220.05 Application for Healthy Kids-Silver Medical Insurance SR 04-04, 05/04 (FAM-A)

Application for Healthy Kids-Silver (HKS) may be made on Form 800, Application for Assistance, Form 800HR, Heights-generated Application for Assistance, or Form 800P, Application For New Hampshire Healthy Kids Medical Insurance or Medical Coverage For Pregnant Women. Certain client information must be verified. See Section 220.13, Verification Requirements.

Process applications for HKS using the following procedures:

• Conduct Client Registration (CR) and Application Entry (AE).

• Ensure that the AG is not also eligible for any other programs of assistance.

• Request all verifications required by policy. Allow the applicant 10 days to provide verifications.

• If all verifications are not provided within the 10-day time frame, deny the application, allowing an Advance Notice Period (ANP).

• When all verifications have been received, enter all missing information and verifications. Delete any income entries older than the most recent 4 weeks.

• If net income is higher than 300% of federal poverty income guidelines, confirm the denial, but do not allow any Notices of Decision (NOD) to be generated.

• If net monthly income is within the subsidized HKS limits (>185% but <300% of federal poverty) and all other eligibility criteria are met, refer the application to NHHKC. NHHKC will follow up and issue a letter of eligibility to the child’s parent/caretaker relative, explain and collect required premiums, help the family select a Primary Care Physician, explain co-payment requirements, and answer any questions the family may have about the program, covered services, cost shares, etc.

• Once all eligibility criteria have been verified and the application has been referred to NHHKC for enrollment, the 45-day timeframe no longer is in effect. Allow the case to remain in pending status until NHHKC informs the District Office:

- of enrollment and premium payment; or

- that the family has chosen not to continue with the application. In this situation, confirm the application but do not issue an NOD. NHHKC will issue the appropriate NOD to the family.

• When notification is received that premium payment has been made, suppress all NODs for the HKS assistance group. NHHKC is responsible for issuing notices of eligibility.

Face to face interviews at the District Office for initial eligibility and redeterminations for HKS are waived provided there is no other program involvement, such as food stamps or child care. Redeterminations must be conducted every 12 months, unless the District Office becomes aware of the need to schedule an earlier redetermination.

HKS-only recipients may participate in the mail-in redetermination process using Form 800PR, Review For Continued Eligibility for NH Healthy Kids Medical Insurance and Medical Coverage For Pregnant Women.