SR 05-01 Dated 01/05

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases a 2.7% cost of living increase to SSA/SSI and VA Annual Review benefits effective January 1, 2005, and the updated:

·   SSI payment levels for individuals and couples;

·   adult Standards of Need for individuals in independent living arrangements, residential care facilities, and community residences;

·   Protected Income Limit (PIL) for an assistance group size of 1;

·   Medicare Part B premium amount;

·   spousal impoverishment figures and Nursing Facility CAP; and

·   Substantial Gainful Activity (SGA) income ceiling.

In addition, the following forms were revised to reflect the increased spousal impoverishment figures:

·   Form 798A, Resource Assessment for Institutionalized Individuals with Community Spouses;

·   Form 799, Spousal Income Protection; and

·   Form 799A, Income Computation Worksheet for Allocation of Income for Institutionalized Individuals.

POLICY

COLA INCREASE

Based upon the 2.7% cost of living increase to SSA/SSI and VA Annual Review benefits, the SSI maximum monthly benefit levels for independent living arrangements increased as follows:

-   for an individual, from $564 to $579;

-   for an individual and a spouse or needy essential person, from $846 to $869; and

-   for a couple and needy essential person, from $1,128 to $1,159.

The adult Standard of Need for OAA, ANB, and APTD individuals increased as follows:

The Protected Income Limit (PIL) for an assistance group size of one increased from $578 to $593. The PILs for all other group sizes remained the same.

The Medicare Part B monthly premium cost will increase from $66.60 to $78.20.

VA Annual Review cases will have a 2.7% cost of living increase.

The Nursing Facility CAP remains at $1,250.

Spousal Impoverishment limits increased:

·   Maximum monthly maintenance allowance from $2,319 to $2,378;

·   Minimum resource standard from $18,552 to $19,020; and

·   Maximum spousal resource allowance from $92,760 to $95,100.

SGA INCREASE

The Substantial Gainful Activity (SGA) income ceiling increased from $810 to $830. The SGA is used only during initial APTD eligibility determinations to determine earned income limits for working disabled individuals. To be eligible for APTD, working applicants must have an adjusted earned income of less than the SGA.

The SGA figure is adjusted annually in accordance with changes to the national average wage index per 20 CFR 416.974.

PROCEDURES

Mass Change procedures for New HEIGHTS are noted under the appropriate heading below.

SSA/SSI Increase

SSA/SSI benefits are updated in January by crossmatching open SSA/SSI cases in New HEIGHTS against the BENDEX and SDX tapes using the individual’s Social Security Number (SSN). New HEIGHTS will conduct a pre-mass change crossmatch to determine the number of SSA/SSI cases in New HEIGHTS that are identified as having an SSN that differs from the BENDEX/SDX tapes. District Offices were provided with a listing of cases with SSN discrepancies and a deadline for fixing them, under separate cover.

During the January mass change, all open SSA/SSI cases will be re-crossmatched against the BENDEX and SDX tapes. For those cases that match, the SSA/SSI amount will be replaced with the actual check amount listed on the BENDEX/SDX tape and benefits will be recomputed. For those SSA/SSI cases that do not match, New HEIGHTS will apply the 2.7% increase and round up to the nearest dollar.

VA Increase

New HEIGHTS will apply a 2.7% COLA increase, dropping all cents, to all VA benefits with an annual review indicator. If a case with an annual review indicator also has Aid and Attendance (A&A) benefits, the 2.7% COLA will also be applied to the A&A benefits, dropping all cents.

Widows and children of veterans are entitled to a COLA only through an Act of Congress. This type of increase is referred to as a Periodic Legislative Increase (PLI) since their benefits do not automatically increase with the January COLA. Congress recently authorized a 2.7% PLI for these individuals beginning with the December 2004 benefits, which are payable in January 2005. Any cases that have an annual review indicator on New HEIGHTS will have the 2.7% COLA applied to their benefits during the mass change.

