SR 00-27 Dated 08/00

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

/3This SR revises the eligibility criteria for extended medical assistance due to increased child or spousal support or due to employment so that NHEP/FAP categorically needy medical assistance recipients not also receiving financial assistance may qualify for this extended coverage. Previously, only NHEP/FAP financial assistance recipients could qualify for extended medical assistance.

The attached SR also makes two related technical corrections to the Family Assistance Manual:

References to IV-E foster care have been removed from PART 171, EXTENDED MEDICAL ASSISTANCE DUE TO EMPLOYMENT, because the responsibility for the foster care program was transferred from the Division of Family Assistance to the Division for Children, Youth and Families per SR 94-7, effective February 1, 1994. In addition, a misleading statement that termination of the NHEP/FAP case must have occurred due in whole or in part to employment reasons has been revised to remove the phrase "in whole or in part," as this language is only used in federal regulations when referring to 4 month EMA.

Section 173.03, Financial Eligibility, has been revised to correct obsolete policy regarding the treatment of earned income received by a dependent child who is included in an assistance group and is classified as a student. SR 97-08, dated March 1997, released policy excluding all earnings of students when determining NHEP/FAP financial and medical assistance eligibility. Due to an oversight, Section 173.03 was not revised at that time. No District Office action is required as a result of this technical correction, because New HEIGHTS properly excludes student earnings.

In addition, special procedures are included for processing 12 month EMA cases that close due to failure to submit a timely Quarterly Report of Earnings. These procedures are necessary in order to comply with the federal requirement that individuals whose medical assistance is terminated must have their eligibility determined for all other medical assistance programs.

POLICY

Revised Family Assistance Manual Topics

PART 167 TERMINATION OF MEDICAL ASSISTANCE

PART 169 EXTENDED MEDICAL ASSISTANCE DUE TO INCREASED CHILD OR SPOUSAL SUPPORT

Section 169.05 Redetermination of Eligibility During the Four-Month Coverage Period

PART 171 EXTENDED MEDICAL ASSISTANCE DUE TO EMPLOYMENT

Section 171.01 Determining the Coverage Period

Section 171.03 Termination Due to Employment of an Incapacitated Parent

Section 173.03 Financial Eligibility

Section 173.09 Reinstatement After Termination

Section 173.15 Scheduled Redeterminations of Eligibility

Extended medical assistance (EMA) is now available to categorically needy medical assistance-only cases that lose eligibility due:

 to new or increased earnings,

 to increased hours of employment of the principal wage earner, or

 in whole or in part to increased child or spousal support.

Previously, EMA was available only to NHEP/FAP financial assistance cases that lost eligibility due to employment, or in whole or in part due to increased child or spousal support. The requirements for receipt of EMA for NHEP/FAP financial assistance recipients remain unchanged and are addressed in revised Family Assistance Manual PART 169, EXTENDED MEDICAL ASSISTANCE DUE TO INCREASED CHILD OR SPOUSAL SUPPORT, and PART 171 EXTENDED MEDICAL ASSISTANCE DUE TO EMPLOYMENT.

The sections below address eligibility requirements for EMA for NHEP/FAP categorically needy medical assistance cases.

4 Month Extended Medical Assistance due to Increased Child Or Spousal Support for Categorically Needy Medical Assistance Cases

NHEP/FAP assistance group members who become ineligible for NHEP/FAP categorically needy medical assistance because of increased child or spousal support are eligible for 4 month extended medical assistance if both of the following criteria are met:

 the assistance group received NHEP/FAP categorically needy medical assistance, with or without financial assistance, during any 3 of the 6 months before the month in which the case closed, and;

 the termination of NHEP/FAP categorically needy medical assistance is due in whole or in part to increased child or spousal support income.

12 Month Extended Medical Assistance due to Employment for Categorically Needy Medical Assistance Cases

NHEP/FAP assistance group members who become ineligible for NHEP/FAP categorically needy medical assistance due to increased earnings, or to increased hours of employment of the principal wage earner, are eligible for 12 month extended medical assistance if both of the following criteria are met:

 the assistance group received NHEP/FAP categorically needy medical assistance, with or without financial assistance, during any 3 of the previous 6 months before the case closed; and *

 ineligibility for categorically needy medical assistance is due to new or increased earnings, or to an increase in the number of hours the principal wage earner is employed.

*NOTE: The requirement that the assistance group must have received NHEP/FAP categorically needy medical assistance in 3 of the 6 months prior to case closing applies only to NHEP/FAP categorically needy medical assistance cases. NHEP/FAP financial assistance cases must only be currently receiving financial assistance at the time of case closing to qualify for 12 month EMA, assuming all other EMA eligibility requirements are met.

Determining the Begin Date of Eligibility for 4 and 12 Month EMA

For purposes of policy, the first month of the 4 month EMA coverage period is the month in which categorically needy medical assistance ends and EMA begins. The first month of the 12 month EMA coverage period begins on the first day of the month following the last month in which the individual was eligible to receive categorically needy medical assistance. Although New HEIGHTS sets the begin date for cases that have closed for categorically needy medical assistance as the day following the expiration of the advance notice period (ANP), this an internal processing procedure that requires no special District Office action. This information is being provided so that District Offices can be aware that some cases on HEIGHTS will receive 12 full months plus some additional days of EMA based on the ANP expiration date.

