SR 02-04 Dated 02/02

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR establishes a new medical assistance coverage group, Medicaid for Employed Adults with Disabilities (MEAD), which enables MEAD-eligible individuals to retain and secure gainful employment and still maintain health insurance coverage.

Major provisions of the MEAD coverage group are summarized below.

·   The individual must be age 18 through 64 inclusive.

·   Individuals must meet the medical criteria for either APTD, ANB, or MEAD.

·   The individual must be employed, or self-employed, for pay.

·   The income limit for MEAD is 450% of the Federal Poverty Guidelines.

·   Resource limits for MEAD are $20,000 for an individual and $30,000 for a married couple. In addition, MEAD-eligible individuals are entitled to special resource exclusions.

·   MEAD-eligible individuals must enroll in cost-free health insurance through their employer, if such a plan is available to them.

·   MEAD-eligible individuals may be required, as a condition of eligibility, to pay premiums, depending upon income.

·   Retroactive medical assistance is available to MEAD-eligible individuals; however, eligibility through MEAD is not available prior to February 1, 2002.

·   The processing timeframes for MEAD are the same as those for APTD.

·   MEAD provides the same Medicaid services that are available to current adult category medical assistance recipients, including services available under the HCBC waivers to individuals who are HCBC-eligible.

·   The Department has the right to recover costs for medical services provided under MEAD for individuals over age 55, and for any institutionalized individuals age 18 or older who receive coverage under MEAD.

This SR also releases:

·   new Form 940M, Cover Memo to Accompany Medical Eligibility Information for Medicaid for Employed Adults with Disabilities (MEAD);

·   manual workaround procedures, including suggested text for manually prepared notices of decision, because MEAD will not be established as a separate coverage group in New HEIGHTS as of the SR effective date; and

·   District Offices procedures for processing MEAD applications.

BACKGROUND

It has been a long-standing concern of disabled individuals on Medicaid that when they become employed their income causes them to lose Medicaid eligibility. The Ticket to Work and Work Incentives Improvement Act of 1999 enhances the employment services system for millions of disabled Americans and makes it possible for them to no longer have to choose between accepting employment and having health care coverage. This Act supports disabled working individuals and helps them maximize their employment potential. On June 15, 2001, Governor Shaheen signed House Bill 350-FN into law which enables New Hampshire to establish a Medicaid for Employed Adults with Disabilities coverage group. Policy for this program has been developed with the input and collaboration of disabled individuals, client advocacy groups, benefits experts, medical professionals, community resources, and representatives from the Department of Health and Human Services.

POLICY

Eligibility for MEAD is evaluated after an individual is determined ineligible for APTD/ANB cash assistance, categorically needy and medically needy medical assistance, and 1619 status.

Note: Individuals who are ineligible for APTD or ANB due to excess income have the option to choose MEAD or In and Out. Although MEAD has higher income limits, eligibility may require payment of a premium. Depending upon the individual’s spenddown, incurred medical expenses, and whether the individual has additional insurance, it may be more advantageous for the individual to choose In and Out.

Whenever a workaround is necessary for the implementation of policy, it will be preceded by the word Workaround in boldface type for easy reference. As systems changes are completed, District Offices will be notified under separate cover.

Eligibility Requirements

General and Technical Requirements

To be eligible for MEAD, the individual must meet general and technical requirements for ANB and APTD such as citizenship/alien status, NH residency, and furnishing an SSN. Refer to Adult Assistance Manual (AAM) Chapter 300, NONFINANCIAL CRITERIA, for additional information.

Age Requirement

An individual must be age 18 through age 64 inclusive, to qualify for medical coverage under MEAD. When the individual turns age 65, eligibility under MEAD ceases.

Workaround: For individuals age 64, the District Office must use the "Expected Change" Screen and create an entry to coincide with the month prior to the individual’s 65th birthday as a reminder to close MEAD eligibility effective on the individual’s birthday. Before the case is closed for MEAD, evaluate the case for OAA/MA.

Medical Criteria

To be eligible for assistance under MEAD, the individual must meet the medical criteria for APTD, ANB, or MEAD as determined by the Medicaid Administration Bureau (MAB). Specifically, the individual must have a documented medical impairment that meets or exceeds the SSI criteria for disability and the medical impairment has persisted or is expected to persist for a minimum of 48 months.

