SR 02-10 Dated 04/02

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases mandatory income limit increases for the following programs:

·   Qualified Medicare Beneficiaries (QMB);

·   Specified Low-Income Medicare Beneficiaries (SLMB, SLMB135, SLMB175);

·   Qualified Disabled Working Individuals (QDWI);

·   Medical Coverage for Pregnant Women (MCPW);

·   Children’s Medical Assistance (CMA);

·   Qualified Pregnant Women (QPW);

·   Healthy Kids-Silver (HKS), and Healthy Kids-Gold medical coverage groups based on a percentage of federal poverty limits (HKG-185 and HKG-300); and

·   Twelve-Month Extended Medical Assistance (EMA).

In addition, this SR releases updates to the:

·   gross annual income used to determine if a relative is liable to contribute to the support of an individual requesting assistance; and

·   income and resource limits for Medicaid for Employed Adults with Disabilities (MEAD).

These increases reflect the 2002 Federal Poverty Income Guidelines published in the Federal Register of February 14, 2002.

POLICY

The updated net income limits for QMB, SLMB, SLMB135, SLMB175, QDWI, 12-Month EMA, CMA, QPW, MCPW, Healthy Kids-Silver, affected Healthy Kids-Gold groups, liability of relatives to support, and MEAD, are effective as of April 1, 2002. Resource limits for the MEAD program have also increased effective April 1, 2002.

The premium breaks have changed for the Healthy Kids-Silver and MEAD programs:

·   The increase in the Healthy Kids-Silver income limits (250% of poverty guideline) may make some families eligible for the $20 per child premium rather than the $40 per child premium.

·   Payment of MEAD premiums is processed through New Hampshire Healthy Kids Corporation (NHHKC), however the changes to the MEAD program premium break levels have been included in this SR for reference.

Qualified Medicare Beneficiaries (QMB)

QMB monthly net income limits are based on 100% of the 2002 Federal Poverty Income Guidelines.

Specified Low-Income Medicare Beneficiaries (SLMB)

Monthly net income limits for SLMB are set at 120% of the 2002 Federal Poverty Income Guidelines.

SLMB135

Monthly net income limits for SLMB135 are set at 135% of the 2002 Federal Poverty Income Guidelines.

SLMB175

Monthly net income limits for SLMB175 are set at 175% of the 2002 Federal Poverty Income Guidelines.

NOTE: Because SLMB175 cases are processed manually, instructions for proper updating of open SLMB175 cases may be found in the Manual Procedures for SLMB175 Eligibility Determination and Benefit Issuance section below.

Qualified Disabled Working Individuals (QDWI)

Monthly net income limits for QDWI are set at 200% of the 2002 Federal Poverty Income Guidelines.

Medical Coverage for Pregnant Women (MCPW) and 12-Month Extended Medical Assistance (EMA)

Monthly net income limits for MCPW and the second 6 months of 12-Month EMA are based on 185% of the 2002 federal poverty income guidelines.

Healthy Kids-Silver and Healthy Kids-Gold

Monthly net income limits for affected Healthy Kids-Gold (HKG-185 and HKG-300) and for Healthy Kids-Silver medical coverage groups are provided below.

Healthy Kids-Gold (HKG-185)

Monthly net income limits for HKG-185 are based on 185% of the 2002 Federal Poverty Income Guidelines.

Healthy Kids-Silver (HKS) and Healthy Kids-Gold Expanded Infants (HKG-300)

Monthly net income limits for HKS and HKG-300 are based on 300% of the 2002 Federal Poverty Income Guidelines.

Healthy Kids-Silver Premium Break (250%)

Cases with income above 185% but no higher than 250% of the Federal Poverty Income Guidelines, pay a per child monthly premium of $20 for Healthy Kids Silver medical insurance. Cases with income over 250% but at or under 300% pay a $40 per child premium. Some families paying $40 per child per month may now be eligible for the $20 premium payment.

Annual Income Limits for Legally Liable Relatives

Each April 1, income limits for legally liable relatives must be updated according to 200% of the current year’s federal poverty guidelines.

Medicaid for Employed Adults with Disabilities (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 as noted below:

Workaround: Until the MEAD income limits are programmed, the "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 application date as the begin date of the deduction, unless retroactive coverage is requested. Note that retroactive MEAD coverage may only go back to 2/1/02, if the individual is eligible. Leave the end date blank until the case no longer meets MEAD eligibility requirements.

Resource Requirements

To be eligible for assistance under MEAD, the individual’s countable resources must not exceed the following:

This treatment also applies to a married couple when either or both spouses are eligible for HCBC services.

