SR 05-22 Dated 05/05

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases revised eligibility criteria for the Medicaid for Employed Adults with Disabilities (MEAD) program. Specifically, policy for the MEAD program has changed regarding:

·   employment requirements;

·   medical coverage extensions during periods of unemployment;

·   medical impairments criteria;

·   premium requirements; and

·   the treatment of MEAD Protected Earned Income Resources when determining eligibility for non-MEAD adult categories of medical assistance.

This SR also clarifies that MEAD individuals may also be eligible for Home and Community-Based Care for the Elderly and Chronically Ill (HCBC-ECI) services, if the individual meets the medical eligibility criteria for HCBC-ECI.

POLICY

The revised MEAD eligibility criteria are listed below.

MEAD Employment Requirements

·   Applicants must be continuously employed at the time of application through the entire eligibility determination process. If retroactive coverage is requested, applicants must also be employed during any retroactive months for which assistance is requested.

·   Applicants and recipients must earn at least the federal minimum wage.

·   Preparation for employment, such as participation in trainings, does not meet MEAD employment requirements for MEAD eligibility.

·   Resignation by a person under the age of 60 that is recognized by the employer as retirement is not considered a good cause reason for leaving employment.

MEAD Unemployment Extensions

·   If a MEAD recipient becomes unemployed, MEAD medical coverage will continue uninterrupted for 6 months, if the individual remains otherwise eligible, unless unemployment is due to a voluntary quit without good cause. The 6-month extension begins on the day the recipient becomes unemployed.

·   One additional 6-month extension may be granted if the recipient provides:

-   documentation of employment;

-   a written statement from a doctor indicating that the medical condition prevents the recipient from working and an estimated timeframe of when the recipient will be able to return to work; or

·   documentation of the recipient’s job search during the unemployment grace period indicating contacts that have been made to employers and/or employment agencies such as One-Stops, Vocational Rehabilitation, or Employment Networks. Acceptable documentation includes a list of who was contacted, the date of each contact, and a contact name and phone number for each employer or employment agency listed.

MEAD Medical Impairment Criteria

Applicants must have a medical impairment that:

·   meets the Social Security Administration’s Listing of Impairments; and

·   has persisted or is expected to persist for 48 consecutive months.

MEAD Protected Earned Income (EI) Resources

MEAD Protected EI Resources, including interest earned by the resources, will be excluded for the first 6 months from the date an individual began receiving non-MEAD adult category medical assistance. Any remaining funds in the MEAD Protected EI Resources account are counted beginning the 7th month from the date an individual began receiving non-MEAD adult category medical assistance.

MEAD Premium Schedules

A Director’s Memo dated 1/26/05, subject line, "Changes to the Medicaid for Employed Adults with Disabilities (MEAD) Program Premium Schedule," released interim policy regarding the following changes that were effective February 1, 2005:

·   Only the recipient's annual adjusted gross income is used to determine the premium amount if the recipient’s income exceeds $75,000.

·   MEAD premiums, including payments for retroactive months, are due on the first day of the month, rather than the last day of the month.

·   Recipients terminated from the MEAD program for non-payment of premiums will be reinstated upon payment of past due premiums, with a maximum of a 3-month payment plan. The payment plan option is only available once every 2 years. If the balance of the payment plan is not paid in full by the end of the 3 months, MEAD will be terminated.

PROCEDURES

Automation of MEAD

MEAD eligibility determinations were fully automated in New HEIGHTS effective November 1, 2004.

Determining Minimum Wage for Self-Employed Individuals

All MEAD applicants and recipients must be earning minimum wage to meet MEAD employment criteria. To determine if a self-employed individual is earning the federal minimum wage of $5.15 per hour, use current procedures and calculate the individual’s net self-employment income. Divide the net self-employment income by the number of hours the individual has worked. The resulting figure is the hourly wage of the self-employed individual. If the hourly wage is less than $5.15, then the individual is not earning the federal minimum wage and does not meet the employment requirements of the MEAD program.

Manual Workaround for MEAD Protected EI Resource Spenddown

The spenddown of MEAD Protected EI resources only applies to current or former MEAD recipients who:

·   have funds in a protected EI MEAD account; and

·   are applying for an adult category of medical assistance other than MEAD.

Automatic Transition to Non-MEAD Medical Assistance

Some MEAD recipients will automatically transition to OAA medical assistance when they age out of the MEAD program. For these cases, review the individual’s resources at the next case action or redetermination.

