SR 02-01 Dated 01/02

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases a 2.6% cost of living increase to SSA/SSI and VA Annual Review benefits effective January 1, 2002, and the updated:

·   SSI payment levels for individuals and couples;

·   adult Standards of Need for individuals in independent living arrangements, residential care facilities, and community residences;

·   Protected Income Limit (PIL) for an assistance group size of 1;

·   Medicare Part B premium amount and the SLMB175 portion of that premium;

·   spousal impoverishment figures and Nursing Facility CAP; and

·   Substantial Gainful Activity (SGA) income ceiling.

Family Assistance Manual (FAM) Chapter 600 and Adult Assistance Manual (AAM) Chapters 100, 200, 400, and 600 were revised accordingly. In addition, Forms 798A, Resource Assessment for Institutionalized Individuals with Community Spouses, Form 799, Spousal Income Protection, and Form 799A, Income Computation Worksheet for Allocation of Income for Institutionalized Individuals, were also revised to reflect the increased spousal impoverishment figures. Copies of the updated forms are attached to this SR for reference.

POLICY

Revised Family Assistance Manual Topics

Part 601, TABLE C TANF Medical Assistance Net Income, Limits and Percentages of Poverty Level

Revised Adult Assistance Manual Topics

Section 167.03 COLA Adjustments Since 1977

PART 209 AID TO THE PERMANENTLY AND TOTALLY DISABLED

Section 209.03 SGA Adjustments Since 2000

Section 419.03 Determining the Protected Resource Amount

Part 601, TABLE A INCOME LIMITS

Part 601, TABLE B INCOME LIMITS FOR HCBC INDIVIDUALS

Part 617 GRANT DETERMINATION

Section 621.05 Cost of Care: HCBC-ECI Financial or Medical Assistance

Section 627.03 Allocation to a Community Spouse

COLA INCREASE

Based upon the 2.6% cost of living increase to SSA/SSI and VA Annual Review benefits, the SSI maximum monthly benefit levels for independent living arrangements increased as follows:

-   for an individual, from $530 to $545;

-   for a spouse or needy essential person, from $796 to $817; and

-   for a couple and needy essential person, from $1,062 to $1,090.

The adult Standard of Need for OAA, ANB, and APTD individuals increased as follows:

The Protected Income Limit (PIL) for an assistance group size of one increased from $544 to $559. The PIL’s for all other group sizes remained the same.

The Medicare Part B monthly premium cost will increase from $50 to $54.

NOTE: The portion of the Part B Medicare premium that represents home health care costs and affects SLMB175 cases, has increased from $3.09 to $3.91 per month. This increase affects SLMB175 cases that apply for SLMB175 on or after January 1, 2002. These cases will be entitled to reimbursement of $3.91 per month towards their Part B Medicare premium. See SR 99-18 for further information on SLMB175.

VA Annual Review cases will have a 2.6% cost of living increase.

The Nursing Facility CAP remains at $1,250. This amount is mandated by state law, and cannot be changed without further legislation.

Spousal Impoverishment limits increased:

·   Maximum monthly maintenance allowance from $2,175 to $2,232;

·   Minimum resource standard from $17,400 to $17,856; and

·   Maximum spousal resource allowance from $87,000 to $89,280.

SGA INCREASE

The Substantial Gainful Activity (SGA) income ceiling increased from $740 to $780. The SGA is used only during initial APTD eligibility determinations to determine earned income limits for working disabled individuals. To be eligible for APTD, working applicants must have an adjusted earned income of less than the SGA.

The SGA figure will be adjusted annually in accordance with changes to the national average wage index per 20 CFR 416.974.

PROCEDURES

Mass Change procedures for New HEIGHTS are noted under the appropriate heading below.

