SR 02-09 Dated 04/02

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases the elimination of the requirement that legally liable relatives must provide financial support to individuals who request medical assistance. This change only affects individuals who are:

·   participating in the adult categories of medical assistance;

·   under age 21 and receiving TANF medical assistance only or TANF-related medical assistance [e.g., an individual receiving Medical Coverage for Pregnant Women (MCPW)]; or

·   blind or disabled, receiving TANF medical assistance only or TANF-related medical assistance, and have opted not to apply for another category of assistance.

POLICY

In accordance with amendments to RSA 167:3-b, Responsibility for Public Medical Assistance, relatives are no longer required to provide financial support to individuals who request medical assistance in the adult, TANF, or TANF-related programs.

The following chart summarizes the changes:

PROCEDURES

Effective April 1, 2002, do not complete Form 64, Legally Responsible Relative Financial Statement, for individuals requesting medical assistance. This form will only be used when an individual requests adult categories of cash assistance (OAA, ANB, APTD). When an individual requests OAA, ANB, or APTD cash assistance, do the following:

1. After identifying the individual’s legally liable relatives in accordance with AAM PART 311, LIABILITY OF RELATIVES TO SUPPORT, enter the information into New HEIGHTS.

2. Because New HEIGHTS no longer generates the AE0029, Statement of Legally Liable Relative, manually complete the top section of page 1 of Form 64 for each legally liable relative identified. Mail the original along with a stamped self-addressed envelope to each relative.

Note: Until District Offices are supplied with the revised 2-Part NCR version of Form 64, use the electronic version released with this SR. The version released with the SR must be printed onto District Office letterhead and may be completed electronically or manually. Make a copy of the Form for the case record prior to mailing it to the relative.

3. Upon return of the Form 64, determine the relative’s monthly contribution, if any, and notify the relative of this determination using Form 66, Notification of Financial Responsibility.

SYSTEMS CHANGES

As of December 1, 2001, New HEIGHTS discontinued the automatic generation of the Legally Liable Relative Letter (AE0018) and the Statement of Legally Liable Relative (AE0029), due to the amendments to RSA 167:3-b. See the System Fix Memo dated 11/30/01 for reference.

FORMS

Form 64, Legally Responsible Relative Financial Statement

Prior to December 1, 2001, New HEIGHTS automatically generated client letter AE0029, Statement of Legally Liable Relative, to the legally liable relatives of individuals requesting financial and/or medical assistance in the adult programs and to the legally liable relatives of individuals requesting TANF medical assistance or TANF-related medical assistance. Because New HEIGHTS was programmed to generate only one AE0029, Case Technicians manually sent Form 64, the DFA paper version of the AE0029, to any additional legally liable relatives.

Once New HEIGHTS discontinued generating the AE0029, Case Technicians were responsible for manually sending out the Form 64 to all legally liable relatives in accordance with the System Fix Memo dated 11/30/01.

Effective with the release of this SR, Form 64 is only to be used to contact legally liable relatives of individuals requesting adult category cash assistance (OAA, APTD, or ANB). Once the legally liable relative completes Form 64 and returns it to the District Office, the Case Technician uses the information provided on the form to determine whether or not the relative is expected to contribute to the individual requesting assistance.

New Form 66, Notification of Financial Responsibility

Form 66, Notification of Financial Responsibility, replaces client letter AE0018 which was previously generated by New HEIGHTS and sent to legally liable relatives who returned a completed AE0029/Form 64. Form 66 indicates:

·   the amount of financial assistance the liable relative is legally required to contribute towards the support of the client;

·   the date the required contributions must begin; and

·   how the amount of the required contribution was determined.

Form Revisions

The revisions made to Form 66 during its transference from a HEIGHTS-generated client letter to a DFA paper form, Form 64, and the instructions for Form 64 were primarily technical in nature and include:

·   removal of the reference to RSA 167:3-b, Responsibility for Public Medical Assistance, from Form 64; and

·   form title changes as reflected in the following table:

Please Note: New check-off box, "Grandparent," has been added to Form 64, under "A. Relationship to the applicant." However, there is only one scenario in which a grandparent could be a legally liable relative in an adult category cash assistance case: when a blind child is born to an unwed minor and that blind child is eligible for ANB. The grandparent(s) of the ANB child in this scenario are legally liable to contribute to the support of that child.

REVISED MANUAL PAGES

Revised Family Assistance Manual Topics

Section 313.01 Medical Assistance Cases: Who Is Liable for Support?

Section 313.03 Medical Assistance Cases: Relative's Ability to Contribute

Section 313.05 Medical Assistance Cases: Determining the Amount of Relative's Contribution

Section 313.07 Cooperation

PART 505 WHOSE INCOME COUNTS?

Revised Adult Assistance Manual Topics

PART 311 LIABILITY OF RELATIVES TO SUPPORT

IMPLEMENTATION

The changes identified in this SR will be implemented statewide beginning April 1, 2002 for current cases, and will apply to any new cases processed on or after that date. For current medical assistance-only cases in which a legally liable relative is contributing (there are fewer than 5 cases in the state in which a legally liable relative is providing a financial contribution to an individual who has requested medical assistance), notify the client at their next redetermination that the contributing relative is no longer liable to support them, but may continue to do so voluntarily.

District Offices will be sent electronic versions of Forms 64 and 66 during the electronic transmission of this SR in anticipation of the April 1, 2002 implementation date:

·   Form 66, Notification of Financial Responsibility, may be detached into your template folder and completed electronically as necessary. This form must be copied or printed onto District Office letterhead and may be printed out in advance for use in case of a power outage or systems failure.

·   Similarly, detach Form 64, Legally Responsible Relative Financial Statement, into your template folder for temporary electronic use beginning April 1, 2002. Use this revised form, printed or copied onto District Office Letterhead, until receiving the initial supply of the NCR forms from State Office.

CLIENT NOTIFICATION

No special notification will occur. Individuals will be advised of the revised policy on an individual as needed basis, when requested, or when application or reapplication for medical assistance-only benefits is requested.

TRAINING

No special training is required or needed for this revision.

POSTING INSTRUCTIONS

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 May 1, 2002.

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

DFA/JBV:s

CERTIFICATE OF DESTRUCTION

I hereby certify that all copies of Form 64, dated July, 1994, SR 94-27, have been destroyed or recycled upon electronic receipt of Form 64, dated April 2002, SR 02-09.

Office Manager: _____________________ District Office: ______________________

Please return this to Stock Control, 6 Hazen Drive, upon receipt of revised forms.