230.01 NHHPP/NHHPP-M Eligibility Criteria SR 15-03, 01/15 (MAM-A)

The New Hampshire Health Protection Program (NHHPP) and the New Hampshire Health Protection Program – Medically Frail (NHHPP-M) offer 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 NHHPP/NHHPP-M. To be eligible for NHHPP/NHHPP-M:

• 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 NHHPP/NHHPP-M 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 NHHPP/NHHPP-M 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 NHHPP/NHHPP-M. If an individual is determined ineligible for NHHPP/NHHPP-M 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 NHHPP/NHHPP-M, if an NHHPP/NHHPP-M recipient becomes pregnant during the NHHPP/NHHPP-M eligibilty period, the NHHPP/NHHPP-M recipient continues to receive NHHPP/NHHPP-M and is not transitioned to Pregnant Women Medical Assistance (MA). However, if an NHHPP/NHHPP-M recipient is pregnant at her regularly scheduled NHHPP/NHHPP-M renewal, she must be transitioned to Pregnant Women MA, if otherwise eligible;

• 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, 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 NHHPP/NHHPP-M, 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, NHHPP/NHHPP-M ends;

• 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, NHHPP/NHHPP-M recipients must report all changes in circumstances which affect eligibility, or, if enrolled in the NH Health Insurance Premium Payment (NH HIPP) Program, any changes that impact NH HIPP eligibility such as, but not limited to, changes in health insurance coverage, within 10 days of the date the change occurs;

• unemployed NHHPP/NHHPP-M applicants and recipients are referred to NH Employment Security (NHES) to receive help in obtaining employment and to file for unemployment benefits, if eligible;

• individuals are eligible for NHHPP/NHHPP-M 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; and

• All NHHPP/NHHPP-M recipients are automatically placed in the Alternative Benefit Plan (ABP). Additionally, individuals eligible for NHHPP/NHHPP-M are enrolled in either:

- the NH Health Insurance Premium Program (NH HIPP). Under NH HIPP, individuals who have access to employer sponsored insurance (ESI) must enroll in ESI or maintain EIS coverage if NH HIPP determines ESI to be cost-effective. If determined to be cost-effective, the employer deducts the employee’s share of the insurance premium from the employee’s paycheck, and NH HIPP pays the employee’s share of the premium to the employee. Co-pays and deductibles are paid to the individual only if the individual paid those expenses out-of-pocket, otherwise NH HIPP reimburses the provider; or

- the Bridge Program. Individuals who do not have access to ESI through an employer, or for whom ESI is not determined cost-effective, are enrolled in the Bridge Program. Under the Bridge Program, the household chooses one of the Health Plans offered under NH Medicaid Care Management (MCM). The Health Plans cover the 10 essential health benefits required under the ACA, and the Bridge Program provides additional “wrap” benefits, such as coverage for non-emergency medical transportation and early periodic screening diagnostic and treatment (EPSDT) for ages birth to 21.

References: He-W 511-512, He-W 841.01, He-W 841.08, RSA 126-A:5,XXIII-XXVI, 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]