The Substantial Gainful Activity (SGA) test does not apply to MEAD-eligible individuals. Individuals medically eligible for MEAD can earn more than the substantial gainful employment income limit.

Employed CSD and HC-CSD children who are age 18 and become ineligible for these CSD and HC-CSD coverage groups due to excess income and/or resources, are potentially eligible for MEAD. A MEAD eligibility determination is required if MEAD is requested because these individuals do not necessarily meet ANB/APTD medical criteria.

Certain employed individuals who are medically eligible for ANB or APTD do not require a separate MEAD medical eligibility determination because they already meet APTD/ANB medical criteria based on case circumstances.

The chart below summarizes the type of medical determination used to evaluate MEAD eligibility.

Note: A MEAD medical eligibility determination only confirms that MEAD medical eligibility criteria is met and does not indicate that APTD/ANB medical criteria are met. If the individual does not meet MEAD medical eligibility criteria and wants to apply for ANB or APTD, a separate medical eligibility determination is required.

If the District Office determines that a MEAD medical determination is required, the following forms must be included when forwarding the request to MAB:

·   Form 177, Non-Medical Evaluation of Disability;

·   Form 900, Authorization to Release Information (2 copies); and

·   Form 940M, Cover Memo to Accompany Medical Eligibility Information for Medicaid for Employed Adults with Disabilities (MEAD).

When a medical eligibility determination is required for a MEAD applicant, New HEIGHTS will generate an alert as "Medical Decision Entered" if MAB enters a disability approval in New HEIGHTS. This is a standard procedure when a disability determination is made by MAB.

Employment

An individual must be employed by others for pay, or self-employed for pay, to qualify for MEAD. To be considered employed or self-employed the individual must:

·   receive cash payment, pay stubs or written documentation from his or her employer which provides the frequency and amount of:

- earnings; and

- payments withheld from earnings pursuant to the Federal Insurance Contributions Act; or

·   if self-employed, provide documentation that he or she makes regular income tax payments based on earnings.

Note: Self-employed individuals are required to file Schedule SE, Self-Employment Income, with Form 1040 if their earnings are $400 or more per year, or, if a church employee, their earnings exceed $108.28 per year. Self-employed individuals with annual self-employment income that equals or exceeds these amounts must furnish last year’s tax return, if they filed one, and, if they make quarterly tax payments, provide proof of this year’s quarterly tax payment. If clients are newly self-employed and anticipate earning enough income to meet filing requirements, set a review to coincide with April 15th (the deadline for filing annual federal income tax returns) as a reminder that they must furnish a copy of their current year’s tax return. Failure to provide a copy of the return will result in termination of MEAD eligibility. However, individuals who are not required to file because they do not meet filing requirements cannot be penalized for failure to provide proof of payment of taxes. In this situation, accept the client’s self-employment records as proof of earnings.

Individuals determined eligible for medical assistance under MEAD who subsequently become unemployed, will continue to meet the employment requirement for a period of one year from the day the individual became unemployed if the individual plans to return to work and:

·   was involuntarily terminated from employment; or

·   voluntarily terminated employment with good cause.

Workaround: If the District Office determines that an individual meets the above requirement, the end of the one year period must be tracked using the "Expected Change" screen.

DFA will determine if an individual has good cause for leaving employment based on the following criteria:

·   discrimination by an employer based on age, race, sex, color, physical or mental disability, religious belief, national origin, or political beliefs;

·   work demands or conditions that render continued employment unreasonable, including but not limited to, employment in which the degree of risk to health or safety is unreasonable or employment yielding weekly earnings of less than the state or federal hourly minimum wage;

·   resignation by a person under the age of 60 which is recognized by the employer as retirement;

·   employment which becomes or is revealed to be unsuitable following acceptance of such employment, including, but not limited to, employment which the individual is physically or mentally unfit to perform, or employment in which the distance from the individual’s home to the place of employment is unreasonable considering the wage and the time and cost of commuting;

·   leaving a job in order to accept a bona-fide job offer which, because of subsequent circumstances beyond the control of the applicant, is withdrawn;

·   leaving a job in connection with patterns of employment in which workers frequently move from one employer to another, such as migrant farm labor or construction work, even though employment at the new site has not actually begun; or

·   leaving a job because of circumstances beyond the control of the individual which render continued employment impracticable, including but not limited to, lack of transportation or child care, or illness, incapacity or disability, or illness, incapacity or disability of another household member serious enough to require the presence in the home of the individual, net loss of cash income, required court appearance, or mandatory appointments.