$2 Minimum Grant Cases

Certain cases currently eligible for adult category cash assistance, but not actually receiving the grant because the amount is under $2 per month, may now qualify to receive a grant due to the increase in the SON.

Medically Needy Cases that Become Categorically Eligible

All open adult category medically needy medical assistance (MA) assistance groups (AG’s) will be part of the Mass Change. Because the SON is also the categorically needy income limit, if a medically needy AG’s income is now below the SON, and resources do not exceed the limit for categorically needy MA, New HEIGHTS will change their AG type to categorically needy. In addition, District Offices need to be aware that affected AG’s may now be eligible for adult category cash assistance, subject to the $2 minimum grant requirement. Affected AG’s desiring cash assistance must file an application and meet all eligibility requirements.

Individuals who make inquiry regarding this possibility must be informed of:

·   the requirement to file an application for cash assistance;

·   the State’s right to recover the cost of adult category OAA and APTD financial assistance provided; and

·   the State’s right to file a lien against real property as part of the recovery process.

In and Out Medical Assistance

In and Out Medical Assistance cases of one will use the new PIL amount for the January spenddown. Note that the PIL for group sizes larger than one did not change for 2005. The new PIL and adjusted benefit increases will be used for all January In and Out cases currently in a six-month application period.

If a medically needy assistance group (AG) currently in "deductible status" has income over the old PIL, but less than or equal to the new PIL for a group size of 1, New HEIGHTS will open medical assistance. The appropriate mass change reason message will be included in the NOD issued as a result of this calculation.

Three-Month Retroactive Medical Assistance Cases

New HEIGHTS will automatically use pre-mass change SON/PIL amounts for Three-Month Retroactive Medical Assistance eligibility determinations for months prior to January 1, 2005.

Pickle Amendment Cases

The Pickle Amendment prevents SSA cases with a state supplement (ANB, APTD, OAA) from closing due to the COLA increase. New HEIGHTS Pickle Amendment cases are processed automatically. The calculations and COLA deduction for cases that would lose cash payment are invisible to DO staff. Questions about the calculations or COLA deduction on New HEIGHTS Pickle cases should be directed to the New HEIGHTS Help Desk.

QMB, QDWI, SLMB, and SLMB135 Cases

Federal law mandates that COLA increases for the year 2005 cannot be used to determine QMB, QDWI, SLMB, and SLMB135 eligibility until after the annual update to the federal poverty levels is effective April 1, 2005. Until the new figures are available, cases that would close due to the COLA will be kept open automatically by New HEIGHTS.

Adult Category Recoupment

For recoupment cases, New HEIGHTS will recompute the amounts when the case goes through the mass change. The notice of the revised amount will be generated automatically as well.

Spousal Impoverishment Cases

New HEIGHTS will handle spousal cases automatically.

Effective January 1, 2005, the maximum monthly maintenance allowance increases from $2,319 to $2,378 per month. When determining income allocated to the community spouse for months prior to January 2005, use the $2,319 amount. For example, if an individual applied for institutionalized care in January and requested retroactive medical assistance for December, the District Office would calculate the spousal allocation separately for December and January.

The minimum and maximum resource allowances for the community spouse are also increasing from $18,552 to $19,020 and from $92,760 to $95,100, respectively.

·   The new figures apply only to requests for resource assessments after 12/31/04.

·   Use amounts in effect when the individual applies, regardless of when the assessment was done.

·   These amounts do not affect individuals whose resource amount is between the minimum and maximum.

·   An individual could be resource ineligible in December but resource eligible in January due to the higher figures.

Rollbacks

New HEIGHTS will process rollbacks automatically and the correct values will be used for the pre-January amounts.

Patient Liability

Nursing facilities are automatically notified of the patient’s liability, the monthly amount the resident is expected to pay towards their care, through EDS-AIMS. Any time a new patient liability is created or a change is made to a current resident’s patient liability, New HEIGHTS will automatically generate client letter AE0009 for the nursing facility resident and/or the authorized representative. A copy of this client letter is attached to this SR for reference.

