SR 13-36 Dated 11/13

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

FROM OFFICE OF THE DIRECTOR, DFA:	Terry R. Smith
DFA SIGNATURE DATE:	November 7, 2013
AT (OFFICE):	Division of Family Assistance
TO:	District Office Supervisors
SUBJECT:	Release of the Final Four Chapters of the New Medical Assistance Manual (MAM)
EFFECTIVE DATE:	November 25, 2013

SUMMARY

This SR releases the final four Chapters of the new Medical Assistance Manual (MAM).

POLICY

With the release of this SR, the Medical Assistance Manual (MAM) will contain the final four Chapters needed to complete the manual:

· Chapter 300, NON-FINANCIAL CRITERIA, which explains the other factors that are used to determined eligibility for the medical assistance programs administered by DFA;

· Chapter 400, RESOURCES, which explains how resources are treated in the medical assistance programs administered by DFA.

· Chapter 500, INCOME, which explains how income is treated in the medical assistance programs administered by DFA.

· Chapter 600, STANDARDS AND BUDGET, which explains how DFA determines eligibility based on household income.

See DFA SR 13-35, dated October 2013, for more information on the new MAM.

NEW HEIGHTS SYSTEMS PROCEDURES AND IMPLEMENTATION

Now that all the Chapters are complete in the MAM, New HEIGHTS will begin to update the mapping logic in the notices of decision (NODs) and screen help, as the NODs and screens are edited.

POLICY MANUAL REVISIONS

Due to the large number of pages that must be released for a new manual, the following Chapters will be released in this SR: Chapters 300, 400, 500, and 600. DFA SR 13-35, dated October 2013, released the MAM Introduction, Chapters 100, 200, 700, and the Glossary.

New Medical Assistance Manual Topics

CHAPTER 300 NONFINANCIAL CRITERIA

PART 301 RESIDENCY

Section 301.01 Individuals Incapable of Indicating Intent of Residency

Section 301.03 How to Determine Residency for Medical Assistance

Section 301.05 Absence from New Hampshire

Section 301.07 Out-of-State Recipient Moves into New Hampshire

Section 301.09 Medicaid-Only Residency: Individuals Placed Out-of-State

Section 301.11 Medicaid-Only Residency: Transient Individuals

Section 301.13 Verification of Residency

PART 303 CITIZENSHIP

Section 303.01 Declaration of Citizenship or Non-Citizen Status

Section 303.03 Definition of U.S. Citizen

Section 303.05 Verification of Citizenship and Identity

Section 303.07 Determining Qualified Alien Status

Section 303.09 Eligibility for Certain Qualified Aliens

Section 303.11 Qualified Aliens Eligible Without Restriction

Section 303.13 Qualified Aliens with Restricted Eligibility Based on Date of Entry into the U.S.

Section 303.15 Ineligible Sponsored Non-Citizens

Section 303.17 Crediting SSA Work Quarters for FANF and FANF-Related MA

Section 303.19 Documentation of BCIS Status

Section 303.21 Verification of Qualified Alien Status

Section 303.23 When BCIS Responds Late

Section 303.25 Administrative Appeals Based on VIS Verification

Section 303.27 Reporting Illegal Non-Citizens to BCIS

PART 305 INSTITUTIONS

Section 305.01 Individuals in Designated Receiving Facilities

Section 305.03 Medical Assistance: Institutions for Tuberculosis or Mental/Emotional Disorders

Section 305.05 Medical Assistance: Public Institutions (New Hampshire Hospital)

Section 305.07 Medical Assistance: Inmates

Section 305.09 Verification

PART 307 SOCIAL SECURITY NUMBERS (SSN)

Section 307.01 SSN Eligibility and Applicant Notification Requirement

Section 307.03 Completing an Application for an SSN

Section 307.05 Verification

Section 307.07 Good Cause for Failure to Provide an SSN

PART 309 LIABILITY FOR SUPPORT FOR RESIDENTS OF NURSING AND ASSISTED LIVING FACILITIES

Section 309.01 Fiduciary Responsibilities for Support

Section 309.03 Responsibilities of an Individual Receiving a Transfer of Assets

Section 309.05 Responsibility of the Individual Controlling the Income of a Resident in an LTC Facility