DFA is required to base good cause decisions on all available facts and circumstances, including written or verbal information provided by:

·   the individual;

·   the employer; or

·   any other party with first hand knowledge of the facts and/or circumstances of the individual’s reasons for leaving employment.

If the individual becomes unemployed due to one of the reasons below, the individual will not continue to be eligible for MEAD.

·   the individual has voluntarily quit or lost employment without good cause;

·   the individual has made a decision not to seek employment or return to work; or

·   the individual terminated employment to seek medical treatment which will not enable the individual to become re-employed.

The District Office must determine the individual’s eligibility for medical assistance through other coverage groups available through the Department prior to terminating eligibility for MEAD.

Income Requirements

The individual’s net income and the spouse’s net income, if living together, must not exceed 450% of the Federal Poverty Level Guidelines. The limits are noted below.

Workaround: Until the MEAD income limits are programmed, a new "MEAD Only" allowable deduction must be selected from the "Expense/Shelter/Utility Other Allowable Deduction" screen. The amount must be entered as $4,000 per month. Select the MEAD effective date as the begin date of the deduction. Leave the end date blank until the case no longer meets MEAD eligibility requirements.

The income limits will be adjusted each April 1st to reflect adjustments to the Federal Poverty Guidelines. District Offices will be notified by SR of the revised figures as part of the annual mass change.

Treatment of Income

Net income for MEAD is determined by applying the APTD or ANB treatment and disregards to the individual’s and, if applicable, the spouse’s gross income, based on the individual’s disability.

Note: This determination also applies if either or both spouses qualify for HCBC services. If the couple meets MEAD financial eligibility requirements, and either or both spouses meet the medical criteria for HCBC services, the HCBC-eligible individual is opened for HCBC services as a group size of 1, but financial eligibility criteria is based on a group size of 2.

Elimination of Cost of Care Liability for MEAD HCBC-Eligible Individuals: There is no longer a cost of care liability for the MEAD HCBC-eligible individual, but there may be a premium required based upon the combined income of the MEAD HCBC-eligible individual and his or her spouse. Complete Form 517-C, Payment Toward Cost of Care Agreement, and identify the individual as MEAD HCBC-eligible with zero cost of care liability.

Due to the complexity of HCBC cases, MEAD-eligible HCBC cases will remain with their current HCBC Case Technician rather than being referred to the MEAD Specialist. In some District Offices, the Case Technician responsible for HCBC cases may also be a MEAD Specialist.

Resource Requirements

To be eligible for assistance under MEAD, the individual’s countable resources must not exceed $20,000. If the individual requesting MEAD resides with a spouse, the combined countable resources of the couple must not exceed $30,000. This treatment also applies to a married couple when either or both spouses are eligible for HCBC services.

In addition to resources excluded for ANB and APTD, the following resources are excluded when determining eligibility for medical coverage under MEAD:

·   retirement plans, including all IRA accounts and Keogh plans;

·   MEAD employability accounts as defined below; and

·   medical savings accounts as defined below.

Note: MEAD protected EI (earned income) resources, as defined below, are excluded when determining future eligibility for non-MEAD adult category medical assistance.

MEAD resource limits will be adjusted each April 1st to reflect percentage increase or decrease adjustments to the Federal Poverty Guidelines. District Offices will be notified by SR of the revised figures as part of the annual mass change.

Definitions

MEAD Employability Account

A MEAD employability account is a separately identifiable account specifically designated and set aside by the individual for the purpose of purchasing certain goods or services that will enhance the individual’s employability and which are not:

·   covered by the Medicaid program;

·   otherwise reimbursable;

·   excluded as income or a resource; or

·   allowed as a deduction as noted in Adult Assistance Manual Chapters 400, 500, or 600.

An individual cannot simultaneously set aside funds for the same item in both a PASS plan and a MEAD employability account.