Categorically Eligible Food Stamp Households

Food stamp policy in FSM PART 231, CATEGORICALLY ELIGIBLE HOUSEHOLDS, states that certain public assistance and SSI households are categorically eligible for food stamps without regard to income or resources. To be considered categorically eligible, all members of the food stamp household must be included in an open public assistance and/or SSI case.

New HEIGHTS will calculate food stamp categorical eligibility automatically.

SYSTEM CHANGES

System changes for New HEIGHTS resulting from the mass change are noted under the appropriate headings below.

Mass Change Schedule

The January Mass Change will be included in the daily run over the course of four weeks and is divided into four different groups. Except for nursing facility cases, New HEIGHTS will run no more than 4,000 cases per day over the course of the 4 weeks. The schedule is as follows:

A 10-day ANP will be provided to all AP and MA cases experiencing a change as a result of the mass change. Food Stamp cases experiencing a change will only receive an advance notice if another program of assistance within the case experiences a change due to the mass change.

Mass Change NOD

All cases experiencing a change during the January Mass change will receive an NOD containing an appropriate text message, which correlates to the change(s) in the case as indicated below:

Group 1: In and Out Cases

THE FEDERAL GOVERNMENT INCREASED SOCIAL SECURITY, SSI, AND SOME VA BENEFITS TO REFLECT INCREASES IN THE COST OF LIVING. THE INCOME LIMIT USED TO FIGURE ELIGIBILITY FOR MEDICALLY NEEDY MEDICAL ASSISTANCE FOR ONE PERSON ALSO INCREASED TO $593. YOUR ELIGIBILITY FOR MEDICAL ASSISTANCE WAS REFIGURED USING THE NEW BENEFIT AMOUNT AND INCOME LIMIT.

Group 2: Nursing Facility Cases

THE FEDERAL GOVERNMENT INCREASED SOCIAL SECURITY, SSI, AND SOME VA BENEFITS TO REFLECT INCREASES IN THE COST OF LIVING. THE MEDICARE PART B PREMIUM ALSO INCREASED TO $78.20. YOUR COST OF CARE LIABILITY WAS REFIGURED USING YOUR NEW BENEFIT AMOUNT AND YOUR NEW MEDICARE PART B PREMIUM.

Group 3: All Cash Cases

THE FEDERAL GOVERNMENT INCREASED SOCIAL SECURITY, SSI, AND SOME VA BENEFITS TO REFLECT INCREASES IN THE COST OF LIVING. THE INCOME LIMITS FOR OAA, ANB AND APTD CASH ASSISTANCE WERE ALSO INCREASED. FOR INDIVIDUALS LIVING IN AN INDEPENDENT LIVING ARRANGEMENT, THE INCOME LIMIT INCREASED TO $593 FOR A GROUP SIZE OF ONE AND $870 FOR A COUPLE. FOR INDIVIDUALS LIVING IN A RESIDENTIAL CARE FACILITY OR AN ENHANCED FAMILY CARE RESIDENCE, THE INCOME LIMIT INCREASED TO $773. FOR INDIVIDUALS LIVING IN A SUBSIDIZED COMMUNITY RESIDENCE, THE INCOME LIMIT INCREASED TO $665. FOR INDIVIDUALS LIVING IN A NON-SUBSIDIZED COMMUNITY RESIDENCE, THE INCOME LIMIT INCREASED TO $715.

SOMEONE IN YOUR CASH ASSISTANCE CASE, WHICH MAY INCLUDE A FOSTER CHILD OR AN ADOPTION SUBSIDY CHILD IN YOUR CARE, HAD A CHANGE IN THEIR SOCIAL SECURITY, SSI, OR VA BENEFIT AMOUNT. ELIGIBILITY FOR CASH ASSISTANCE WAS REFIGURED USING THE NEW BENEFIT AMOUNT. IF YOU RECEIVE OAA, ANB, OR APTD CASH ASSISTANCE, THE NEW INCOME LIMITS WERE ALSO USED. THE CHANGE IN YOUR CASH ASSISTANCE BENEFIT AMOUNT MAY HAVE ALSO CHANGED YOUR FOOD STAMP AND/OR MEDICAL ASSISTANCE BENEFITS.

