ModifiedConnecticut Department of Social ServicesPolicy UP-11-02

2011 Federal Poverty Level Tables

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Revises Uniform Policy Manual income limits and eligibility procedures for Medicaid, AIDS assistance, waiver, and Jobs First-related programs.

Policy Summary

PayerConnecticut Department of Social Services

Policy2011 Federal Poverty Level Tables

Policy CodePolicy N/A

Change TypeModified

Effective DateMarch 1, 2011

Next Review DateN/A

Key ActionRoute all CADAP requests to the Central Office Medical Services CADAP Coordinator and send CADAP Fair Hearing requests to Fair Hearings while notifying the CADAP Coordinator.

SourceLink

POLICY UPDATE CHANGES

UPM procedures were revised to incorporate the newly published 2011 Federal Poverty Level income limits.

400%CADAP income threshold

200%QDWI income threshold

185%Pregnant women and children threshold

100%-400%FPL table range

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ModifiedConnecticut Department of Social ServicesPolicy UP-11-02

2011 Federal Poverty Level Tables

Customize your policy alerts

Sign up for Connecticut Department of Social Services Policy UP-11-02 alerts

Get alerted when Policy UP-11-02 changes without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Revises Uniform Policy Manual income limits and eligibility procedures for Medicaid, AIDS assistance, waiver, and Jobs First-related programs.

Policy Summary

PayerConnecticut Department of Social Services

Policy2011 Federal Poverty Level Tables

Policy CodePolicy N/A

Change TypeModified

Effective DateMarch 1, 2011

Next Review DateN/A

Key ActionRoute all CADAP requests to the Central Office Medical Services CADAP Coordinator and send CADAP Fair Hearing requests to Fair Hearings while notifying the CADAP Coordinator.

SourceLink

POLICY UPDATE CHANGES

UPM procedures were revised to incorporate the newly published 2011 Federal Poverty Level income limits.

400%CADAP income threshold

200%QDWI income threshold

185%Pregnant women and children threshold

100%-400%FPL table range

Program Eligibility and Income Criteria

Pregnant Women and Children Under 185% FPL

Determine eligibility for pregnant women and children under 185% of the Federal Poverty Level (FPL) under the FMA-CN procedure.

ALL of the following

Determine the size of the needs group.
Compare the needs-group income, after allowing for income deductions, with 185% of the FPL for the applicable needs-group size.
For needs groups with more than eight (8) members, add $590.15 for each additional member.

185% FPL monthly income limits

Needs group size 1: $1,679.80
Needs group size 2: $2,268.10
Needs group size 3: $2,858.25
Needs group size 4: $3,446.55
Needs group size 5: $4,034.85
Needs group size 6: $4,625.00
Needs group size 7: $5,213.30
Needs group size 8: $5,801.60

Qualified and Disabled Working Individuals (QDWI)

Determine QDWI eligibility using the needs-group size and applied income.

ALL of the following

Determine the size of the needs group.
Compare the applied income of the needs group with 200% of the FPL for the applicable needs-group size.

200% FPL monthly income limits

Needs group size 1: $1,816.00
Needs group size 2: $2,452.00

CADAP Income Eligibility and Application Processing

Determine CADAP eligibility by comparing the family's total monthly income with the applicable 400% FPL limit. Upon receipt of the combined CADAP/Medicaid application form, process the application for CADAP eligibility and forward the original application to the appropriate regional office. Do not forward the application if the CADAP applicant is pending Medicaid or is in a Medicaid spenddown.

400% FPL monthly income limits

Family size 1: $3,632.00
Family size 2: $4,904.00
Family size 3: $6,180.00
Family size 4: $7,452.00
Family size 5: $10,000.00

CIAPAP Income Eligibility and Continuation Procedures

Use the monthly income figures below to determine CIAPAP income eligibility. Refer to P-1500 for general application processing procedures. The individual's or family's gross income, minus medical expenses and premium payments, must be less than the applicable limit for the family size. Use the 175% FPL figures to determine whether verification of income may be postponed under P-8036.05.

Income eligibility limits by family size

Family size 1: gross income minus medical expenses and premium payments must be less than $1,816.00 (200% FPL); the 175% FPL figure is $1,589.00.
Family size 2: gross income minus medical expenses and premium payments must be less than $2,452.00 (200% FPL); the 175% FPL figure is $2,145.50.
Family size 3: gross income minus medical expenses and premium payments must be less than $3,090.00 (200% FPL); the 175% FPL figure is $2,703.75.
Family size 4: gross income minus medical expenses and premium payments must be less than $3,726.00 (200% FPL); the 175% FPL figure is $3,260.25.