Premiums

Medical coverage under MEAD requires no premium for individuals whose net income is less than 150% of the Federal Poverty Level Guidelines. 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. The following figures are provided for informational purposes only because payment of premiums is processed through New Hampshire Healthy Kids Corporation (NHHKC).

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.

SYSTEMS PROCEDURES AND IMPLEMENTATION

New HEIGHTS will update all reference tables with the new income limits effective April 1, 2002, and will use the new amounts for any eligibility periods beginning on or after that date.

Due to the small number of cases that are affected by the updates released by this SR, all cases that will experience a change have been incorporated into the daily "mass changes" in the following ways:

1. On the evening of March 20, 2002, New HEIGHTS will recalculate eligibility based upon current SSA/SSI income for QMB, SLMB, SLMB 135, and QDWI cases that were kept open at the January 2002 mass change.

2. During the daily mass change the evening of March 29, 2002, New HEIGHTS will recalculate eligibility for the following categories:

·   CMA and QPW cases that are in "deductible" status;

·   HKS; and

·   MEAD cases with net income equal to or over $1,074, but less than $1,108 (the new $0 premium break).

Note: Currently open HKG-185 and HKG-300 cases, MCPW, and 12-Month EMA cases are not affected by the new income limits. Rerun SFU and EDBC at the next change action so that the new case budgets reflect the new limits.

Special New HEIGHTS and manual procedures are detailed below.

NOTICES

Assistance groups experiencing no change in eligibility status will not receive a notice. Assistance groups experiencing a change in eligibility due to the mass change will receive Notices of Decision (NOD) as follows:

·   HKS, CMA, and QPW assistance groups that become eligible for another medical assistance program due to the income limit changes will receive the regular New HEIGHTS "open for medical assistance" NOD.

·   QMB and SLMB assistance groups that become eligible for another medical assistance category due to the income limit changes will receive the regular New HEIGHTS "open for QMB/SLMB assistance" NOD.

·   QDWI, QMB, SLMB, and SLMB135 cases that close will receive the regular New HEIGHTS "closing for QMB/SLMB/QWDI" NOD.

QMB, QDWI, SLMB, SLMB135, and SLMB175

Federal law mandates that the SSA/SSI COLA increase of January 2002 cannot be used to determine QMB, QDWI, SLMB, SLMB135, and SLMB175 eligibility until after the annual update to the federal poverty levels effective April 1, 2002. These cases will now have their current income, including the COLA, compared to the new limits for their programs by New HEIGHTS and appropriate notices will be generated to all cases that change category. Manually processed SLMB175 cases, however, require the special procedures specified in the Manual Procedures for SLMB175 Eligibility Determination and Benefit Issuance section below.

Although it is expected that very few cases will experience a change in medical assistance categories, DFA will generate a client mailing to all QMB, SLMB, and SLMB135 cases that closed or opened during the mass change, to explain program requirements and benefits for each of the Medicare Beneficiary Programs. The client letter is attached for reference.

Manual Procedures for SLMB175 Eligibility Determination and Benefit Issuance

As detailed in SR 02-01 and SR 99-18, separate manual eligibility determinations for SLMB175 cases must be performed for the months January, February, and March, and for the period April through December.

For any application for SLMB175 coverage made after April 1, 2002:

·   When determining retroactive eligibility for the months January through March 2002, the January 2002 COLA increase must be deducted from the SSA benefit amount and the 2001 Federal Poverty Income Guidelines must be used.

·   When determining eligibility for the remainder of the year, April through December, use the full SSA benefit, including the COLA increase, and the 2002 Federal Poverty Income Guidelines.

·   Issue benefits and notices as directed in SR 02-01 and SR 99-18.

For all current SLMB175 cases:

·   Eligibility must be redetermined for the period April through December using the full SSA benefit, including the COLA increase, and the 2002 Federal Poverty Income Guidelines.

·   Issue benefits and notices for April through December as directed in SR 02-01 and SR 99-18.

Note: Some individuals currently eligible for SLMB175 may now be eligible for SLMB135 due to the increase in the income limits. Should this occur, send a manual NOD informing the individual of the termination of SLMB175 eligibility, that their eligibility for other programs is being reviewed, and that they will receive another Notice shortly. Enter the appropriate case information into the New HEIGHTS system. If the case is eligible for SLMB135, a regular "open for SLMB assistance" NOD will be sent.

Children’s Medical Assistance (CMA) and Qualified Pregnant Women (QPW)

New HEIGHTS will run CMA and QPW cases that are in "deductible" status through the mass change. Deductible status refers to cases that have not yet opened for Medicaid because the spenddown has not been met.