PART 311 LEGAL LIABILITY

Section 311.01 Legal Liability of Counties

Section 311.03 Verification

Section 311.05 Liability for Support: Relative’s Ability to Contribute

PART 313 ASSIGNMENT OF CHILD/SPOUSAL MEDICAL SUPPORT RIGHTS

PART 315 DEVELOPING POTENTIAL SOURCES OF INCOME

Section 315.01 Requirements for Developing Potential Sources of Income

Section 315.03 Application Requirements for Developing Potential Sources of Income

Section 315.05 Cooperation Requirements for Developing Potential Sources of Income

Section 315.07 Good Cause for Not Developing Potential Sources of Income

Section 315.09 Denial or Termination of Assistance

PART 317 REIMBURSEMENT

Section 317.01 Reimbursement – Medical Assistance for Non-Institutionalized Individuals

Section 317.03 Reimbursement – Medical Assistance Provided to Permanent Residents of Medical Institutions

Section 317.05 Verification

Section 317.07 Disposal of Property and Conflict of Interest

Section 317.09 Fire Insurance

Section 317.11 Tax Sale

Section 317.13 Death of Recipient and Reimbursements

Section 317.15 Release of Liens

Section 317.17 Recovery Distribution

Section 317.19 Recovery for Medical Assistance Provided - Estates

CHAPTER 400 RESOURCES

PART 401 GENERAL INFORMATION

PART 403 WHOSE RESOURCES COUNT?

PART 405 TREATMENT OF RESOURCES

PART 407 RESOURCE LIMITS

Section 407.01 Categorically Needy Medical Assistance

Section 407.03 Medically Needy Medical Assistance

Section 407.05 QDWI Resource Limits

Section 407.07 QMB, SLMB, and SLMB135 Resource Limits

PART 409 VERIFICATION

PART 411 COMMON TYPES OF RESOURCES

ANNUITIES

ALIEN SPONSOR’S RESOURCES

BANK ACCOUNTS

BURIAL FUND

BURIAL FUND EXCLUSION

BURIAL PLOT

CERTIFICATES OF DEPOSIT

CORRECTIVE PAYMENTS

DIVIDENDS AND INTEREST (RESOURCE)

HOUSEHOLD ITEMS AND POSSESSIONS

INACCESSIBLE RESOURCE

INDIVIDUAL RETIREMENT ACCOUNT (IRA)

JOINTLY OWNED PERSONAL PROPERTY

KEOGH PLAN

LIFE ESTATE

LIFE INSURANCE

LIFE INSURANCE OFFSET

LOANS (RESOURCE)

LUMP SUM DEATH BENEFITS (RESOURCE)

LUMP SUM EARNED INCOME (RESOURCE)

LUMP SUM PAYMENT: NONRECURRING (RESOURCE)

MEDICAID QUALIFYING TRUST

PLAN FOR ACHIEVING SELF-SUPPORT (PASS)

TRUSTS USING THE ASSETS OF OTHER PARTIES

TRUSTS USING THE ASSETS OF THE INDIVIDUAL OR SPOUSE

VEHICLES

PART 413 LESS COMMON TYPES OF RESOURCES

CONTINUING CARE RETIREMENT COMMUNITIES (CCRC)

EARNED INCOME TAX CREDIT (RESOURCE)

DISASTER RELIEF EMERGENCY ASSISTANCE

FARM MACHINERY, LIVESTOCK, TOOLS, AND EQUIPMENT

INDIVIDUAL DEVELOPMENT ACCOUNT (IDA)

MEAD PROTECTED EARNED INCOME (EI) RESOURCES

RESOURCES EXCLUDED BY FEDERAL MANDATE

SUSAN WALKER V. BAYER CORPORATION ET AL, 96-C 5024 (N.D. III) PAYMENTS

TAX REFUND

PART 415 TRANSFER OF ASSETS

Section 415.01 What Is an Asset Transfer

Section 415.03 Look-back Period for Transfers of Assets

Section 415.05 Transfers by Financial Assistance Applicants or Recipients

Section 415.07 Transfers by an Institutionalized Individual

Section 415.09 Transfers by the Community Spouse of an Institutionalized Individual