Items that enhance employability include, but are not limited to:

·   equipment, supplies, operating capital, and inventory required to establish a business;

·   any cost associated with an educational or occupational training facility, including tutoring, counseling, etc.;

·   work-related attendant care services to enable the individual to prepare for work, such as bathing and dressing, or services provided in the workplace;

·   medical devices which enable the individual to work, such as wheelchairs, prosthetics, pacemakers, and respirators;

·   equipment or tools either specific to the individual's condition or designed for general use;

·   least costly transportation expenses to and from work, such as weekly or monthly bus passes;

·   purchase of a private vehicle;

·   operational or accessibility modifications to buildings or vehicles to accommodate a disability;

·   routine drugs or medical services to ameliorate a disability;

·   diagnostic procedures related to evaluation, control, or treatment of a disabling condition;

·   prescribed non-medical appliances and devices essential for controlling the disabling condition at home or work, such as air filtering equipment;

·   expendable medical supplies; and

·   guide dogs, dog food, licenses, and veterinary services.

In accordance with current policy, excluded resources must be reviewed at each redetermination, whenever the client reports a change which affects the resource, and when conflicting information is reported or discovered. Since a MEAD employability account is designated for a specific purpose, if funds are withdrawn from this account for unapproved items, the remaining balance of the account is counted as a resource.

Medical Savings Account

A medical savings account is a tax-exempt account with a financial institution, such as a bank or insurance company, set up for the sole purpose of paying qualified medical expenses of the account holder. Medical savings accounts can be set up by employed individuals who have a high deductible health insurance plan which provides protection against catastrophic illnesses. Funds in a medical savings account are used to pay for out-of-pocket expenses such as routine care, deductibles, co-insurance, and co-payments, but not premiums.

Acceptable documentation of a medical savings account is a copy of the account or account statement, and a copy of completed IRS Form 8853, Archer MSAs and Long Term Care Insurance Contracts.

MEAD protected EI (Earned Income) Resources

MEAD protected EI (Earned Income) resources are liquid resources, including interest earned by the resources, accumulated solely from earnings by a MEAD-eligible individual while on MEAD, and kept in a separate account from other liquid resources.

MEAD protected EI (Earned Income) resources are excluded when determining future medical assistance eligibility for non-MEAD adult category medical assistance. In order for these accounts to be excluded for future eligibility, they must be kept separate and not co-mingled with any other funds. Deposits made after MEAD eligibility ceases, or during the one year period of unemployment, will result in the account being counted as a resource.

Workaround: The MEAD resource limits will not be programmed into New HEIGHTS by the effective date of this SR. If the Case Technician determines that the assistance group’s countable resources exceed $2,500 for an individual or $4,000 for a couple (the resource limits for adult category medical assistance), each resource in excess of the $2,500/$4000 limits must be entered as inaccessible.

Enrollment in Cost-Free Health Insurance Through the Employer

Participants who are eligible for private health insurance through employment or membership in an organization, at no cost to them, must be enrolled in those insurance plans in order to be eligible for MEAD.

/¡¾Medical coverage under MEAD requires no premium for individuals whose net income is less than 150% of the Federal Poverty Level Guidelines. Individuals whose net income is equal to or greater than 150% and less than or equal to 450% of the Federal Poverty Level Guidelines are required to pay a premium based on a sliding scale. Payment of Premiums is processed through New Hampshire Healthy Kids Corporation (NHHKC).

Note: The method of determining the amount of premium payments differs from the net income computation in that SSI payments are counted when determining the premium amount, but are excluded when determining MEAD eligibility.

Participants with net income of at least 150% of the FPL and less than or equal to 450% of the FPL must pay a premium that does not exceed 7.5% of the appropriate lower income range of the FPL. Refer to the charts below.

 Income Ranges by Percentage of FPL

Premium amounts by Dollar Values

Exception: For individuals with annual adjusted gross income over $75,000, the premium is equal to 7.5% of the participant’s and their spouse’s net income, including any SSI payments received by the individual and/or spouse.

The amount of any health insurance premium payments, including Medicare premiums, paid by a participant for the participant or the participant’s spouse or dependent children, will be deducted from the participant’s MEAD premium.

Premium Payment Schedules

The provisions noted below apply to premiums due dates.

·   The first premium payment will be applied to the 2nd calendar month of MEAD coverage and is due on the last day of the month following the month in which eligibility is determined. Premiums for retroactive periods are due at the same time that the first premium payment is due.

EXAMPLE 1 - No Retroactive Coverage Requested

The applicant applies for MEAD in February and is determined eligible in March. There is no premium due for February. The premiums for March and April are due on April 30th.