SSA/SSI Increase

SSA/SSI benefits are updated in January by crossmatching open SSA/SSI cases in New HEIGHTS against the BENDEX and SDX tapes using the individual’s Social Security Number (SSN). In a pre-mass change crossmatch, 264 SSA/SSI cases in New HEIGHTS were identified as having an SSN that diverged from the BENDEX/SDX tapes. Alerts were sent to District Offices on November 13, 2001 listing the 264 SSN discrepancies and District Offices were asked to have these cases fixed by December 12, 2001.

During the January mass change, all open SSA/SSI cases will be re-crossmatched against the BENDEX and SDX tapes. For those cases that match, the SSA/SSI amount will be replaced with the actual check amount listed on the BENDEX/SDX tape and benefits will be recomputed. For those SSA/SSI cases that do not match, New HEIGHTS will apply the 2.6% increase and round up to the nearest dollar.

VA Increase

New HEIGHTS will apply a 2.6% COLA increase, dropping all cents, to all VA benefits with an annual review indicator. If a case with an annual review indicator also has Aid and Attendance (A&A) benefits, the 2.6% COLA will also be applied to the A&A benefits, dropping all cents.

Certain VA beneficiaries, widows and children of veterans, are entitled to a COLA only through an Act of Congress. This type of increase is referred to as a Periodic Legislative Increase (PLI) since their benefits do not automatically increase with the January COLA. Congress recently authorized a 2.6% PLI for these individuals, effective January 1, 2002. District Offices will be sent a report of these cases and processing instructions under separate cover prior to the mass change.

$2 Minimum Grant Cases

Certain cases currently eligible for adult category cash assistance, but not actually receiving the grant because the amount is under $2 per month, may now qualify to receive a grant due to the increase in the SON.

·   For cases in which New HEIGHTS has sufficient information to provide the Benefit Issuance type (Electronic Benefit Transfer, Electronic Funds Transfer, or paper check), the following standard mass change reason message will be added to the NOD informing the client of the change in benefit issuance status:

YOUR NEW SOCIAL SECURITY, SSI AND/OR VA BENEFIT WAS USED TO REFIGURE YOUR ELIGIBILITY FOR ALL TYPES OF AID. THE INCOME LIMITS FOR SOME MEDICALLY NEEDY MEDICAL ASSISTANCE CASES AND FOR OAA, ANB, AND APTD FINANCIAL ASSISTANCE WERE ALSO INCREASED. THE ENCLOSED LETTER EXPLAINS THESE CHANGES. ADULT AND FAMILY ASSISTANCE CHAPTERS 600.

·   It is anticipated that all $2.00 minimum grant cases will already have benefit issuance information since this data is required in New HEIGHTS. Any cases that do not have sufficient Benefit Issuance information at the time of the Mass Change will appear on the "MC Exception" report (NMC550RA) with the Reason for Exception listed as "Cash/FS need benefit issuance information." District Offices must rerun eligibility, supplying the missing Benefit Issuance information when that screen appears in the driver flow. NOTE: these cases should be contacted prior to confirmation to identify whether the client wishes EBT or EFT as the cash benefit issuance type and to explain the processes required to establish either issuance type. When the benefit issuance type has been chosen and entered, confirm the case. Make certain to add the additional NOD text above to the systems-generated NOD.

Medically Needy Cases that Become Categorically Eligible

All open adult category medically needy medical assistance (MA) assistance groups (AG’s) will be part of the Mass Change. Because the SON is also the categorically needy income limit, if a medically needy AG’s income is now below the SON, and resources do not exceed the limit for categorically needy MA, New HEIGHTS will change their AG type to categorically needy. In addition, District Offices need to be aware that affected AG’s may now be eligible for adult category cash assistance, subject to the $2 minimum grant requirement. Affected AG’s desiring cash assistance must file an application and meet all eligibility requirements.

Individuals who make inquiry regarding this possibility must be informed of:

·   the requirement to file an application for cash assistance;

·   the State’s right to recover the cost of all adult category financial assistance provided; and

·   the State’s right to file a lien against real property as part of the recovery process.

