[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