If the next case action occurs more than 6 months from the date the individual has transitioned to OAA:

1. Add a new savings account to the recipient’s resources, and enter the figure displayed in the MEAD Protected EI Resources field as the amount in the new savings account.

2. Note in "Case Comments" that this savings account was created using the dollar amount in the MEAD protected account to ensure that the funds are counted, per policy.

3. Save, confirm, and rerun eligibility.

If the resources now cause the individual to be over the resource limit for the adult program of medical assistance, a closing notice will be generated automatically from New HEIGHTS.

If the next case action occurs within the first 6 months from the date the individual began receiving non-MEAD medical assistance, contact the individual and set expected changes, as indicated below, regarding any excess resources in the MEAD protected EI account.

Application for Non-MEAD Medical Assistance

For individuals applying for non-MEAD medical assistance who will need to spenddown protected EI MEAD resources to meet the non-MEAD adult category medical assistance resource limits, the following manual workaround is required:

1. At application for non-MEAD adult category medical assistance, notify the individual that MEAD Protected EI Resources will be counted as a resource 6 months after the date that the individual begins receiving non-MEAD adult category medical assistance. Note: A template with suggested language for the notification letter will be e-mailed to the District Offices under separate cover.

2. Enter "Case Comments" that contact was made and ensure that the case file contains proof that the individual has been provided with this information.

3. Enter an expected change dated 11 days before the end of the 6th month, counting from the date the individual became eligible for the non-MEAD adult category of medical assistance, to ensure that at the end of the 6-month spenddown period, any remaining funds in the MEAD protected accounted are counted.

4. On the eleventh day before the end of the 6th month:

·   end-date the "MEAD Protected EI Resource" row in the "Resources" screen and add a new resource with the type "savings account"; and

·   enter the figure displayed in the MEAD Protected EI Resources field as the amount in the new savings account.

5. Note in "Case Comments" that this savings account was created using the dollar amount in the MEAD protected account to ensure that the funds are counted, per policy, beginning in the 7th month from the date the individual began receiving the non-MEAD adult category of medical assistance.

6. Save, confirm, and rerun eligibility.

If the resources now cause the individual to be over the resource limit for the adult program of medical assistance, a closing notice will be generated automatically from New HEIGHTS.

SYSTEMS CHANGES

Automation of MEAD

Effective November 1, 2004, New HEIGHTS automated eligibility determination for MEAD under policy released by SR 02-04/February, 2002. A System Alert dated 10/15/04, Full Automation of The MEAD Program, identified the changes to New HEIGHTS associated with this automation.

Employment Requirements

Effective May 1, 2005, a switch on the Payment Details and Self-Employment screens has been renamed from "Individual makes regular FICA contributions" to "Individual meets all MEAD employment requirements." If an individual does not meet all MEAD employment requirements, the worker must deselect this switch and run eligibility to close or deny MEAD for the reason "Does Not Meet MEAD Employment Requirements." See the Client Notices section of this SR for the complete text of this message.

Unemployment Grace Period-Phase 1 Extension

Effective May 1, 2005, MEAD individuals who lose employment for any reason, except Voluntary Quit without good cause, will automatically be put into a grace period, referred to as the Phase 1 Extension, which begins on the day the individual becomes unemployed and ends 6 months from the first day of unemployment. Individuals losing one form of employment but maintaining at least one other type of employment that meets all MEAD employment requirements, remain MEAD-eligible even if the lost employment was due to voluntary quit without good cause.

Individuals still unemployed on the last day of the 5th month of the Phase 1 Extension will automatically receive New HEIGHTS-generated client letter CM0021, MEAD Extension Letter, which notifies them of the information they must provide in order to continue MEAD eligibility beyond the last day of the Phase 1 Extension period. Ten days prior to the last day of the Phase 1 Extension, New HEIGHTS will automatically close individuals who have not provided the information requested. The notice of decision (NOD) will display the following reason message: "Expiration of MEAD Phase 1 Extension." See the Client Notices section of this SR for the complete text of this message. Eligibility for MEAD ends after the 10-day advance notice period.

Unemployment Extension-Phase 2 Extension

To continue MEAD eligibility beyond the Phase 1 Extension period, individuals must provide verification that they have regained employment or have good cause to remain eligible even though they are still unemployed. Individuals who provide verification of good cause for continued unemployment are eligible for one additional 6-month extension, referred to as the Phase 2 Extension. Ten days prior to the last day of the Phase 2 Extension, New HEIGHTS will automatically close individuals due to expiration of a second extension. Closing NODs will display the following reason message: "Expiration of MEAD Phase 2 Extension." See the Client Notices section of this SR for the complete text of this message.