Section 415.11 Evaluation of Transfers

Section 415.13 Reasons for Transfers

Section 415.15 Allowable Property Transfers

Section 415.17 Transfer of Assets into a Life Estate

Section 415.19 Transfer of Assets into an Annuity

Section 415.21 Penalty for Transferring Assets – Financial Assistance

Section 415.23 Penalty Period for Transferring Assets – Medical Assistance

Section 415.25 Determining and Applying the Penalty Period

Section 415.27 When a Penalty Period for Transferring Assets is Not Assessed

Section 415.29 Undue Hardship

Section 415.31 Required Documentation for an Undue Hardship Waiver Application

Section 415.33 Verification of Asset Transfers

PART 417 RESOURCE ASSESSMENT

Section 417.01 Entitlement to a Resource Assessment

Section 417.03 Requirements of the Resource Assessment

Section 417.05 Verification Requirement

Section 417.07 Resource Assessment Procedures

Section 417.09 Administrative Appeal

Section 417.11 Spenddown of Excess Resources

PART 419 PROTECTION OF RESOURCES

Section 419.01 Entitlement to Protection of Resources

Section 419.03 Determining the Protected Resource Amount

Section 419.05 Procedures for Protection of Resources

Section 419.07 Resource Increases During the First Year of Eligibility

Section 419.09 Revision of Protected Resources, Spousal Share, and Spousal Allowance

Section 419.11 Verification Requirement

PART 420 RESOURCE TABLES

SSA LIFE EXPECTANCY TABLES: MALE

SSA LIFE EXPECTANCY TABLES: FEMALE

LIFE ESTATE TABLES

CHAPTER 500 INCOME

PART 501 GENERAL INFORMATION

PART 503 AVAILABLE INCOME

PART 505 WHOSE INCOME COUNTS?

PART 507 TREATMENT OF INCOME

PART 509 VERIFICATION

Section 509.01 Countable Income

Section 509.03 Excluded Income

Section 509.05 Self-Employment Income

Section 509.07 Lump Sum Income

PART 511 INCOME TYPES

ADOPTION SUBSIDIES

ALIEN SPONSOR’S INCOME

DISQUALIFIED MEMBER’S INCOME

DIVIDENDS AND INTEREST (INCOME)

EARNINGS

EARNINGS OF CHILDREN WHO ARE STUDENTS

EDUCATIONAL INCOME

FEDERAL FUEL ASSISTANCE

FEDERAL WORK AND TRAINING PROGRAMS

LUMP SUM EARNED INCOME (INCOME)

LUMP SUM UNEARNED INCOME (INCOME)

PLAN FOR ACHIEVING SELF-SUPPORT (PASS)

RENTAL INCOME

RETIRED SENIOR VOLUNTEER PROGRAM (RSVP)

ROOMER INCOME

SELF-EMPLOYMENT

SENIOR CITIZEN COMMUNITY SERVICE EMPLOYMENT INCOME

SOCIAL SECURITY ADMINISTRATION (SSA) BENEFITS

SOCIAL SECURITY DISABILITY INSURANCE (SSDI) BENEFITS

SUPPLEMENTAL SECURITY INCOME (SSI) BENEFITS

TAX REFUNDS

VA AID and ATTENDANCE ALLOWANCE

VA BENEFITS

VA $90 NURSING FACILITY PENSION

VENDOR PAYMENTS

VOLUNTEERS IN SERVICE TO AMERICA (VISTA)

PART 513 LESS COMMON TYPES OF INCOME

AGENT ORANGE SETTLEMENT

ALASKAN NATIVES

ALEUTIAN AND PRIBILOF ISLANDERS

AMERICAN INDIANS

CENSUS INCOME

DONATED FOODS

EARNED INCOME TAX CREDIT (INCOME)

GERMAN REPARATION PAYMENTS

HOME-PRODUCED FOOD

IDA WITHDRAWALS

NUTRITION PROGRAM FOR THE ELDERLY

RADIATION EXPOSURE COMPENSATION

RELOCATION ASSISTANCE

SUPPLEMENTAL FOOD ASSISTANCE

U.S. CITIZENS OF JAPANESE ANCESTRY

YOUTH EMPLOYMENT PROGRAM

CHAPTER 600 STANDARDS AND BUDGETS

PART 601 INCOME LIMITS

Table A: Income Limits

Table B: Special Income Limits for CFI and HCBC Individuals

Table C: Qualified Medicare Beneficiary (QMB)