Group 4: Remaining Selected Cases (Cases Experiencing a Change in VA/SSI/SSA; Part A/B; Food Stamp Only; Child Care Only; or MA Only)

THE FEDERAL GOVERNMENT INCREASED SOCIAL SECURITY, SSI, AND SOME VA BENEFITS TO REFLECT INCREASES IN THE COST OF LIVING. BECAUSE SOMEONE IN YOUR ASSISTANCE GROUP HAD A CHANGE IN THEIR SOCIAL SECURITY, SSI, OR VA BENEFIT AMOUNT, ELIGIBILITY FOR ASSISTANCE WAS REFIGURED USING THE NEW BENEFIT AMOUNT.

QMB, SLMB, OR QDWI CASES WHOSE ELIGIBILITY WOULD END DUE SOLELY TO THE COST OF LIVING INCREASE, WILL REMAIN OPEN UNTIL THE NEW FEDERAL POVERTY GUIDELINES ARE AVAILABLE. IN MARCH WE WILL REFIGURE YOUR CASE AND NOTIFY YOU OF ANY CHANGE.

Group 5: Clean Up Cases, (Includes cases that exceptioned out during the mass change)

THE FEDERAL GOVERNMENT INCREASED SOCIAL SECURITY, SSI, AND SOME VA BENEFITS TO REFLECT INCREASES IN THE COST OF LIVING. THE INCOME LIMITS FOR MEDICALLY NEEDY MEDICAL ASSISTANCE FOR 1 PERSON AND INCOME LIMITS FOR CASH ASSISTANCE FOR OAA, ANB, AND APTD WERE ALSO INCREASED.

BECAUSE SOMEONE IN YOUR ASSISTANCE GROUP HAD A CHANGE IN THEIR SOCIAL SECURITY, SSI, OR VA BENEFIT AMOUNT, ELIGIBILITY FOR ASSISTANCE WAS REFIGURED USING THE NEW BENEFIT AMOUNT. IF SOMEONE IN YOUR ASSISTANCE GROUP RECEIVES OAA, ANB, OR APTD CASH ASSISTANCE, THE NEW INCOME LIMITS WERE USED IN THE REFIGURING, TOO.

QMB, SLMB, OR QDWI CASES WHOSE ELIGIBILITY WOULD END DUE SOLELY TO THE COST OF LIVING INCREASE, WILL REMAIN OPEN UNTIL THE NEW FEDERAL POVERTY GUIDELINES ARE AVAILABLE. IN MARCH WE WILL REFIGURE YOUR CASE AND NOTIFY YOU OF ANY CHANGE.

Medicare Part B

New HEIGHTS will automatically update the Medicare Part B premium amount with the figure specified on the BENDEX report.

If New HEIGHTS identifies a case with Medicare Part B premium information but the individual is not found on the BENDEX report, New HEIGHTS will automatically update the premium amount to $78.20 if the old premium entered into New HEIGHTS was equal to $66.60. However, some cases experienced an adjusted Medicare Part B premium in 2004. Because New HEIGHTS cannot depict why these cases had an adjusted premium and the case is not listed on the BENDEX report, the system cannot assume that the adjustment will continue for 2005. These cases will exception out onto the New HEIGHTS NMC840RA report and the client will need to provide their current Part B premium information at their next redetermination.

Some cases will have information on the BENDEX report but no information in New HEIGHTS. These cases cannot be updated automatically by New HEIGHTS because the BENDEX report does not indicate when the client began paying for Medicare Part B. Because there is Medicare Part B information in New HEIGHTS, a report will be run indicating which cases need further action. Procedures for processing these cases will be released at a later date under separate cover.