PROCESS

Phase 1 Extension Process

For New HEIGHTS to initiate a Phase 1 Extension follow the guidelines for "Employment" or "Self-Employment" as follows:

Employment

1. Go to the "Employment Screen," "Loss of Employment" tab. Answer, "Yes" to the "Lost Employment" question and enter the actual "Date Employment Lost."

2. Select a "Termination Reason." If "Voluntary Quit" is selected, answer the "Good Cause" question and, if appropriate, select a "Good Cause Reason." Note: Selecting "Household Emergency" is not considered a "Good Cause" for Voluntary Quit by the MEAD program and will result in MEAD closure.

3. Complete "Payment Details" as directed by the system.

4. Run eligibility and confirm. If otherwise eligible, MEAD will remain open. The "MEAD Extension" screen will automatically populate with Phase 1 Extension information, using the "Date Employment Lost" as the "Begin Date" of the Phase 1 Extension.

Note: End-dating the Employment screen without completing the Loss of Employment tab will close MEAD for "Does Not Meet MEAD Employment Requirements" and an extension will not be built.

Self-Employment

1. End-date the "Self-Employment" screen with the actual date the self-employment ended.

2. Run eligibility and confirm. The "MEAD Extension" screen will automatically populate with Phase 1 Extension information, using the end date of the "Self-Employment" screen as the "Begin Date" of the Phase 1 Extension.

New Client Letter CM0021, MEAD Extension Letter

New HEIGHTS-generated client letter CM0021, MEAD Extension Letter, attached for reference, will be sent to individuals who are enrolled in a Phase 1 Extension, 30 days prior to the extension expiring. This letter informs the individual of the date that MEAD eligibility will end unless the individual provides verification of employment or good cause for a second 6-month extension of MEAD eligibility.

New HEIGHTS will automatically generate CM0021, MEAD Extension Letter, 30 days prior to the end of the Phase 1 Extension, and populate the "Date Letter Sent" field of the MEAD Extension screen. Once the client letter is sent, there are 3 possible outcomes:

·   Client Fails to Provide Verification for a Phase 2 Extension: No worker action is required. If no Phase 2 Extension information has been entered by ten days prior to the end of the Phase 1 Extension, New HEIGHTS will automatically close the individual from MEAD, giving the NOD reason, "Expiration of MEAD Phase 1 Extension." See the Client Notices section of this SR for the complete text of this message. Other Medicaid eligibility will be automatically explored; if eligible, the individual will be opened in a different category.

·   Client Provides Verification of Employment: Enter the new employment information, and run and confirm the case. The Phase 1 Extension will automatically be end-dated and, if the individual is otherwise eligible, MEAD will remain open.

·   Client Provides Required Verification of Phase 2 Requirements at Any Time Prior to the End of the Phase 1 Extension:

1. Go to the "MEAD Extension" screen.

2. Enter "Yes" in the "Grant Extension" field.

3. Select an "Extension Reason" based on the verification provided.

4. Save and run eligibility. The night that the Phase 1 Extension is due to end, New HEIGHTS will automatically populate the "MEAD Extension" screen with the Phase 2 Extension information, using the first day after the end of the Phase 1 Extension as the "Begin Date" of the Phase 2 Extension.

Phase 2 Extension Process

Once the worker completes the actions indicated above, MEAD remains open for an additional 6 months unless:

·   the individual becomes employed, at which time the worker must enter the new employment information and, when verified, run eligibility and confirm the case. The Phase 2 Extension will be automatically end-dated and, if otherwise eligible, the individual will remain open for MEAD; or

·   the individual becomes ineligible for MEAD.

Ten days prior to the end of the Phase 2 Extension, New HEIGHTS will automatically close MEAD, giving the NOD reason, "Expiration of MEAD Phase 2 Extension." See the Client Notices section of this SR for the complete text of this message. Other Medicaid eligibility will be automatically explored; if eligible, the individual will be opened in a different category.

Extension Override Process

Supervisors can override the Begin date of a current extension, or add a new extension, through the "Override" fields built into the "MEAD Extension" screen. This should only be necessary in very limited circumstances, such as when a MEAD recipient reports that he/she lost employment more than 6 months ago and the individual would have been eligible for both a Phase 1 and Phase 2 extension, or a valid MEAD extension was not built due to a system problem.