Table D: Specified Low-Income Medicare Beneficiary (SLMB) and SLMB135

Table E: Qualified Disabled and Working Individual (QWDI)

Table F: Medicaid for Employed Adults with Disabilities (MEAD)

Table H: Federal Information, Taxes, Income Ceilings, and Minimum Wage Standards

PART 603 DISREGARDS

Section 603.01 Earned Income Disregard (EID)

Section 603.03 Earned Expense Disregard (EED)

Section 603.05 Employment Expense Disregard (EED)

Section 603.07 Adult Standard Disregard

PART 605 DEDUCTIONS

Section 605.01 Verification of Deductions

PART 607 BUDGETING OVERVIEW

PART 609 CONVERSION TO MONTHLY AMOUNTS

PART 611 FLUCTUATING INCOME

Section 611.01 Averaging Fluctuating Income

Section 611.03 Time Frames for Using Averaged Fluctuating Income

PART 613 COMPUTING ELIGIBILITY

PART 615 BUDGETING: INDEPENDENT LIVING, RCF, CR, QMB, QDWI, SLMB, AND SLMB135

PART 619 BUDGETING: NURSING FACILITY

Section 619.01 Cost of Care: Nursing Facility

PART 621 BUDGETING: HCBC-CFI

Section 621.01 HCBC-CFI Financial Assistance

Section 621.03 HCBC-CFI Medical Assistance

Section 621.05 Cost of Care: HCBC-CFI Medical Assistance

Section 621.07 Payment for Cost of Care: HCBC-CFI Medical Assistance

PART 622 BUDGETING: HCBC-IHS

Section 622.01 HCBC-IHS Financial Assistance

Section 622.03 HCBC-IHS Medical Assistance

Section 622.05 Cost of Care: HCBC-IHS Medical Assistance

Section 622.07 Payment for Cost of Care: HCBC-IHS Medical Assistance

PART 623 BUDGETING: HCBC-DD

Section 623.01 HCBC-DD Financial Assistance

Section 623.03 HCBC-DD Medical Assistance

Section 623.05 Cost of Care: HCBC-DD Medical Assistance

Section 623.07 Payment for Cost of Care: HCBC-DD Medical Assistance

PART 624 BUDGETING: HCBC-ABD

Section 624.01 HCBC-ABD Financial Assistance

Section 624.03 HCBC-ABD Medical Assistance

Section 624.05 Cost of Care: HCBC-ABD Medical Assistance

Section 624.07 Payment for Cost of Care: HCBC-ABD Medical Assistance

PART 625 IN AND OUT MEDICAL ASSISTANCE

Section 625.01 One- Month Spenddown

Section 625.03 Six-Month Spenddown

Section 625.05 Allowable Medical Expenses

Section 625.07 Offsetting the Spenddown

PART 627 ALLOCATION OF INCOME

Section 627.01 Allocation to Dependents

Section 627.03 Allocation to a Community Spouse

Section 627.04 Criteria for Increased Income Allocation Due to Significant Financial Duress

Section 627.05 Allocation to Dependents Who Reside With the Community Spouse

Section 627.07 Allocation for Expenses Incurred Outside of the Nursing Facility

Section 627.09 Allocation to Maintain the Home

Section 627.11 Verification of Allocated Income

PART 633 RECOUPMENT OF MEDICAL ASSISTANCE

PART 635 RECOUPMENT: LEGAL ACTION

IMPLEMENTATION

The manual sections described in this SR will be available following an upload scheduled for the evening of November 22, 2013.

CLIENT NOTIFICATION

No special client notification is planned.

TRAINING

No special training is planned.

DISPOSITION

This SR may be destroyed or deleted after its contents have been noted and the new 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 www.dhhs.nh.gov/DFA/publications.htm, effective November 25, 2013. Additionally, this SR, and printed pages with posting instructions, will be distributed under separate cover to all internal hard copy holders of the Medical Assistance Manual.

DFA/JBV:s