SR 05-10 Dated 04/05

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 and SLMB135);

·   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);

·   Twelve-Month Extended Medical Assistance (EMA); and

·   Medicaid for Employed Adults with Disabilities (MEAD).

This SR also 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

·   resource limits for MEAD.

These increases reflect the 2005 Federal Poverty Income Guidelines published in the Federal Register of February 18, 2005.

POLICY

The updated net income limits for QMB, SLMB, SLMB135, QDWI, 12-Month EMA, CMA, QPW, MCPW, Healthy Kids-Silver, affected Healthy Kids-Gold groups, MEAD, and liability of relatives to support, are effective April 1, 2005. Resource limits for the MEAD program also increased effective April 1, 2005.

The premium breaks have changed for the Healthy Kids-Silver program, which means the increase in the Healthy Kids-Silver income limits (250% of poverty guideline) may make some families eligible for the $25 per child premium rather than the $45 per child premium.

Qualified Medicare Beneficiaries (QMB)

For QMB, monthly net income must be less than or equal to 100% of the Federal Poverty Level (FPL).

Specified Low-Income Medicare Beneficiaries (SLMB)

For SLMB, monthly net income must be greater than 100% of the FPL, but less than or equal to 120% of the FPL.

SLMB135

For SLMB135, monthly net income must be greater than 120% of the FPL, but less than or equal to 135% of the FPL.

Qualified Disabled Working Individuals (QDWI)

For QDWI, monthly net income must be less than or equal to 200% of the FPL.

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 FPL.

Healthy Kids-Gold and Healthy Kids-Silver

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 FPL.

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 FPL.

Healthy Kids-Silver Premium Break (250%)

Cases with income above 185% but no higher than 250% of the FPL, pay a per child monthly premium of $25 for Healthy Kids Silver medical insurance. Cases with income over 250% but equal to or less than 300%, pay a $45 per child premium. Some families paying $45 per child per month may now be eligible for the $25 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 FPL.

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 FPL as noted below:

Resource Requirements

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

UNRELATED POLICY CLARIFICATION IN FAM GLOSSARY

The definition of "processing month" was revised to clarify that the processing month is the month that computer entries are made and confirmed. FAM, Glossary P-Words, has been updated to align manual topics with current policy.

SYSTEMS PROCEDURES AND IMPLEMENTATION

New HEIGHTS will update all reference tables with the new income limits effective April 1, 2005, 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" that will run on the evening of March 14, 2005.

For QMB, SLMB, SLMB135, and QDWI cases that were kept open at the January 2005 mass change, New HEIGHTS will recalculate eligibility based upon current SSA/SSI income. Because these households will now have their current income, including the COLA, compared to the new income limits for their programs, some cases may change category, or in very limited circumstances some cases may close, requiring an advance notice period.

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.

NOTICES

Assistance groups experiencing a change in eligibility due to the mass change will receive the following Notice of Decision (NOD):

FEDERAL INCOME LIMITS FOR CERTAIN MEDICAL ASSISTANCE PROGRAMS WERE UPDATED EFFECTIVE APRIL 1. IN ADDITION, IF YOU RECEIVED A COST-OF-LIVING INCREASE IN YOUR SSA, VA, OR SSI BENEFIT THAT WE DID NOT COUNT IN JANUARY, FEDERAL LAW STATES WE MUST NOW COUNT THE ADDITIONAL INCOME. DUE TO CHANGES IN THE FEDERAL INCOME LIMITS OR BECAUSE YOUR COST-OF-LIVING INCREASE IS NOW COUNTED, A CHANGE WAS MADE TO YOUR BENEFITS.

QMB, QDWI, SLMB, and SLMB135

Federal law mandates that the SSA/SSI COLA increase of January 2005 cannot be used to determine QMB, QDWI, SLMB, and SLMB135 eligibility until after the annual update to the federal poverty levels effective April 1, 2005. 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.

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 (NHHK) will notify these cases; or

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

New HEIGHTS will send a trigger to:

·   NHHK, 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. The reports will be located in the New HEIGHTS Reports folder under both the D.O. Daily Reports and Mass Change Reports folders. Although they will be generated on March 14, 2005, they will become available in New HEIGHTS on March 15, 2005.

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. This report will be available as noted 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.

The Exception Report will contain:

·   QWDI/QMB/SLMB cases, CMA/QPW cases in "deductible" status, and HKS cases that are pending verification, because New HEIGHTS cannot confirm a pending case during a mass change; and

·   SLMB cases that:

-   due to increased income, closed and then re-opened for SLMB135; and

-   are also participating in another Medicaid program.

Procedures for Cases that Have Exceptioned Out Due to Pending Verification

Upon obtaining verification, rerun EDBC.

Procedures for SLMB135 Cases that have Exceptioned Out Due to Concurrent Medicaid Coverage

Because cases may not be concurrently open for SLMB135 and another Medicaid program, contact each individual identified to obtain the client’s choice of coverage (e.g., SLMB135 or the Medicaid program for which they are currently open). Enter when the contact was made and the client’s choice of coverage in the caseload management case comments folder.

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

Glossary   P-Words

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 andSLMB135

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

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

IMPLEMENTATION

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

CLIENT NOTIFICATION

Clients experiencing a change in their case will receive the text message described in the Notice section of this SR. No other client notification is planned or needed.

TRAINING

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

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.nh.gov/DHHS/DFA/LIBRARY, effective April 4, 2005.

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.