As a result of the increase in the HKG and MCPW income limits, some individuals currently eligible for CMA and QPW may become eligible for HKG or MCPW. If eligible for a different medical coverage, New HEIGHTS will send a trigger to MMIS alerting them of the eligibility for HKG or MCPW and will generate the regular "open for medical assistance" NOD.

CMA or QPW assistance groups that are currently open and receiving Medicaid because they have met the spenddown will not be run through the mass change. For open Medicaid CMA or QPW cases, rerun SFU and EDBC at the next change action so that the case budgets reflect the new limits.

Healthy Kids-Silver Premium Break

New HEIGHTS will run the mass change for all open HKS assistance groups. As a result of the increase in income limits, some HKS cases may become eligible for one of the following:

·   the lower HKS premium: New Hampshire Healthy Kids Corporation (NHHKC) will notify these cases and no District Office action is required; or

·   Healthy Kids-Gold (HKG): These cases will be sent an "open for medical assistance" NOD.

New HEIGHTS will send a trigger to:

-   NHHKC, alerting them to close the case from HKS; and

-   MMIS, alerting them of the eligibility for HKG.

Healthy Kids-Silver (HKS)

Currently open HKS cases may become eligible for HKG-185 benefits as a result of the higher income limits. New HEIGHTS will identify cases that appear eligible for a different coverage category and take appropriate action. It is expected that there will be a very small number of affected cases statewide.

Post Mass Change Reports

The two reports described below will be produced as a result of the mass change and both must be reviewed by District Office Staff as District Office action is required. They will become available on CADocView on the following dates:

·   March 21, 2002 for the QWDI, QMB, and the SLMB assistance groups; and

·   March 30, 2002 for HKS and the CMA and QPW cases that are in "deductible" status.

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.

Note: New HEIGHTS pre-screened the QMB and SLMB cases that would be affected by the April mass change and identified the following cases that will close:

·   3 QMB cases (screened for SLMB and SLMB135 and were not eligible);

·   5 SLMB cases (screened for SLMB135 and were not eligibile); and

·   5 SLMB135 cases.

The "AG’s Affected by MC" report generated on March 21, 2002 will identify the 13 anticipated QMB/SLMB/SLMB135 case closings. Case Technicians must contact these individuals to discuss with them their potential eligibility for SLMB175. If eligible, issue benefits and notices as directed in the Manual Procedures for SLMB175 Eligibility Determination and Benefit Issuance section above.

NMC550RA: MC Exception Report

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. The report contains the following information: D.O., Worker Name, Client Name, Case Number, Reason for Exception, and Mass Change Type

Note: The "MC Exception" report generated on March 21, 2002 will contain individuals who:

·   closed for SLMB and then opened for SLMB135; and

·   are also participating in another Medicaid program.

Individuals cannot be concurrently open for SLMB135 and another Medicaid program at the same time, consequently these case have "exceptioned out" during the April Mass Change. Staff must review this report, which is sorted by DO and worker name, to identify those of their cases that might have exceptioned out for this particular reason. Although the client will have received a letter in the mail explaining that they may not be concurrently open for SLMB135 and another Medicaid program at the same time, Case Technicians must contact these individuals and then note in the caseload management case comments folder the individual’s choice (e.g., SLMB135 or the Medicaid program for which they are open).

POLICY MANUAL REVISIONS

Revised Family Assistance Manual Topics

Section 220.03 Eligibility Requirements

PART 601, Table C TANF Medical Assistance Net Income Limits and Percentages of Poverty Level

Revised Adult Assistance Manual Topics

Section 311.01 Relative's Ability to Contribute

Section 407.01 Financial Assistance and Categorically Needy Medical Assistance

PART 601, Table C Qualified Medicare Beneficiary (QMB)

PART 601, Table D Specified Low Income Medicare Beneficiary: SLMB, SLMB135, and SLMB175

PART 601, Table E Qualified Disabled and Working Individual (QDWI)

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

IMPLEMENTATION

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

CLIENT NOTIFICATION

There will be a special client mailing to notify all QMB, SLMB, and SLMB135 cases that closed or opened during the mass change of program requirements and benefits for each of the Medicare beneficiary programs. The client letter is attached for reference. Affected individuals and assistance groups will also receive appropriate notices as detailed above.

TRAINING

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

DISPOSITION

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

Holders of hard copy versions of the FAM and AAM should retain this SR for reference until the printed manuals have been received and their posting instructions carried out.

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 and Adult Assistance Manuals. A copy will also be sent to New Hampshire Healthy Kids Corporation.

DFA/JBV:s