EXAMPLE 2 - Retroactive Coverage Requested

The applicant applies for MEAD on June 1st and requests retroactive coverage for March, April and May. Eligibility is determined in August. There is no premium due for June. The premium for the 3 retroactive periods and the payment for July, August, and September are due September 30th.

·   Subsequent payments are due on the last day of the month and applied to the current month.

·   No payment is due for the last partial month of coverage during the one year period of unemployment.

Non-Payment of Premiums and Good Cause

·   Non-payment of premiums for 2 consecutive months without good cause, as determined by NHHKC, will result in termination of MEAD.

·   A participant may remain eligible for MEAD following a notice of closing for non-payment of premiums during the advance notice period when:

-   the participant has either paid in full the past due premiums or has a payment plan for past due premiums; or

-   it has been redetermined by NHHKC staff that there is good cause for non-payment and the participant has exhausted all available resources with which to pay past due premiums.

·   Good cause for non-payment of premiums exists when the participant has exhausted all available resources with which to pay their premium or cover their unexpected out-of-pocket medical expenses and at least one of the following criteria is met:

-   the participant experiences a temporary or unexpected loss of income which prevents payment of the premium; or

-   the participant incurs an unexpected out-of-pocket medical expense that prevents payment of the premium.

Requests for Fair Hearings for Termination Due to Nonpayment of Premium

Requests for fair hearings on the basis of closing due to nonpayment of premiums require special procedures.

·   Upon receiving such a request, notify NHHKC so that a prehearing conference can be arranged between their representative and the client.

·   If the issue cannot be resolved, notify NHHKC of the date and time of the hearing.

·   NHHKC will represent the agency at the hearing.

Role of NHHKC in Processing Premiums and Other MEAD Related Functions

The NH Department of Health and Human Services has an agreement with NHHKC which governs the exchange of information between the 2 agencies regarding processing and collection of premiums payments and related functions.

New HEIGHTS will notify NHHKC of the individual's financial eligibility through an electronic interface with NHHKC. The following information is provided through the interface:

·   basic identifying information on the individual, including RID number;

·   client’s address and telephone number(s);

·   MEAD indicator (Y/N);

·   MEAD eligibility begin/end date;

·   assistance group size (1 or 2, if the case is open, 0 if closed) and status (open/closed);

·   net income and SSI income, if applicable; and

·   Medicare Part A and/or B premium amounts if paid by the applicant and/or spouse and the amount(s) have been entered on the Medicare Details Screen by the District Office.

NHHKC will collect payment of the first month’s premium and subsequent premiums and will determine good cause for failure to pay the premium. If good cause does not exist, NHHKC will notify the MEAD liaison at New HEIGHTS that the case should be closed for non-payment of the premium. The MEAD liaison at New HEIGHTS will close the case and follow-up with an e-mail to the Case Technician to issue a manually prepared NOD to advise the client of the closing action.

Note: If an individual reapplies for MEAD after having been terminated for MEAD due to non-payment of the premium, the individual must provide written documentation from NHHKC that payment has been made, or arrangements for payment have been made.

Revised Adult Assistance Manual Topics

PART 209  AID TO THE PERMANENTLY AND TOTALLY DISABLED

PART 210  MEDICAID FOR EMPLOYED ADULTS WITH DISABILITIES (MEAD)

Section 210.01 Non-Financial Eligibility Requirements

Section 210.03 Employment-Related Requirements

Section 210.05 Financial Eligibility Requirements

Section 210.07 MEAD-Specific Resources

Section 210.09 Premium Requirements

Section 407.01 Financial Assistance and Categorically Needy Medical Assistance

PART 411 COMMON TYPES OF RESOURCES: INDIVIDUAL RETIREMENT ACCOUNT

PART 411  COMMON TYPES OF RESOURCES: KEOGH PLAN

PART 413 LESS COMMON TYPES OF RESOURCES: MEAD PROTECTED EARNED INCOME (EI) RESOURCES

PART 601  Table A: Income Limits

PART 601  Table B: Income Limits for HCBC Individuals

PART 601  Table F: Medicaid for Employed Adults with Disabilities (MEAD)

PART 615 BUDGETING: Independent Living, RCF, CR, QMB, QDWI, SLMB, SLMB135, AND SLMB175

Section 621.03 HCBC-ECI Medical Assistance

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

Section 623.03 HCBC-DD Medical Assistance

Section 623.05 Cost of Care: HCBC-DD Medical Assistance

Section 624.03 HCBC-ABD Medical Assistance

Section 624.05 Cost of Care: HCBC-ABD Medical Assistance

IMPLEMENTATION

Unless otherwise noted, February 1, 2002, is the effective date for implementation of MEAD. Each District Office has one or more Case Technicians designated as a MEAD Specialist. The MEAD Specialists have been trained in the policies, procedures, and systems workarounds required for processing MEAD applications. Below is a summary showing processing procedures for current In and Out cases, currently open ANB/APTD cases, and other cases with potential MEAD eligibility.

