230.01 Granite Advantage Eligibility Criteria SR 19-31 Dated 07/19

The Granite Advantage Health Care Program (Granite Advantage) offers medical assistance to low-income NH residents who are US citizens or qualified aliens.

All general, categorical, technical, and financial factors related to the MAGI categories of medical assistance apply to Granite Advantage. To be eligible for Granite Advantage:

• the applicant must be at least age 19 but no older than age 64. Note: Although there could be overlap of this age group and the age group of other categories of categorically-needy medical assistance, such as Parent/Caretaker Relative MA or Foster Care Child MA, eligibility for Granite Advantage is explored only if the individual is not eligible for the other categories of medical assistance, excluding In and Out medical assistance and Family Planning Expansion Category (FPEC) medical assistance;

• net income must be less than or equal to 133% of the FPL. See PART 601, Table G, Medically Needy Medical Assistance Net Income Limits and Percentages of Poverty Guidelines. Apply the 5% MAGI-specific income deduction for those individuals who otherwise meet the Granite Advantage program requirements but fail the 133% income limit test, per current policy for all categories of MAGI medical assistance. Note: In and Out medical assistance is not offered for Granite Advantage. If an individual is determined ineligible for Granite Advantage due to being over income, he or she is referred to the Federally Facilitated Marketplace (FFM) for a determination of eligibility for the cost-affordability plans offered there. If, however, the individual is categorically eligible as medically-needy for any other In and Out medical assistance offered in NH, the individual may choose to be covered under that other In and Out medical assistance category;

• if female, she cannot be pregnant at the time of application. Note: Although an individual cannot be pregnant at the time of application for Granite Advantage, if an Granite Advantage recipient becomes pregnant during the Granite Advantage eligibility period, the Granite Advantage recipient continues to receive Granite Advantage and is not automatically transitioned to Pregnant Women Medical Assistance (MA). Granite Advantage recipients who become pregnant may opt out of Granite Advantage. Should a pregnant recipient choose to opt out, override the redetermination date to the current month and run the case in redetermination mode. The system will put the woman in the Pregnant Woman category. Once complete the override the redetermination date back to what it was previously. Pregnant women who opt out of Granite Advantage cannot opt back into Granite Advantage. If a Granite Advantage recipient is pregnant at her regularly scheduled Granite Advantage renewal, she must be transitioned to Pregnant Women MA, if otherwise eligible;

• the applicant cannot otherwise qualify for or be enrolled in a mandatory Medicaid coverage group, and cannot be entitled to or enrolled in Medicare Part A or Part B benefits. Note: If the individual has applied for another non-MAGI category of Medicaid, such as APTD MA, but has not yet been determined eligible for that program, the individual may receive Granite Advantage, if eligible, while the eligibility determination is pending for this other non-MAGI category of assistance. Once the individual opens for the other category of Medicaid, however, Granite Advantage ends;

• the applicant cannot be a parent or caretaker relative living with a child under age 19 unless the child receives Medicaid or has health insurance;

• as with all MAGI categories of medical assistance, there is no resource test and how household composition is determined, whose income counts in that household, and how income is treated, are based on IRS-defined concepts of income and household;

• as is current policy with every category of assistance, Granite Advantage recipients must report all changes in circumstances which affect eligibility * within 10 days of the date the change occurs; and

• individuals are eligible for Granite Advantage for up to 12 months, at which point the individual must participate in a redetermination of eligibility either online or by completing a paper reapplication. As with all MAGI categories of MA, no interviews are required at application or redetermination;

References: He-W 511-512, He-W 837, RSA 126-A:5-b, RSA 126-A:67, 42 CFR 435.119, Section 1902(a)(10)(A)(i)(VIII) of the Social Security Act (SSA) [42 USC 1396a(a)(10)(A)(i)(VIII)], Section 1906 of the SSA [42 USC 1396e], Section 1937 of the SSA [42 USC 1396u-7]