[Federal Register Volume 59, Number 73 (Friday, April 15, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-9112]
[[Page Unknown]]
[Federal Register: April 15, 1994]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES (HHS)
Health Care Financing Administration
Hearing: Reconsideration of Disapproval of Ohio State Plan
Amendment (SPA)
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Notice of hearing.
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SUMMARY: This notice announces an administrative hearing on May 26,
1994, in the Medicaid Conference Room, 14th Floor, 105 W. Adams Street,
Chicago, Illinois, to reconsider our decision to disapprove Ohio SPA
93-11.
CLOSING DATE: Requests to participate in the hearing as a party must be
received by the Docket Clerk by May 2, 1994.
FOR FURTHER INFORMATION CONTACT: Docket Clerk, HCFA Hearing Staff, 1849
Gwynn Oak Avenue, Meadowwood East Building, Ground floor, Baltimore,
Maryland 21207, Telephone: (410) 597-3013.
SUPPLEMENTARY INFORMATION: This notice announces an administrative
hearing to reconsider our decision to disapprove Ohio State plan
amendment (SPA) number 93-11.
Section 1116 of the Social Security Act (the Act) and 42 CFR, part
430 establish Department procedures that provide an administrative
hearing for reconsideration of a disapproval of a State plan or plan
amendment. The Health Care Financing Administration (HCFA) is required
to publish a copy of the notice to a State Medicaid agency that informs
the agency of the time and place of the hearing and the issues to be
considered. If we subsequently notify the agency of additional issues
that will be considered at the hearing, we will also publish that
notice.
Any individual or group that wants to participate in the hearing as
a party must petition the Hearing Officer within 15 days after
publication of this notice, in accordance with the requirements
contained at 42 CFR 430.76(b)(2). Any interested person or organization
that wants to participate as amicus curiae must petition the Hearing
Officer before the hearing begins in accordance with the requirements
contained at 42 CFR 430.76(c).
Ohio submitted SPA 93-11 to seek approval under section 1902(r)(2)
of the Act for an income policy which Ohio believes is more liberal
than that which is used by the Supplemental Security Income (SSI)
program. This policy involves disregarding as income court ordered
child support and alimony payments.
Generally, under section 1902(a)(10) of the Act, the Medicaid
statute requires States to use the eligibility criteria of the SSI
program in determining eligibility for the aged, blind and disabled.
Under certain circumstances, section 2901(f) authorizes States to use
more restrictive criteria than those of SSI. Under section 1902(r)(2)
of the Act, States may use more liberal methodologies than are used by
the cash assistance programs in determining Medicaid eligibility for
certain groups of individuals. Section 1902(a)(10)(A)(ii)(V) authorizes
States to cover institutionalized individuals who meet the SSI resource
requirements and whose income does not exceed a separate income
standard established by the State which is consistent with the Federal
financial participation (FFP) limits. Because the amendment could have
resulted in individuals with income above the levels specified in
section 1903(f), HCFA disapproved the amendment as not consistent with
the proper and efficient administration of the State plan and not
consistent with simplicity of administration and the best interest of
recipients. HCFA believed that providing Medicaid eligibility to
individuals for whom FFP is not available would result in a costly and
inefficient exercise to identify those individuals and disallow claims
for matching funds filed on their behalf.
The issues are: (1) Whether Ohio SPA 93-11 is consistent with the
requirements of sections 1902(a)(4) and (19) insofar as it provides for
disregarding income which could result in individuals receiving
Medicaid even though their income exceeds the limits established by
section 1903(f); and (2) whether the authority found in section
1902(r)(3) to use more liberal eligibility methodologies than those of
the SSI program permits a State to disregard income which would result
in individuals receiving Medicaid even though their income exceeds the
limits established by section 1903(f).
Ohio believes that court ordered alimony and child support would be
disregarded as income for individuals eligible under a special income
level under section 1902(a)(10)(A)(ii)(V) of the Act. HCFA believes
this policy is more liberal than SSI policy, which requires that such
alimony and child support be counted as income. In disapproving the
amendment, HCFA concluded that using this more liberal policy was
likely to result in providing Medicaid to individuals who have income
greater than the limits established under section 1903(f) of the Act.
The notice to Ohio announcing an administrative hearing to
reconsider the disapproval of its SPA reads as follows:
Mr. Arnold R. Tompkins
Director, Ohio Department of Human Services, 30 East Broad Street,
32nd Floor, Columbus, Ohio 43266-0423.
Dear Mr. Tompkins: I am responding to your request for
reconsideration of the decision to disapprove Ohio State Plan
Amendment (SPA) 93-11.
Ohio submitted SPA 93-11 to seek approval under section
1902(r)(2) of the Social Security Act (the Act) for an income policy
which you believe is more liberal than that which is used by the
Supplemental Security Income (SSI) program. This policy involves
disregarding as income court ordered child support and alimony
payments.
Generally, under section 1902(a)(10) of the Act, the Medicaid
statute requires States to use the eligibility criteria of the SSI
program in determining eligibility for the aged, blind and disabled.
Under certain circumstances, section 2901(f) authorizes States to
use more restrictive criteria than those of SSI. Under section
1902(r)(2) of the Act, States may use more liberal methodologies
than are used by the cash assistance programs in determining
Medicaid eligibility for certain groups of individuals. Section
1902(a)(10)(A)(ii)(V) authorizes States to cover institutionalized
individuals who meet the SSI resource requirements and whose income
does not exceed a separate income standard established by the State
which is consistent with the Federal financial participation (FFP)
limits. Because the amendment could have resulted in individuals
with income above the levels specified in section 1903(f), HCFA
disapproved the amendment as not consistent with the proper and
efficient administration of the State plan and not consistent with
simplicity of administration and the best interest of recipients.
HCFA believed that providing Medicaid eligibility to individuals for
whom FFP is not available would result in a costly and inefficient
exercise to identify those individuals and disallow claims for
matching funds filed on their behalf.
The issues are: (1) Whether Ohio SPA 93-11 is consistent with
the requirements of sections 1902(a)(4) and (19) insofar as it
provides for disregarding income which could result in individuals
receiving Medicaid even though their income exceeds the limits
established by section 1903(f); and (2) whether the authority found
in section 1902(r)(3) to use more liberal eligibility methodologies
than those of the SSI program permits a State to disregard income
which would result in individuals receiving Medicaid even though
their income exceeds the limits established by section 1903(f).
I am scheduling a hearing on your request for reconsideration to
be held on May 26, 1994, in the Medicaid Conference Room, 14th
Floor, 105 W. Adams Street, Chicago, Illinois 60603-6201. If this
date is not acceptable, we would be glad to set another date that is
mutually agreeable to the parties. The hearing will be governed by
the procedures prescribed at 42 CFR, Part 430.
I am designating Mr. Stanley Katz as the presiding officer. If
these arrangements present any problems, please contact the Docket
Clerk. In order to facilitate any communication which may be
necessary between the parties to the hearing, please notify the
Docket Clerk of the names of the individuals who will represent the
State at the hearing. The Docket Clerk can be reached at (410) 597-
3013.
Sincerely,
Bruce C. Vladeck,
Administrator.
(Section 1116 of the Social Security Act (42 U.S.C. section 1316);
42 CFR section 430.18)
(Catalog of Federal Domestic Assistance Program No. 13.714, Medicaid
Assistance Program)
Dated: April 8, 1994.
Bruce C. Vladeck,
Administrator, Health Care Financing Administration.
[FR Doc. 94-9112 Filed 4-14-94; 8:45 am]
BILLING CODE 4120-01-P