In and Out Medical Assistance

In and Out Medical Assistance cases of one will use the new PIL amount for the January spenddown. Note that the PIL for group sizes larger than one did not change for 2002. The new PIL and adjusted benefit increases will be used for all January In and Out Cases currently in a six-month application period.

If a medically needy assistance group (AG) currently in "deductible status" has income over the old PIL, but less than or equal to the new PIL for a group size of 1, New HEIGHTS will open medical assistance. The following standard mass change reason message will be included in the NOD issued as a result of this calculation.

YOUR NEW SOCIAL SECURITY, SSI AND/OR VA BENEFIT WAS USED TO REFIGURE YOUR ELIGIBILITY FOR ALL TYPES OF AID. THE INCOME LIMITS FOR SOME MEDICALLY NEEDY MEDICAL ASSISTANCE CASES AND FOR OAA, ANB AND APTD FINANCIAL ASSISTANCE WERE ALSO INCREASED. THE ENCLOSED LETTER EXPLAINS THESE CHANGES. ADULT AND FAMILY ASSISTANCE CHAPTERS 600.

Three-Month Retroactive Medical Assistance Cases

Three Month Retroactive MA eligibility determinations must use pre-mass change SON/PIL amounts for months prior to January 1, 2002. For cases in New HEIGHTS, this will happen automatically.

Pickle Amendment Cases

The Pickle Amendment prevents SSA cases with a state supplement (ANB, APTD, OAA) from closing due to the COLA increase. New HEIGHTS Pickle Amendment cases are processed automatically. The calculations and COLA deduction for cases that would lose cash payment are invisible to D.O. staff. Questions about the calculations or COLA deduction on New HEIGHTS Pickle cases should be directed to the New HEIGHTS Help Desk, which can access the database tables for these cases.

QMB, QDWI, SLMB, SLMB135, and SLMB175 Cases

Federal law mandates that COLA increases for the year 2002 cannot be used to determine QMB, QDWI, SLMB, SLMB135 and SLMB175 eligibility until after the annual update to the federal poverty levels is effective April 1, 2002. Until the new figures are available, cases that would close due to the COLA will be kept open automatically by New HEIGHTS. SLMB175 cases, however, which are processed manually, require special procedures below.

Procedures for SLMB175 Eligibility Determination and Benefit Issuance

Separate manual eligibility determinations and benefit issuances must be performed for the months of January, February, and March, and for the period April through December:

·   For any SLMB175 case that applies from January 1 through March 31, 2002, the January 2002 COLA increase must be deducted from total income when determining eligibility.

·   When the federal poverty income guidelines are updated effective April 2002, eligibility must be redetermined using the full SSA benefit, including the COLA increase.

Procedures for SLMB175 Applications between January 1, 2002 and March 31, 2002

1. Following the procedures in AAM 615, manually calculate income eligibility using the applicant’s full January SSA check. If the individual is income-eligible for SLMB175 at this point, proceed with benefit issuance using the procedures in SR 99-18. Send the individual a manual notice of decision (see SR 99-18 for suggested text). If the individual is over income at this point, go to Step 2.

2. Manually reduce the individual’s January SSA benefit amount by the COLA, and determine eligibility for SLMB175. If the individual is still over income at this point, deny the application. If the individual is now income-eligible, go to Step 3.

3. Calculate the individual’s benefit by multiplying the portion of the Part B premium for home health services ($3.91 per month in calendar year 2002) by 1, 2, or 3, depending on the months (January, February, or March) for which eligibility is requested. For example, if an individual applies on 1/10/02 and is income-eligible after the manual reduction in Step 2, the number of months multiplied by $3.91 would be 3 (January through March). The individual would be issued a paper check for $11.73. See SR 99-18 for procedures to issue paper checks.

