credits. 73. Q: We do not cover military members who have health insurance when they are out of the home but they will be listed in the case to increase the group size. What happens if the whole family is covered under the TRICARE insurance through the military? Is this considered having health insurance? A: No, TRICARE would not be considered employer sponsored insurance so this would not affect the family s eligibility for BadgerCare Plus. 74. Q: Will the Marketplace look at enrolled members differently? Such as Tribal enrolled vs. descendants of enrolled tribal Members? A: It appears the Marketplace is only asking whether someone is an enrolled tribal member. However, for BadgerCare Plus, we will continue to exempt persons from having to pay premiums if they are tribal members, children of tribal members, grandchildren of tribal members or persons eligible to receive services at Indian Health Services facilities. 75. Q: Is verification going to change regarding tribal enrollment? A: There will be no change. 76. Q: How are tribal agencies going to receive Marketplace applications? A: Applications sent to Wisconsin from the Marketplace will be sent to the county of residence. The IM consortium will be responsible for transferring the application to the tribal agency. 77. Q: Is the policy for child welfare parents (CWP) going to remain the same? A: The policy will be very similar to what it is now. We will continue to treat the parents as parents/caretakers and not as childless adults even if that child is the only child listed on their case. In most cases we expect the assistance group size for the parents to remain the same as today. However, under MAGI tax rules, if the parents are filing taxes and if the child is not being claimed as a tax dependent by his or her parents, the child will not be included in the parents group size. 78. Q: Is a married couple applying for FPOS going to have to apply separately? A: No, they should apply together and have their eligibility determined on one case but will be separate assistance groups. This is also true for families in which parents and children are applying for FPOS. 79. Q: Can a member be eligible for BC+ and Qualified Medicare Beneficiary (QMB) or Specified Low-Income Medicare Beneficiary (SLMB)? A: Yes for parent/caretakers, children and pregnant women but childless adults (MAGS assistance groups) cannot be eligible for BadgerCare Plus once he or she is eligible for Medicare. DHS/DHCAA/BEPS Training 10 November 2013

11 80. Q: We heard that people will not be eligible for advanced tax credits at 100%, but would be eligible for the advanced tax credits with income between 133% and 400%. What will happen to the people between 100% and 133%? A: People are eligible for Advanced Premium Tax Credit (APTC) if their income is between 100% and 400% FPL. 81. Q: Are there any notices going out for those Former Foster Care Youth (FFCY) who are over 21 now and closed but are under age 26 to let them know they could be eligible as of ? A: Notices will not be sent to FFCY that turned 21 in the past but would still be eligible as a Former Foster Care Youth with this change in the age limit. If a FFCY reapplies after January 1, 2014 workers would not have to re-verify that the youth was in out of home care at the time he or she turned Q: Will CARES show different budgets for different people on a case? A: Yes. Budget Pages in CWW will display for each assistance group built during the eligibility determination. 83. Q: Why would it matter if the 18 year old in the home is a dependent 18 year old? The parent could still be eligible as a childless adult. Is there a benefit to being tested as a parent/caretaker instead of as a childless adult? A: Childless Adults (MAGS) are not eligible for an extension if his or her income increases above 100% of the FPL. If the only child in the home is 18, the worker should request the information to determine if the child meets the dependent 18 year old criteria. If the information is not provided you would treat the child as if he or she were not a dependent 18 year old and test the adult for MAGS. DHS/DHCAA/BEPS Training 11 November 2013