SR 07-16 Dated 06/07

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases revisions to Form 754A, Your Right to Claim Good Cause for Non-Cooperation with Child Support Requirements, and Form 800A, Programs and Services Guide.

FORM REVISIONS

Revisions to Form 754A, Your Right to Claim Good Cause for Non-Cooperation with Child Support Requirements, include:

§   adding text related to progressive sanctioning, which is applied when New Hampshire Employment Program (NHEP) cash assistance recipients fail or refuse to comply with child support requirements, per SR 06-12, dated October 2006;

§   augmenting the initial paragraphs of the pamphlet to more clearly indicate that establishing and enforcing medical child support is a condition of eligibility for medical assistance for children, per 42 USC 1396k. Although this policy is not new and is currently emphasized on the Form 800, Application for Assistance, it was not clearly indicated on earlier versions of the Form 754A; and

§   updating the address of the Manchester District Office.

Revisions to Form 800A, Programs and Services Guide, were as follows:

§   information about financial assistance for unemployed parents (UP) was added to the form, where appropriate, based on policy released by SR 06-12, dated October 2006;

§   in the benefits issuance section, text was reordered and slightly altered to better emphasize that Electronic Funds Transfer (EFT) is the primary method for issuing financial assistance benefits, per SR 04-03, dated May 2004. Additionally, in the same section, the paragraph on benefit delivery for child care assistance was rewritten and reorganized to better describe the provider process for reimbursement;

§   "identity" was added to the list of types of proof required for applicants per the Director’s Memo dated June 26, 2006, subject line, Deficit Reduction Act of 2005 – Verification of Citizenship and Identity for All Medicaid Applicants and Recipients Effective 07/01/2006; and

§   the description of Emergency Medicaid for Non-Citizens was rewritten to clarify program eligibility requirements.

All previous versions of both forms remain valid and may still be used until the current supply is exhausted. The instructions for both forms did not require revisions, so are not being re-released.

POLICY MANUAL REVISIONS

No policy manual revisions were required as a result of changes to the two forms.

IMPLEMENTATION

The version of the Form 754A dated February 2000, SR 00-08, and Form 800A dated July 2004, SR 04-23, may continue to be provided to clients until the current stock is exhausted. As such, a certificate of destruction has not been included in the SR as the current stock is not to be destroyed or recycled. When the current stock is depleted, the new versions will be printed.

CLIENT NOTIFICATION

No special notification is necessary. District Offices and clients will begin to use the new form upon receipt.

TRAINING

No special training is planned or needed.

FORMS MANUAL POSTING INSTRUCTIONS

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, and for public access on the Internet at http://www.dhhs.nh.gov/DHHS/DFA/LIBRARY, effective July 30, 2007.

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

DFA/JBV:s