SR 03-31 Dated 07/03

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

The attached SR releases a change in the Title XXI Healthy Kids Silver program. The six (6) month eligibility guarantee of continuous medical coverage, regardless of changes in income eligibility during that six months, has been changed to one (1) month of guaranteed coverage under the HKS program.

BACKGROUND

In accordance with SR 99-02, the Division of Family Assistance (DFA) currently provides a minimum of 6 months guaranteed medical coverage to children enrolled in the Healthy Kids Silver (HKS) program regardless of eligibility changes based upon income which occur during that six month period. Although HKS is a managed care plan under Title XXI, HKS-eligible children have historically received the same 6 months guaranteed coverage, regardless of eligibility changes based upon income occurring during that 6 month period, as was provided to children enrolled in NH Title XIX (Medicaid) Managed Care.

This SR officially releases policy changing the guaranteed medical coverage period under HKS from 6 months to one month.

POLICY

Effective July 1, 2003, Healthy Kids Silver enrolled children will receive one month of guaranteed medical coverage, regardless of eligibility changes based upon income occurring during that period. This one month coverage guarantee does not apply under the following circumstances:

·   once the child reaches age 19,

·   when eligibility was obtained due to fraud or false or misleading statements,

·   when the child becomes ineligible for HKS due to obtaining other medical insurance,

·   when the child becomes ineligible for HKS due to nonpayment of premium, or

·   when the child is no longer a resident of New Hampshire.

District Offices are reminded that this SR changes only the length of the guaranteed medical coverage period under the HKS program, and that all other eligibility aspects of the HKS program remain in effect as released by SR 99-02.

There are no Family Assistance Manual pages to revise.

IMPLEMENTATION

This change is effective July 1, 2003.

CLIENT NOTIFICATION

No enrollment or public education information changes are necessary.

TRAINING

Training is not planned or needed for this change.

NEW HEIGHTS PROCEDURES

A date exchange process was crafted between New HEIGHTS and New Hampshire Healthy Kids to allow a case to close at the end of the month in which the case income was determined to be in excess of the HKS limits.

If a manual workaround is needed, the following process should be used:

When a FSS worker enters a change that could potentially result in an individual being over income in the first 6 months, the worker must first review the budget to determine whether the individual is actually over income. If the individual is over income, the worker should go to the Program of Assistance Screen (POA) and turn the individual's medical assistance request to "No," select the closure reason of "Income Exceeds the Program Limit," and then run SFU/EDBC and confirmation. This will allow the individual's medical assistance coverage to terminate at the end of the month the advance notice period expires in. The closure transaction will then be sent over the HEIGHTS interface to the New Hampshire Healthy Kids Corporation (NHHKC).

DISPOSITION

This SR may be destroyed or deleted after its contents have been noted and the SR has been posted to the On-line manual.

DISTRIBUTION

This SR will be distributed according to the electronic distribution list for Division of Family Assistance policy releases. This SR will be available for agency staff in the On-Line Manual Library, effective September 1, 2003, and for public access on the Internet at http://www.dhhs.state.nh.us/DHHS/DFA/LIBRARY.

This SR will be distributed under separate cover to all hard copy holders of the Family Assistance Manual.

OHPM/JB