Federal Poverty Level Reference Thresholds

Pregnant women and children

ProgramFMA-CN

Income threshold185% of the Federal Poverty Level

Additional member adjustmentAdd $590.15 for each needs-group member beyond eight

QDWI

ProgramQualified and Disabled Working Individuals (QDWI)

Income threshold200% of the Federal Poverty Level

Income measureApplied income of the needs group, based on needs-group size

CADAP and Medicaid Processing Actions

Documentation Required

Route CADAP requests and hearings

Route all requests for the CADAP program to Central Office, Medical Services, Attn: CADAP Coordinator. Send CADAP Fair Hearing requests to Fair Hearings and notify the CADAP Coordinator.

Billing Rule

Discontinue CADAP upon Medicaid eligibility

When a CADAP recipient is determined to be eligible for Medicaid, discontinue the CADAP assistance unit in EMS using reason code 522 and notify the CADAP worker.

Documentation Required

Policy Summary

PayerConnecticut Department of Social Services

Policy2011 Federal Poverty Level Tables

Policy CodePolicy N/A

Change TypeModified

Effective DateMarch 1, 2011

Next Review DateN/A

Key ActionRoute all CADAP requests to the Central Office Medical Services CADAP Coordinator and send CADAP Fair Hearing requests to Fair Hearings while notifying the CADAP Coordinator.

SourceLink

On This Page

Family size 6: $11,272.00

Family size 7: $12,544.00

Family size 5: gross income minus medical expenses and premium payments must be less than $4,362.00 (200% FPL); the 175% FPL figure is $3,816.75.

Family size 6: gross income minus medical expenses and premium payments must be less than $5,000.00 (200% FPL); the 175% FPL figure is $4,375.00.

Family size 7: gross income minus medical expenses and premium payments must be less than $5,636.00 (200% FPL); the 175% FPL figure is $4,931.50.

Family size 8: gross income minus medical expenses and premium payments must be less than $6,272.00 (200% FPL); the 175% FPL figure is $5,488.00.

Continuation and notice procedures

When granting benefits, indicate on the award notice the last date of eligibility based on both the initial continuation period and the additional eleven-month period, if appropriate.
When proposing to discontinue benefits, inform the assistance unit in writing that benefits will not continue beyond the date established in the preceding step, even if the unit requests a Fair Hearing within 10 days of the adverse action notice.
Include the following notice language: "Benefits will not continue beyond (&), even if you request a Fair Hearing within 10 days of this notice."

CADAP

ProgramConnecticut AIDS Drug Assistance Program (CADAP)

Income threshold400% of the Federal Poverty Level

Income measureFamily's total monthly income

CIAPAP primary income limit

Primary income limit200% of the Federal Poverty Level

Calculation basisGross income minus medical expenses and premium payments

ApplicationUse the applicable monthly income amount for the individual's or family's size

CIAPAP verification postponement

Verification-postponement reference175% of the Federal Poverty Level

Procedure referenceP-8036.05

UseDetermine whether income verification may be postponed

Federal Poverty Level percentage thresholds

Lower percentage thresholds100%, 125%, 130%, and 150%

Middle percentage thresholds175%, 200%, 225%, and 250%

Upper percentage thresholds275%, 300%, 325%, and 400%

Selected percentage thresholds

100%Federal Poverty Level

185%Federal Poverty Level

235%Federal Poverty Level

300%Federal Poverty Level

Selected percentage thresholds

100%Federal Poverty Level

120%Federal Poverty Level

135%Federal Poverty Level

175%Federal Poverty Level

185%Federal Poverty Level

200%Federal Poverty Level

300%Federal Poverty Level

EMS household-size range

Household-size range1 through 20

Income frequenciesAnnual and monthly amounts

100% referenceFor household size 1: $10,890 annual and $908 monthly

Escalate failure to cooperate

If a CADAP recipient fails to cooperate with the Medicaid eligibility process, notify the CADAP worker through an alert, email, or M-2-T.

Prior Authorization

Process combined CADAP and Medicaid applications

Upon receipt of the combined CADAP/Medicaid application form, process it for CADAP eligibility and forward the original application to the appropriate regional office. Do not forward the application if the CADAP applicant is pending Medicaid or in a Medicaid spenddown.