SR 02-38 Dated 04/01

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

 

SIGNATURE DATE:

DFA September 11, 2002

SIGNATURE DATE:

OHPM September 13, 2002

FROM:

OFFICE OF THE DIRECTOR, DFA Mary Anne Broshek

OFFICE OF THE DIRECTOR, OHPM Lori Real

AT (OFFICE):

Division of Family Assistance

Office of Health Planning and Medicaid

TO:

DFA Supervisors

Managers of Administration

 

SUBJECT:

Elimination of the Current and Prior Health Insurance Restriction for Healthy Kids Gold Medical Coverage for Infants Under Age 1 (HKG-300)

RETROACTIVE

EFFECTIVE DATE:

 

April 11, 2001

 

 

SUMMARY

 

This SR releases revised policy which eliminates the eligibility restriction that Healthy Kids Gold infants under age 1 (HKG-300) cannot have:

 

·   current medical insurance;

·   had medical insurance within 6 months from the date of application for HKG-300; or

·   terminated prior insurance within 6 months of the HKG-300 application without good cause.

 

Current Policy

Revised Policy

 

Infants under age 1 are ineligible for HKG-300 medical coverage due to the "other Insurance" restriction. This restriction prohibits HKG-300 infants from having:

 

·   current health insurance, or

·   their prior insurance terminated within 6 months of the date of application for HGK-300 without good cause.

 

The "other insurance" restriction has been eliminated for HKG-300 infants. These infants can no longer be denied HKG-300 medical coverage due to current or past health insurance coverage.

 

POLICY

 

The "other insurance" restriction has been eliminated for Healthy Kids Gold medical coverage for infants under age 1 (HKG-300). These infants may be eligible regardless of whether they currently have other medical insurance or if their prior health insurance coverage was terminated within the past 6 months of application, regardless of the reason. Infants eligible for medical coverage under HKG-300 are now treated the same as other children eligible for Medicaid with respect to current or past health insurance coverage.

 

Revised Family Assistance Manual Topics

 

PART 219 CHILDREN UP TO AGE 19

 

IMPLEMENTATION

 

The revised policy is retroactive to April 11, 2001. If District Offices become aware of any HKG-300 cases that were denied on or after that date due to the "other insurance" requirement, the case must be reviewed for all applicable past months. If the case would have been eligible during a past month or months, District Offices must open the case retroactively, as appropriate. The revised policy takes effect immediately for any new or pending applications for HKG-300.

 

In the future, New HEIGHTS will be reprogrammed to eliminate the "other insurance" requirement for HKG-300 infants. Interim implementation procedures are required until the changes can be made.

 

·   Do not complete the TPL (Third Party Liability) screen.

·   Complete Form 956, Heath Insurance Information, and in the upper right hand corner of the form below the form number, write, "HKG-300."

·   Forward completed Form 956 to the TPL Unit, Medicaid Administrative Services."

·   Enter the following statement on the "Maintain Case/Indv Comments" screen, "HKG-300 infants exempt from other insurance restriction per SR 02-38."

 

NOTE: Completion of Form 956 will enable TPL to update the Advanced Information Management (AIM) system with current third party insurance information and ensure that the HKG-300 infant’s other insurance will be billed and processed prior to Medicaid billing.

 

CLIENT NOTIFICATION

 

District Offices must advise clients of the revised policy on 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/DHHS/DFA/LIBRARY/Manual/A1.htm effective October 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 Manual.

 

DFA/SJC:s