4. Send the individual a manual Notice of Decision (see below for suggested text).

5. As soon as the updated federal poverty income guidelines are released by SR, redetermine eligibility for SLMB175 for the period April through December using the full January 2002 SSA benefit. No new application is required. If the individual is income eligible, issue a second paper check covering the individual’s benefit for the remainder of calendar year 2002 ($3.91 x 9 = $35.19). If the individual is no longer eligible, issue no further benefit.

6. Send the individual a second manual Notice of Decision (see below).

Applications for Retroactive SLMB175

·   Due to the federal funding cycle for SLMB175 (January through December of each calendar year), applications for retroactive SLMB175 coverage that include a request for months in the prior calendar year require a separate check for the prior year period. For example, if an individual applies on February 1, 2002, and requests retroactive coverage for November 2001, December 2001, and January 2002, calculate the benefit amount and issue one check for the months of November and December 2001, based on the 2001 payment of $3.09 per month. Then proceed with eligibility determination and benefit issuance for the current year using the steps above.

·   If an application for retroactive SLMB175 coverage made after April 1 includes a request for the months of January, February, or March, follow the steps above when determining eligibility for any of those months. However, if the individual is eligible for the retroactive month(s), combine the benefit for these months with any benefit for the months April through December and issue only one check for the total amount.

Notices

Opening Between January 1 and March 31:

The manual NOD issued upon opening a SLMB175 case at Step 3 above serves as both a notice of eligibility and a notice of that eligibility will be reviewed for April. The following text is suggested:

YOU ARE ELIGIBLE TO HAVE A PORTION OF YOUR [YYYY] MEDICARE PART B PREMIUM PAID TO YOU AS A SPECIFIED LOW INCOME BENEFICIARY WHOSE INCOME IS BETWEEN 135% AND 175% OF FEDERAL POVERTY INCOME GUIDELINES (SLMB175). YOU WILL RECEIVE A CHECK FOR $[XX.XX]. THIS PAYMENT REPRESENTS THE PARTIAL PART B PREMIUM FOR [MONTH] THROUGH MARCH 31, [YYYY]. IN APRIL, WE WILL REVIEW YOUR CONTINUED ELIGIBILITY FOR THIS BENEFIT. IF YOU ARE STILL ELIGIBLE, YOU WILL RECEIVE ANOTHER NOTICE AT THAT TIME.

Continuing Eligibility (April through December):

YOUR ELIGIBILITY FOR SLMB175 HAS BEEN REVIEWED. YOU REMAIN ELIGIBLE FOR PAYMENT OF A PORTION OF YOUR [YYYY] MEDICARE PART B PREMIUM. YOU WILL RECEIVE A SECOND CHECK FOR $[XX.XX]. THIS SECOND PAYMENT REPRESENTS THE PARTIAL PART B PREMIUM FOR APRIL THROUGH DECEMBER 31, [YYYY]. THIS IS THE ONLY NOTICE YOU WILL RECEIVE THAT YOUR LAST MONTH OF BENEFITS FOR THIS PROGRAM IS DECEMBER [YYYY]. IN ORDER TO RECEIVE THIS BENEFIT FOR THE NEXT CALENDAR YEAR, YOU MUST REAPPLY FOR THIS BENEFIT NEXT JANUARY.

Closings Due to Excess Income as a Result of SSA COLA

A manual NOD is also required for closings occurring as a result of the redetermination of eligibility in March based on the full SSA benefit amount (Step 5 above). Suggested wording follows:

WHEN WE FIGURED YOUR ELIGIBILITY FOR SLMB175 FOR THE MONTHS OF JANUARY, FEBRUARY, OR MARCH, [YYYY], WE SUBTRACTED THE JANUARY SOCIAL SECURITY COST OF LIVING ADJUSTMENT (COLA) AMOUNT FROM YOUR INCOME. AS OF APRIL [YYYY], WE REFIGURED YOUR ELIGIBILITY USING YOUR FULL SSA BENEFIT, INCLUDING THE JANUARY COLA AMOUNT. YOUR INCOME IS NOW OVER THE LIMIT FOR SLMB175.