POST-MASS CHANGE REPORTS

The reports described below will be produced as a result of the Mass Change. These reports will be available in New HEIGHTS as indicated below.

NMC820RA: MC Skipped Cases RPT

The Unearned Income Type Unverified report lists cases that were not selected for computation during the Mass Change because there was an unverified SSA, SSI or VA income type or claim number or an unverified Part B premium amount. These cases require further District Office action. The report contains the following information: DO, Worker ID, Client Name, and Case Number. This report will be available on December 21, 2004 with a run date of December 20, 2004.

NMC840RA: MC Part B Premium RPT

The Part B Premium report lists cases whose Part B premium was not updated to the new amount because their existing Part B premium amount was not $66.60 and the case was not found on the BENDEX report with their current premium amount. The clients on this report will need to provide their current Part B premium information at their next redetermination. The report contains the following information: DO, Worker ID, Client Name, and Case Number. This report will be available on December 21, 2004 with a run date of December 20, 2004.

NMC540RA: AG’s Affected by MC

This report lists all cases that the Mass Change ran successfully through confirmation. It contains the following information: DO, Worker Name, Client Name, and Case Number. This report will be available on December 21, 2004, and on the first business day after each run of the mass change.

NMC550RA: MC Exception

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. It contains the following information: DO, Worker Name, Client Name, Case Number, Reason for Exception, and Mass Change Type. This report will be available on December 21, 2004, and on the first business day after each run of the mass change.

NMC810RA: MC PT Liab Override RPT

The Nursing Facility with Patient Liability Override report lists cases that contain a Patient Liability override and therefore the amount did not change. These cases require further District Office action. The report contains the following information: DO, Worker ID, Client Name, and Case Number. This report will be available on December 28, 2004 with a run date of December 27, 2004.

FORMS REVISIONS

Form 798A, Resource Assessment for Institutionalized Individuals with Community Spouses, Form 799, Spousal Income Protection, and Form 799A, Income Computation Worksheet for Allocation of Income for Institutionalized Individuals, have been revised to include the increase in the spousal impoverishment limits. With new spousal applications January 1, 2005 or later, use the updated 2005 forms that replace Form 798A, released by SR 04-01/January, 2004 and Forms 799 and 799A, released by SR 04-19/July, 2004. However, rename and retain the PC templates for the 2004 versions of Forms 798A, 799, and 799A, for reference purposes.

The new versions of Forms 798A, 799, and 799A will be electronically transmitted to each District Office with the electronic distribution of the SR. Contact Linda White, DFA/State Office, at 271-4580 with any questions related to detaching the forms to your PC.

Revised Family Assistance Manual Topics

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

Revised Adult Assistance Manual Topics

Section 167.03   COLA Adjustments Since 1977

PART 209    AID TO THE PERMANENTLY AND TOTALLY DISABLED

Section 209.03   SGA Adjustments Since 2000

Section 419.03   Determining the Protected Resource Amount

PART 601, TABLE A  INCOME LIMITS

PART 601, TABLE B  INCOME LIMITS FOR HCBC INDIVIDUALS

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

Section 627.03   Allocation to a Community Spouse

IMPLEMENTATION

Changes identified in this SR are effective January 1, 2005 for current cases, and apply to any new cases processed on or after that date.

CLIENT NOTIFICATION

Client letters to institutionalized individuals and their community spouses will be sent during the last week of December 2004 alerting them of the changes in the spousal impoverishment figures.

Additionally, the New HEIGHTS-generated AE0009 will be sent to those nursing facility residents and/or their authorized representative if a new patient liability is created or a change is made to a current resident’s patient liability.

Copies of all the letters are attached to this SR for reference.

TRAINING

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

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.nh.gov/DHHS/DFA/LIBRARY, effective January 10, 2005.

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

DFA/DMS:s