The supervisor must take the following steps to override an extension:

1. Go to the "MEAD Extension" screen.

2. In the "Override" section, select the "Phase" (ONE or TWO), enter the "Begin Date" (same as the date employment or self-employment ended for Phase 1, or 6 months after that date for Phase 2), and the "Override Reason" (System Problem or Administrative-Other). Note: New HEIGHTS does not allow entering a future "Begin Date," or a "Begin Date" more than 6 months prior to the current date.

3. If entering a Phase 2 Extension, complete the Phase 2 Extension fields as directed above.

4. Save and run eligibility.

Example: At the December 2005 redetermination, Ms. White reports loss of employment on 4/19/05 because the business closed. Had Ms. White reported timely, she would have been eligible for a Phase 1 Extension from 4/19/05 through 10/18/05. However, since it is now more than 6 months since the loss of employment, Ms. White must be eligible for a Phase 2 Extension in order to remain eligible for MEAD.

The worker requests and receives verification that Ms. White qualifies for a Phase 2 Extension and requests the Supervisor to enter an Override.

The Supervisor enters the "MEAD Extension" screen, selects "TWO" as the Phase, enters 10/19/05 as the "Begin Date," selects the appropriate "Override Reason," (Administrative-Other), completes the "Phase 2" fields, saves and closes the screen.

The worker runs eligibility and confirms the case. MEAD remains open, and the "Extension" screen now displays a "Phase 2 Extension" beginning on 10/19/05.

Note: If Ms. White is still open in the Phase 2 Extension on 4/9/06, New HEIGHTS will automatically generate a closing MEAD NOD for 4/19/06 with the reason "Expiration of MEAD Phase 2 Extension."

Non-Payment of Premiums

Once a month, NHHKC sends an electronic file to New HEIGHTS listing any individuals who have failed to pay their MEAD premiums and must be closed. Ten days prior to the end of the month, the file is applied to the system and New HEIGHTS automatically closes the cases with a ten-day advance notice period (ANP). See the Client Notices section of the SR for the NOD message generated for this type of closing.

New HEIGHTS automatically populates the new "MEAD Premium Nonpayment Information" screen, which prevents any further MEAD eligibility until the following actions occur.

To regain MEAD eligibility, NHHKC must first notify the worker that the past-due premiums have been paid or a payment arrangement for the past-due premiums is in place. The worker will then request that a Supervisor go to the "MEAD Premium Nonpayment Information" screen and enter, "Yes" to the "Paid Past Due Premiums?" question. The next time eligibility is run, if the individual is currently open for another category of medical assistance and if the individual is otherwise eligible for MEAD, MEAD will reopen.

CLIENT NOTICES

The following Notice of Decision (NOD) reason messages were generated, as appropriate, to cases closed on or after November 1, 2004, the date the MEAD program was automated:

·   Terminated Employment without Good Cause – You must be employed or self-employed to get Medicaid for Employed Adults with Disabilities (MEAD) or have a good reason for not working. You voluntarily stopped working without good cause.

·   Failed to Pay MEAD Premium – You must pay a monthly premium to get Medicaid for Employed Adults with Disabilities (MEAD). You did not pay your premium and did not have a good reason. To be eligible for MEAD again, you must first pay the current premium and any past due premiums or show that you have a good reason for not paying.

·   Failed to Enroll in Cost-Free Health Insurance – To get Medicaid for Employed Adults with Disabilities (MEAD), you must enroll in your employer’s health insurance plan if the plan’s coverage is free to you. You did not enroll in your employer’s cost-free plan.

Clients whose cases close on or after May 1, 2005, will receive the following NOD reason messages as appropriate:

·   Does Not Meet MEAD Employment Requirements – To be eligible for Medicaid for Employed Adults with Disabilities (MEAD), you must be employed for at least the federal minimum wage or self-employed with income equivalent to at least federal minimum wage, and making regular contributions to FICA based on your earnings. You are not eligible for MEAD medical assistance because you do not meet the MEAD program’s definition of employed or self-employed.

·   Expiration of MEAD Phase 1 Extension – You must be employed or self-employed to get Medicaid for Employed Adults with Disabilities (MEAD) or have a good reason for not working. Because you had a good cause reason for being unemployed, and expected to go back to work, we extended your MEAD medical coverage for 6 months. Your extended coverage period is ending, and you do not have good cause to get an additional 6 months of MEAD without working.