See SR 99-18 for suggested wording of other manual notices for SLMB175 openings, closings, and denials.

Adult Category Recoupment

For recoupment cases, New HEIGHTS will recompute the amounts when the case goes through the mass change. The notice of the revised amount will be generated automatically as well.

Spousal Impoverishment Cases

New HEIGHTS will handle spousal cases automatically.

Effective January 1, 2002, the maximum monthly maintenance allowance increases from $2,175 to $2,232 per month. When determining income allocated to the community spouse for months prior to January 2002, use the $2,175 amount. For example, if an individual applied for institutionalized care in January and requested retroactive medical assistance for December, the District Office would calculate the spousal allocation separately for December and January.

The minimum and maximum resource allowances for the community spouse are also increasing from $17,400 to $17,856 and from $87,000 to $89,280, respectively.

·   The new figures apply only to requests for resource assessments after 12/31/01.

·   Use amounts in effect when the individual applies, regardless of when the assessment was done.

·   These amounts do not affect individuals whose resource amount is between the minimum and maximum.

·   An individual could be resource ineligible in December but resource eligible in January due to the higher figures.

Rollbacks

New HEIGHTS will process rollbacks automatically and the correct values will be used for the pre-January amounts.

Patient Liability

Nursing Facilities are automatically notified of the patient’s liability, the monthly amount the resident is expected to pay towards their care, through EDS-AIMS. Effective December 7, 2001, the process of notifying the nursing facility resident and/or the individual’s authorized representative of the patient’s liability will be fully automated. Any time a new patient liability is created or a change is made to a current resident’s patient liability, New HEIGHTS will automatically generate for the nursing facility resident and/or the authorized representative, the client letter AE0009. AE0009 is attached to this SR for reference.

Categorically Eligible Food Stamp Households

Food stamp policy in FAM Part 231 states that certain public assistance and SSI households are categorically eligible for food stamps without regard to income or resources. To be considered categorically eligible, all members of the food stamp household must be included in an open public assistance and/or SSI case.

New HEIGHTS will calculate food stamp categorical eligibility automatically.

SYSTEM CHANGES

The New HEIGHTS mass change run date will begin after the daily run, the evening of December 28, 2001.

1. All reference table changes are effective starting January 1, 2002. This includes all adult financial assistance cases in independent living arrangements and adult categorically needy MA cases, all residential care facility and community residence individuals, and cases whose eligibility is based on the one person PIL.

2. Ten day advance notice periods will be given to all AP and MA cases with a negative action resulting from the mass change. Food stamps decreasing or closing as a result of the mass change will only receive an advance notice if any other case program receives one.

3. The following generic MASS CHANGE NOD reason messages will be generated:

For all cases except Pickle and QMB, SLMB, SLMB135, AND QDWI:

YOUR NEW SOCIAL SECURITY, SSI AND/OR VA BENEFIT WAS USED TO REFIGURE YOUR ELIGIBILITY FOR ALL TYPES OF AID. THE INCOME LIMITS FOR SOME MEDICALLY NEEDY MEDICAL ASSISTANCE CASES AND FOR OAA, ANB AND APTD FINANCIAL ASSISTANCE WERE ALSO INCREASED. THE ENCLOSED LETTER EXPLAINS THESE CHANGES. ADULT AND FAMILY ASSISTANCE CHAPTERS 600.

For new Pickle cases:

THE PICKLE AMENDMENT PROVIDES THAT IF YOUR MONEY PAYMENT ENDS DUE TO THE SSA COST OF LIVING INCREASE, YOUR ELIGIBILITY FOR CATEGORICALLY NEEDY MEDICAL ASSISTANCE WILL BE REFIGURED WITHOUT COUNTING THE SSA INCREASE. OTHER CHANGES IN YOUR CIRCUMSTANCES COULD STILL MAKE YOU INELIGIBLE FOR MEDICAL ASSISTANCE. ADULT ASSISTANCE CHAPTER 100.

