Date: August 30, 2021
To: Long Term Care Facilities - Nursing Facilities (NF), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), Supportive Living Program (SLP), Medically Complex for Developmentally Disabled Facilities (MC/DD) and Specialized Mental Health Rehabilitation Facilities (SMHRF)
Re: Application for Benefits Eligibility (ABE) – Applicant's Choice of Medical Benefit Program
Pursuant to Title 42 Code of Federal Regulations (CFR) Section §435.404 Applicant's choice of category, the agency must allow an individual who would be eligible under more than one medical category to have their eligibility determined for the category of their choice. This Notice provides guidance to Long Term Care (LTC) providers related to implementation of this federal requirement.
Beginning 07/29/2021, the Application for Benefits Eligibility (ABE) and Manage My Case (MMC) will display a new question on the Individual screen to confirm an applicant's medical benefit choice when applying for benefits. The medical benefit choice question will allow applicants or customers to select if they would prefer the following:
- Aid to the Aged, Blind, and Disabled (AABD);
- Family Care or Affordable Care Act (ACA) Adults;
- No Preference.
When the 'Question Mark' hover text is selected, a table is displayed to provide a summary of the medical program options.
|Aid to Aged, Blind and Disabled (AABD) Medical||Covers seniors, persons who are blind and persons with disabilities with income up to 100% of the federal poverty level (FPL) and no more than $2,000 of non-exempt resources (one person). If income or resources are over the FPL limit, the person may be eligible for spenddown. Please see HFS 591SP Medicaid Spend-down for more info on AABD spenddown.|
|FamilyCare/All Kids||Covers children 18 years of age and younger, and their parents or caretaker relatives. To be eligible, children must live in families with countable family income within 318 % of the federal poverty level (FPL). The parents/caretaker relatives are eligible for coverage if the countable income is up to 138% FPL.|
|ACA Adults||Covers adults 19-64, who are not parents or caretakers of minor children, with income up to 138% of the federal poverty level.|
Note: All the above-mentioned programs provide the same medical coverage.
The eligibility system will consider the preference selection as a priority over other medical benefit program if the individual is eligible for more than one type of medical program. If "No Preference" is selected or if the individual is not eligible for their preferred medical program, the eligibility system will assign the most beneficial medical program for the eligible individual.
Only a future medical benefit month may be changed due to a medical benefit program request for an individual currently receiving medical benefits. A previously certified month will not be changed.
Choosing a program will not affect managed care organization (MCO) options. The same MCO plans are available across the State regardless of what medical program an individual chooses.
If you have questions, contact the Bureau of Long Term Care toll free at 844-528-8444.
Kelly Cunningham, Administrator
Division of Medical Programs