·   Expiration of MEAD Phase 2 Extension – You must be employed or self-employed to get Medicaid for Employed Adults with Disabilities (MEAD), or have a good reason for not working. Because you had good reasons for being unemployed, and expected to go back to work, we gave you two 6-month extensions of your MEAD medical assistance while you were not working. Your last extension is ending. If you become employed or self-employed in the future, contact your District Office to reapply for MEAD.

·   MEAD-Employed 3 Times in a Row in Last Month of Extension – To be eligible for the MEAD Extension, your date of hire during the unemployment grace period cannot take place during the last month of three (3) MEAD extension periods that follow one another.

RELATED POLICY CLARIFICATION

Individuals enrolled in the MEAD program may also be eligible for Home and Community-Based Care for the Elderly and Chronically Ill (HCBC-ECI) services, if they meet the medical eligibility criteria for HCBC-ECI. MEAD-eligible individuals are considered categorically needy and do not have a cost of care requirement. If a MEAD-eligible individual resides with a spouse, consider the income and resources of the spouse and base eligibility on a household size of two when determining financial eligibility for HCBC-ECI services. If the couple meets MEAD financial eligibility requirements, and either or both spouses meet the medical criteria for HCBC services, the HCBC-eligible individual is opened for HCBC services as a group size of one. AAM PART 221, HOME AND COMMUNITY-BASED CARE FOR THE ELDERLY AND CHRONICALLY ILL, has been revised accordingly.

POLICY MANUAL REVISIONS

The MEAD section of the Adult Assistance Manual has been reformatted and rewritten for clarity. Entire sections have been added to AAM PART 210, MEDICAID FOR EMPLOYED ADULTS WITH DISABILITIES.

Revised Adult Assistance Manual Topics

PART 210    MEDICAID FOR EMPLOYED ADULTS WITH DISABILITIES (MEAD)

Section 210.01    MEAD Medical Criteria

Section 210.03    MEAD Employment-Related Requirements

Section 210.05    MEAD Good Cause for Loss of Employment

Section 210.07    MEAD Income Requirements

Section 210.09    MEAD Resource Requirements and Treatments

Section 210.11    MEAD-Specific Resources

Section 210.13    MEAD Premium Requirements

Section 210.15    Good Cause for Non-Payment of MEAD Premiums

Section 210.17    Extensions of MEAD Coverage Due to Unemployment

Section 210.19    Termination of MEAD

PART 221    HOME AND COMMUNITY-BASED CARE FOR THE

ELDERLY AND CHRONICALLY ILL

Section 221.01    Verification: HCBC-ECI

PART 413    LESS COMMON TYPES OF RESOURCES: MEAD PROTECTED

EARNED INCOME (EI) RESOURCES

PART 601, TABLE B   INCOME LIMITS FOR HCBC INDIVIDUALS

IMPLEMENTATION

Changes to the MEAD premium policy were effective February 1, 2005. The remaining MEAD and HCBC-ECI policy changes are effective May 1, 2005.

On May 21, 2005, New HEIGHTS will close all individuals open in months 7-11 of the 12-month MEAD extension period unless "Yes" has been entered in the "Grant Extension" field and a Reason has been selected on the MEAD Extension screen (see also CLIENT NOTIFICATION section below). For these individuals, MEAD eligibility will end as of May 31st, 2005. However, each individual will be evaluated for other forms of medical assistance and, if otherwise eligible, opened in the new category.

For open MEAD cases, verify that the recipient is meeting new MEAD employment requirements at the next case action or redetermination.

CLIENT NOTIFICATION

A public hearing regarding the changes outlined in this SR was held on September 10, 2004.

In addition to the public hearing, client letters were mailed:

·   on March 15, 2005, to all MEAD recipients notifying them of the impending changes released by this SR;

·   on March 22, 2005, to MEAD recipients in the first 6 months of an extension. The letter notified individuals of the extension policy changes released by this SR; and

·   on April 18, 2005, to MEAD recipients in the last 6 months of an extension. The letter notified them of the criteria that had to be met in order to remain eligible for MEAD for the balance of the extension.

The client letters are attached to this SR for reference.

TRAINING

A remote training related to the automation of MEAD was held on October 27, 2004. The changes released by this SR were also discussed at the March 16, 2005 DFA Supervisor’s Meeting.

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 http://www.dhhs.nh.gov/DHHS/DFA/LIBRARY, effective June 6, 2005.

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

DFA/MC:dms