Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth Eligibility Operations Memo 06-01 March 1, 2006 TO: MassHealth Eligibility Operations Staff FROM: Russ Kulp, Director, MassHealth Operations RE: 2006 Social Security Benefit Cost-of-Living Adjustment (COLA) for Community and Long-Term-Care MassHealth Cases on PACES Introduction The following cost-of-living adjustments were effective January 1, 2006. * Retirement/Survivors/Disability Insurance (RSDI) benefits increased by 4.1%. See “Special Note” on page three of this memo. * The maximum monthly spousal maintenance needs allowance increased from $2,377.50 to $2,488.50. * The minimum amount of assets that can be kept by an institutionalized individual’s spouse increased from $19,020 to $19,908. * The maximum amount of assets that can be kept by an institutionalized individual's spouse increased from $95,100 to $99,540. * The basic Medicare Part B premium increased $78.20 to $88.50 per month. See “Special Note” on page three of this memo. * The Medicare Part B premium surcharges increased. The updated surcharge table is attached to this memo. See “Special Note” on page three of this memo. PACES has been updated to reflect these amounts. Federal Poverty Level-Related Issues and PACES Actions Federal law mandates that the following groups of people will not lose their eligibility for MassHealth as a result of a cost-of-living adjustment: elderly or disabled MassHealth members whose income is less than or equal to 100% of the federal poverty level (FPL); MassHealth Senior Buy-In members whose income is less than or equal to 100% of the FPL; (continued on next page) Eligibility Operations Memo 06-01 March 1, 2006 Page 2 MassHealth Buy-In for Specified Low Income Medicare beneficiaries (SLMB) in long-term care whose income is greater than 100% but less than 120% of the FPL; and MassHealth Buy-In for SLMB/Qualifying Individuals in the community whose income is less than 135% of the FPL. PACES Actions To protect the eligibility of the above four groups until new FPL guidelines are issued in April of 2006, PACES has been temporarily updated with the following estimated federal poverty level guidelines. 100% FPL 120% FPL 135% FPL One person $831 $997 $1,121 Two persons $1,114 $1,336 $1,503 PACES also has been temporarily updated with the estimated 133% FPL guidelines for calculating the Hermanson personal-care attendant (PCA) unearned income disregards. PACES will be updated with the actual amounts as soon as the new FPL guidelines are issued. Reminder: The home maintenance needs allowance (HMNA) remains at $798 until the April 2006 FPL change is implemented. BENDEX/PACES Updates Effective in January, RSDI income amounts were updated using the amounts shown on the BENDEX file, unless the RSDI income on PACES exceeded these amounts. When the RSDI income shown on PACES is greater than what appears on the BENDEX file, the PACES amount will automatically be increased by 4.1%. Long-Term-Care Case Actions In December 2005, the following actions were taken: * PACES calculated new patient-paid-amounts (PPAs) using the 2006 RSDI amounts, effective January 1, 2006, for long-term-care members. Notices, in the MA21 notice format, with the new PPA amounts were sent to members, spouses, and conservators. These notices are viewable only through View Direct. * MMIS was updated with the new PPA information. (continued on next page) Eligibility Operations Memo 06-01 March 1, 2006 Page 3 Letter- format notices were mailed to long-term-care facilities informing them of members’ old and new PPAs. Spousal Case Actions The following actions were taken for spousal cases. RSDI amounts were updated for spouses (dependent #50 on PACES) and the new gross RSDI amounts will be used in future calculations. * Spousal cases were recalculated using the new cap for the minimum monthly maintenance needs allowance (MMMNA). PACES will use the new MMMNA cap and minimum and maximum spousal asset allowances for calculations as of January 2006. Community Case Actions In April 2006, PACES will update the income amounts for category 5 community members on PACES. PACES uses the 2005 RSDI income amounts until the April 2006 FPL change is implemented. Special Note Sometimes the amount of the Medicare Part B premium is adjusted so that there is no change in the amount of the January Social Security check. If the dollar amount of the member’s Social Security COLA increase is less than the Medicare Part B premium increase, the member’s Social Security check would actually be decreased instead of increased. To prevent this from happening, when the Social Security COLA increase is so low that it will not cover the increased cost of the Medicare Part B premium, the Social Security Administration reduces the amount of the member’s Medicare Part B premium to an amount that permits the Social Security check in January, after deduction of the premium, to equal the amount of the check received in December. In these instances, the amount of the member’s Medicare Part B premium will differ from the base amount or the amounts listed on the surcharge chart. Reminder: When entering TYPE A income (social security) with a Med Prem amount, always check SVES or BENDEX to verify information. Questions Questions about these procedures should be directed to the MassHealth Policy Hotline through the designee at your enrollment center. Eligibility Operations Memo 06-01 March 1, 2006 Attachment 2006 Medicare Part B Surcharge Premiums [Base Premium of $88.50 Plus Surcharge] 10% $97.40 210% $274.40 20% $106.20 220% $283.20 30% $115.10 230% $292.10 40% $123.90 240% $300.90 50% $132.80 250% $309.80 60% $141.60 260% $318.60 70% $150.50 270% $327.50 80% $159.30 280% $336.30 90% $168.20 290% $345.20 100% $177.00 300% $354.00 110% $185.90 310% $362.90 120% $194.70 320% $371.70 130% $203.60 330% $380.60 140% $212.40 340% $389.40 150% $221.30 350% $398.30 160% $230.10 360% $407.10 170% $239.00 370% $416.00 180% $247.80 380% $424.80 190% $256.70 390% $433.70 200% $265.50