Current In and Out Cases

·   The week of January 21, 2002, New HEIGHTS will run a report to identify the current statewide ANB/APTD In and Out caseload with earned income. This report will include individuals who have currently met their 1 or 6 month spenddown and individuals who have not yet met their spenddown. This report will facilitate transfer of MEAD-eligible individuals to the MEAD Specialist. Similar reports will be run on a monthly basis for the next 6 months.

·   Prior to February 1, 2002, District Offices will be sent the above mentioned report under separate cover. This report will list individuals whose 6 month spenddown date is February 28, 2002 or later. The following spenddown periods will be listed on the report:

-   September 2001--February 2002;

-   October 2001--March 2002;

-   November 2001--April 2002;

-   December 2001--May 2002;

-   January 2002--June 2002; and

-   February 2002--July 2002.

·   If the client contacts the District Office to submit bills for the 1 or 6 month spenddown period or files a new 6-month application at redetermination, and the case is still potentially MEAD-eligible because the client is employed, the Case Technician will transfer the case to the MEAD Specialist. Any reported or discovered changes which affect eligibility must be verified in accordance with current procedures prior to determining if the case is potentially MEAD-eligible.

·   When setting redetermination dates for In and Out cases that become MEAD-eligible, the redetermination date must be no more than 12 months from the most recent application date.

EXAMPLE

In September of 2001, Mrs. Green applied and was determined eligible for In and Out. In February 2002, the District Office determines that she is MEAD-eligible and sets the next redetermination date for September of 2002.

Pending APTD Applications

Employed APTD individuals whose applications are pending at MAB due to the medical eligibility determination process on February 1, 2002, and who are subsequently denied by MAB for medical reasons, will be screened for MEAD eligibility.

Ongoing ANB/APTD Cash and/or Medical Assistance Cases

District Offices must be aware of potential MEAD eligibility for current cash and/or medical assistance APTD/ANB cases with earned income that no longer meet the income and/or resource requirements for ANB/APTD. The individuals must be referred to the MEAD Specialist prior to closing the case or transferring it to In and Out. The MEAD Specialist will discuss the individual’s options.

Other Individuals Potentially Eligible for MEAD

·   New MEAD applicants will be identified through the "Welcome Sheet," a copy of which is attached for reference. Applicants who indicate that they are disabled and employed will be referred to the MEAD Specialist. If another Case Technician conducts the interview, the client must be provided with basic information on MEAD, including the MEAD brochure, and the case must be transferred to a MEAD Specialist for processing.

·   Benefit Counselors, who are funded through federal grants, will be available on an outreach basis to help disabled individuals access all community resources and services for the disabled, including MEAD.

SYSTEMS CHANGES

Several changes have been made to New HEIGHTS to prepare for the implementation of MEAD:

·   A "MEAD Only" deduction has been added to the "Expense/Shelter/Utility Other Deductions" screen and can be accessed through the drop down menu. This deduction enables New HEIGHTS to bypass ANB/APTD income limits for MEAD- eligible individuals. The deduction amount must be entered as $4,000 per month. Select the MEAD effective date as the begin date of the deduction. Leave the end date blank until the case no longer meets MEAD eligibility requirements.

Note: The $4,000 "MEAD Only" deduction may not be selected if the individual is requesting financial assistance. In addition, the $4,000 "MEAD Only" deduction must be removed when the individual is no longer eligible for MEAD.

·   The following account types have been added to the "Liquid Resource" screen and can be accessed through the drop down menu:

-   MEAD Employability Accounts;

-   Medical Savings Accounts; and

-   MEAD Protected EI (earned income) Res’.

Note: No workaround is required when entering these resource types, because New HEIGHTS treats them as specified in policy.