For QMB, SLMB, SLMB135, and QDWI cases:

FEDERAL LAW PROVIDES THAT IF YOUR QMB, SLMB, SLMB135, OR QDWI ELIGIBILITY WOULD END DUE SOLELY TO THE COST OF LIVING INCREASE, WE MUST KEEP YOUR CASE OPEN UNTIL THE NEW FEDERAL POVERTY GUIDELINES ARE AVAILABLE. IN MARCH WE WILL REFIGURE YOUR CASE AND NOTIFY YOU OF ANY CHANGE. ADULT ASSISTANCE CHAPTER 100.

POST-MASS CHANGE REPORTS

The reports described below will be produced as a result of the Mass Change. These reports will be available on CADocView shortly after January 2, 2002.

NMC540RA: AG’s Affected by MC

This report lists all cases upon which the Mass Change ran successfully through confirmation. It contains the following information: D.O., Worker Name, Client Name, and Case Number.

NMC550RA: MC Exception

This report lists cases that were selected for computation during the Mass Change, but were not confirmed due to some discrepancy in data. These cases require further District Office action. It contains the following information: D.O., Worker Name, Client Name, Case Number, Reason for Exception, and Mass Change Type.

NMC810RA: MC PT Liab Override RPT

The Nursing Facility with Patient Liability Override report lists cases that contain a Patient Liability override and therefore the amount did not change. These cases require further District Office action. The report contains the following information: D.O., Worker ID, Client Name, and Case Number.

NMC820RA: MC Skipped Cases RPT

The Unearned Income Type Unverified report lists cases that were not selected for computation during the Mass Change because there was an unverified SSA, SSI or VA Income type. These cases require further District Office action. The report contains the following information: D.O., Worker ID, Client Name, and Case Number.

NMC840RA: MC Part B Premium RPT

The Part B Premium report lists cases whose Part B premium was not updated to the new amount because their existing Part B premium amount was not $50. These cases require further District Office action. The report contains the following information: D.O., Worker ID, Client Name, and Case Number.

FORMS REVISIONS

Form 798A, Resource Assessment for Institutionalized Individuals with Community Spouses, Form 799, Spousal Income Protection, and Form 799A, Income Computation Worksheet for Allocation of Income for Institutionalized Individuals, have been revised to include the increase in the spousal impoverishment limits. With new spousal applications January 1, 2002 or later, use the updated 2002 forms which replace Form 798A, released by SR 01-01/January, 2001 and Forms 799 and 799A, released by SR 01-16/July, 2001. However, rename and retain the PC templates for the 2001 versions of Forms 798A, 799 and 799A, for reference purposes.

On or before January 1, 2002, the new versions of Forms 798A, 799 and 799A will be electronically transmitted to each District Office. Contact Erica Hallstrom, DFA/State Office, at 271-4580 with any questions related to transferring the forms to the PC files.

IMPLEMENTATION

The changes identified in this SR will be implemented on January 1, 2002 for current cases, and will apply to any new cases processed on or after that date.

CLIENT NOTIFICATION

Client letters will be sent:

·   with Notices of Decision during the first week of January to adult category assistance recipients whose benefits have changed as a result of the mass change;

·   to institutionalized individuals and their community spouses in mid-January regarding the changes in the spousal impoverishment figures; and

·   to nursing facility residents and/or their authorized representative, via the New HEIGHTS-generated AE0009, any time a new patient liability is created or a change is made to a current resident’s patient liability.

Copies of all the letters are attached to this SR for reference.

TRAINING

No training is needed or planned due to the procedural nature of this SR.

DISPOSITION

This SR may be deleted or destroyed once its contents have been noted, its posting instructions carried out, 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 February 1, 2002.

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

DFA/JBV:s