623.05 Cost of Care: HCBC-DD Medical Assistance (MAM) |
____________________________________________________________
There is no cost of care liability for individuals who are requesting HCBC-DD services who meet the categorically-needy or medically-needy financial eligibility requirements for any category of financial or medical assistance.
Only individuals determined eligible for HCBC-DD services via the special income limit (the Nursing Facility CAP) are responsible for applying their net income towards the cost of care.
Use the following steps to determine the amount of cost of care.
1. Subtract the following from the gross earned income:
- Employment Expense Disregard (EED), if applicable, per Section 603.03, Employment Expense Disregard (EED).
- Earned Income Disregard (EID), if applicable, per Section 603.01, Earned Income Disregard (EID).
The result is net earned income.
2. Add countable gross unearned income and SSI payments to net earned income. The result is net income.
3. Subtract allowable deductions.
4. Subtract the $74 personal needs allowance if the individual lives in an independent living arrangement.
5. Subtract the standard of need which corresponds to the individual's living arrangement to represent the individual's maintenance allowance.
- If the individual lives in an independent living arrangement with their spouse, use a standard of need for a group size of 2.
6. Subtract all Medicare Premiums if the individual:
- receives Medicare Part A, Part B, Part C, or Part D; and
- is not eligible for the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB) programs, or the Low Income Subsidy (LIS) for Medicare Part D. See PART 715, BUY-IN OF MEDICARE.
7. Subtract other medical expenses incurred by the individual that are not subject to third-party payment including:
- health insurance premiums, deductibles, or coinsurance,
- necessary medical and remedial care that would be covered by medical assistance, except that allowable payment limits have been exceeded;
- necessary medical or remedial care recognized under state law but not covered by medical assistance. For a list of covered and non-covered services, refer to NH administrative rules PART He-W 530, SERVICE LIMITS, CO-PAYMENTS, AND NON-COVERED SERVICES (http://gencourt.state.nh.us/rules/state_agencies/he-w500.html); and
- currently obligated, unpaid prior medical debts.
8. Subtract SSI.
9. Add the VA Aid and Attendance Allowance.
10. The result is the amount of income the individual must apply toward the cost of care.
New HEIGHTS automatically generates AE0105, HCBC/CFI Patient Liability Letter, when the individual is liable for cost of care. If New HEIGHTS is unavailable, use paper DFA Form 517C, the paper backup to the New HEIGHTS-generated AE0105.
References: RSA 167:27-a, RSA 167:27-b,42 CFR 435.217, 42 CFR 435.735