·   The notation "MEAD Only" has been added to the "Disability" screen. This notation is a switch that MAB sets to confirm that an individual meets MEAD medical eligibility criteria. Although the screen implies that the person meets APTD medical criteria, the MEAD Only switch is solely used to show MEAD medical eligibility status. It is never used to show APTD medical status.

·   The following MEAD-specific NOD reason denial and closing indicators have been added to the "Program of Assistance" screen as drop down values:

-   MEAD Applicant Not Employed;

-   Termination of Employment without Good Cause (MEAD);

-   Expiration of MEAD 12 Month Extension;

-   Failure to Pay MEAD Premium;

-   MEAD Recipient Turning Age 65; and

-   Failure to Enroll in Cost-Free Health Ins. through the Employer.

Note: Until New HEIGHTS changes are fully programmed for MEAD, the above reasons serve as indicators only, and do not trigger actual reason messages. Therefore, the District Office must suppress the HEIGHTS-generated NOD and issue a manual NOD. Refer to INTERIM PROCEDURES for suggested NOD wording.

INTERIM PROCEDURES

Workaround: Since New HEIGHTS is not programmed to show MEAD as a separate MA coverage group, it is necessary to issue manual NODs for MEAD openings, denials, closings, and changes.

When creating the manual NOD, the District Office must refer to the type of assistance being requested as Medicaid for Employed Adults with Disabilities (MEAD). If the case is being denied due to excess income or resources, the NOD must show income and/or resource types and amounts, as is currently done when New HEIGHTS generates an income or resource denial or closing.

Suggested wording for MEAD-specific NODs appears below.

DENIAL

MEAD Applicant Not Employed

TO BE ELIGIBLE FOR MEDICAID FOR EMPLOYED ADULTS WITH DISABILITIES (MEAD), YOU MUST BE WORKING AT A JOB FOR WAGES WHICH ARE SUBJECT TO TAXES FOR FEDERAL INCOME AND SSA PURPOSES. IF YOU ARE SELF-EMPLOYED, YOU MUST FILE ALL REQUIRED INCOME TAX FORMS. YOU DO NOT MEET THE MEAD PROGRAM’S DEFINITION OF BEING EMPLOYED.

POLICY: AAM 210

CLOSING

Termination of Employment without Good Cause (MEAD)

YOU MUST BE WORKING TO GET MEDICAID FOR EMPLOYED ADULTS WITH DISABILITIES (MEAD). YOU STOPPED WORKING AND DID NOT HAVE A GOOD REASON. POLICY: AAM PART 210

Expiration of MEAD 12 Month Extension

YOU MUST BE WORKING TO GET MEDICAID FOR EMPLOYED ADULTS WITH DISABILITIES (MEAD), OR HAVE A GOOD REASON FOR NOT WORKING. BECAUSE YOU HAD A GOOD REASON TO STOP WORKING AND EXPECTED TO GO BACK TO WORK IN THE FUTURE, WE CONTINUED YOUR MEDICAL COVERAGE FOR 12 MONTHS. THE 12 MONTH PERIOD IS NOW OVER, AND YOU HAVE NOT RETURNED TO WORK. IF YOU GO TO WORK AND WANT TO REAPPLY, CONTACT YOUR DISTRICT OFFICE.

POLICY: AAM PART 210

Failure to Pay MEAD Premium

YOU MUST PAY A MONTHLY PREMIUM TO GET MEDICAID FOR EMPLOYED ADULTS WITH DISABILITIES (MEAD). YOU DID NOT PAY YOUR PREMIUM AND DID NOT HAVE A GOOD REASON. TO BE ELIGIBLE AGAIN, YOU MUST PAY THE CURRENT PREMIUM AND ANY PAST DUE PREMIUMS OR SHOW THAT YOU HAVE A GOOD REASON FOR NOT PAYING.

POLICY: AAM PART 210

MEAD Recipient Turning Age 65

TO GET MEDICAID FOR EMPLOYED ADULTS WITH DISABILITIES (MEAD), YOU MUST BE AT LEAST 18 YEARS AND UNDER AGE 65. YOU ARE NOW AGE 65.