EXAMPLE

Mrs. Green’s ANP expires and her categorically needy medical assistance ends on August 28, due to increased earned income. The begin date of eligibility for 12 month EMA is August 29. She and her children are eligible for EMA for 3 days in August, and for 12 full months of EMA coverage beginning September 1.

SYSTEMS CHANGES

New HEIGHTS programming changes for the revised 4 and 12 month EMA policy will take effect August 1, 2000.

The NOD text for the expiration of 4 and 12 month EMA will be revised to reflect the policy in this SR.

Expiration of 4 Month EMA

WHEN NHEP/FAP FINANCIAL OR CATEGORICALLY NEEDY MEDICAL ASSISTANCE STOPS DUE TO INCREASED CHILD SUPPORT INCOME, FAMILIES CAN RECEIVE EXTENDED MEDICAL ASSISTANCE FOR AN EXTRA FOUR MONTH PERIOD. YOUR CASE HAS REACHED THE FOUR MONTH LIMIT. WE WILL REVIEW ELIGIBILITY FOR EACH MEMBER OF YOUR ASSISTANCE GROUP TO DETERMINE IF THEY MEET THE REQUIREMENTS OF ANY OTHER TYPE OF MEDICAL ASSISTANCE PROVIDED YOUR REDETERMINATION IS COMPLETED. IF YOU ARE ELIGIBLE, WE WILL NOTIFY YOU. FAMILY ASSISTANCE CHAPTER 100.

Expiration of 12 Month EMA

WHEN YOUR NHEP/FAP FINANCIAL OR CATEGORICALLY NEEDY MEDICAL ASSISTANCE STOPPED DUE TO INCREASED EARNINGS FROM WORK, WE CONTINUED YOUR MEDICAID FOR 12 MONTHS. THIS COVERAGE IS NOW ENDING. WE WILL REVIEW ELIGIBILITY FOR EACH MEMBER OF YOUR ASSISTANCE GROUP TO DETERMINE IF THEY MEET THE REQUIREMENTS OF ANY OTHER TYPE OF MEDICAL ASSISTANCE PROVIDED YOUR REDETERMINATION IS COMPLETED. IF YOU ARE ELIGIBLE, WE WILL NOTIFY YOU. FAMILY ASSISTANCE CHAPTER 100.

In addition, the text of Notice ID PR0002, Notification of 12 Month EMA, has been revised to indicate that EMA is available to certain cases that lose eligibility for categorically needy medical assistance due to employment related reasons. A copy of the revised text is attached to this SR for reference.

Special Procedures: 12 Month EMA Assistance Groups that Fail to File Form 890, Quarterly Extended Medical Assistance Report

When an individual has been determined ineligible for medical assistance, including EMA, that individual must have his or her eligibility determined for any other MA coverage that the Department offers. If a 12 month EMA assistance group (whether the EMA was opened as a result of loss of financial assistance or categorically needy medical assistance) fails to complete Form 890 and closes as a result, special procedures are required to insure that eligibility of all individuals in the case for other types of medical assistance is determined. Procedures differ based on whether or not the case is eligible for other case programs and the type of program at the time of case closing.

EMA Only

If there is no open case program other than EMA, the case will close. The District Office must reactivate the case, set the Form 890 indicator to "incomplete," and rerun eligibility through confirmation.

EMA and Another Type of Medical Assistance

If some case members were eligible for EMA and others were eligible for another type of medical assistance, the EMA assistance group (AG) will close but the case will remain open. The District Office must navigate to the Program of Assistance screen for medical assistance, set the individual indicator to ‘yes’ for each of the former EMA recipients, and rerun eligibility through confirmation.

EMA and Food Stamps and/or Child Care

If EMA was the only type of medical assistance received at the time of EMA termination, and the case was also open for food stamps and/or child care, the EMA AG will close but the case will remain open. The District Office must navigate to the Program of Assistance screen for medical assistance, set the indicator as "yes" for the case, and rerun eligibility through confirmation.

IMPLEMENTATION

The revised policy is effective August 1, 2000 for all initial applications, and at the next case action or redetermination occurring on or after August 1, 2000, whichever is sooner, for currently open cases.

In addition, DFA State Office has requested a report of all NHEP/FAP categorically needy medical assistance cases that closed due to increased support, earned income, or hours of employment of the PWE within the past year. Any cases appearing on this report will be evaluated for potential EMA eligibility based on case circumstances. If potential retroactive EMA eligibility exists, the casehead will be contacted and advised of the policy change released by this SR. Should retroactive EMA be appropriate, District Offices will be provided with instructions under separate cover for applying retroactive provisions.

CLIENT NOTIFICATION

Clients will be advised of the revised policy on an individual, as needed basis.

TRAINING

No training is planned.

DISPOSITION

This SR may be destroyed or deleted after its contents have been noted and the revised manual topics released by this SR have been posted to the On-line manuals.

DISTRIBUTION

This SR will be distributed according to the electronic distribution list for Division of Family Assistance policy releases. This SR, and revised On-Line Manuals, will be available for agency staff in the On-Line Manual Library, and for public access on the Internet at http://www.dhhs.state.nh.us/PMIndex.htm, effective September 5, 2000.

This SR, and printed pages with posting instructions, will be distributed under separate cover to all hard copy holders of the Family Assistance Manual.

DFA/SJC:s