POLICY: AAM PART 210

DENIAL OR CLOSING

Failure to Enroll in Cost-Free Health Insurance through the Employer

TO GET MEDICAID FOR EMPLOYED ADULTS WITH DISABILITIES (MEAD), YOU MUST ENROLL IN YOUR EMPLOYER’S HEALTH INSURANCE PLAN IF THE PLAN’S COVERAGE IS FREE TO YOU. YOU DID NOT ENROLL IN YOUR EMPLOYER’S COST-FREE PLAN. IF YOU ENROLL IN A COST-FREE PLAN AVAILABLE TO YOU THROUGH YOUR EMPLOYER AND WANT TO REAPPLY, CONTACT YOUR DISTRICT OFFICE.

MISCELLANEOUS MANUAL NOD ACTION MESSAGES FOR MEAD

Open

YOU ARE ELIGIBLE FOR MEDICAID FOR EMPLOYED ADULTS WITH DISABILITIES. POLICY: AAM PART 210

Beginning of 12 Month MEAD Extension

YOU MUST BE WORKING TO GET MEDICAID FOR EMPLOYED ADULTS WITH DISABILITIES (MEAD). YOU HAD A GOOD REASON TO STOP WORKING AND EXPECT TO GO BACK TO WORK IN THE FUTURE. YOU CAN KEEP GETTING MEDICAL COVERAGE FOR 12 MONTHS AS LONG AS YOU MEET OTHER MEAD ELIGIBILITY REQUIREMENTS. IF YOU HAVE NOT RETURNED TO WORK WHEN THE 12 MONTH PERIOD IS OVER, YOU WILL NO LONGER BE ELIGIBLE FOR MEAD. POLICY: AAM PART 210

FORMS

New Form 940M, Cover Memo to Accompany Medical Eligibility Information for Medicaid for Employed Adults with Disabilities (MEAD), is a tri-colored 3-part NCR document serves as a cover memo for the medical, social, and other information upon which the medical eligibility determination is based, as required by Medicaid policy. It is a communication document between DFA District Offices and MAB during the disability determination process for Medicaid for Employed Adults with Disabilities (MEAD). Specialized MAB staff will conduct MEAD medical eligibility determinations. The decision was made to use a new and separate form for MEAD instead of modifying the existing Form 940, Cover Memo for Medical Eligibility Determination, so that the Medicaid Administration Bureau (MAB) staff can clearly identify requests for MEAD eligibility determinations and capture information specific to MEAD applicants.

The District Office sends copy 1 (yellow) and copy 3 (white) to MAB with the medical eligibility packet, and keeps copy 2 (pink). MAB retains the yellow and white copies of completed Form 940M and enters the information into the Department’s Electronic Eligibility System. If MAB is unable to enter the results of the medical eligibility determination in New HEIGHTS, MAB retains only the yellow copy and sends the annotated white copy indicating the results of the medical eligibility determination to the District Office DFA Case Technician.

The instructions to Form 940M are shadow-printed on the back of each colored copy. Therefore, the posting instructions list Form 940M and 940M(i) together rather than separately.

District Offices were sent an initial photocopied distribution of Form 940M under separate cover prior to the SR effective date. Upon receipt of the printed NCR versions, District Offices must destroy or recycle the photocopied versions. Form 940M will be printed, maintained, and revised as necessary by MAB. It is anticipated that the new forms will be available in mid February and may then be ordered through logistics.

CLIENT NOTIFICATION

Ongoing newsletters to the disability group population have been issued to advise interested parties about MEAD. Consumer groups have received information from trainings and forums. The "Ready, Willing and Able Campaign" has done outreach to publicize MEAD. Web sites through "Dollars and Sense" and "Granite State Independent Living" (GSIL) are also available to assist individuals in learning about MEAD. These web sites encourage potential clients to call the Benefit Counselor at GSIL at 1-800-826-3700 for more information about MEAD. A statewide press release will be issued on or about February 1st.

In addition, District Offices must advise clients of the revised policy on an as needed basis or at client request.

TRAINING

Statewide training was held on January 8, 2001. Selected District Office Supervisors, Case Technicians, other DHHS staff and representatives from Granite State Independent Living Foundation were in attendance. Further trainings will be conducted as the need arises.

POSTING INSTRUCTIONS

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 March 4, 2002.

This SR, and printed pages with posting instructions, will be distributed under separate cover to all hard copy holders of the Adult Assistance and the Forms Manuals. Hard copies of this SR will also be sent to selected staff in the Divisions of Developmental Services, Behavioral Health, and Elderly and Adult Services.

DFA/SJC:s