SR 15-01 Dated 01/15

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases a 1.7% Cost-of-Living Adjustment (COLA) to Social Security Administration (SSA), Supplemental Security Income (SSI) and Veterans Affairs (VA) Annual Review benefits and its associated increase to the SSI maximum monthly benefit levels. This COLA increase is:

·      “passed along” in NH via formula-based updates to the adult Standards of Need (SON) which are used in the Old Age Assistance (OAA), Aid to the Permanently and Totally Disabled (APTD), and Aid to the Needy Blind (ANB) eligibility and benefit determination process for applicants and recipients residing in independent living arrangements, residential care facilities, and community residences, per the mandates of 42 USC 1382g, 20 CFR 416.2095-2099, RSA 167:3-c,II-b, RSA 167:7,I & I-a, & RSA 167:27-c, and He-W 648.04 & He-W 658.03; and

·      used to determine the Nursing Facility (NF) CAP which is then used to determine NF and Home and Community-Based Care (HCBC), including HCBC Choices For Independence (CFI) categorically-needy services, as well as the income disregard for HCBC or HCB-CFI medically-needy recipients who were receiving services as of 10/1/08, per the mandates of 20 CFR 416.405, 20 CFR 416.414, and He-W 658.05.

Additionally, this SR releases updates to the:

·      Medicare Part B, as mandated by Section 1839(a)(1) of the Social Security Act (SSA) [42 USC 1395r(a)(1)], and Part D premium amounts, as mandated by Section 1860D-2(b)(6) of the SSA [42 USC 1395w-102(b)(6)];

·      spousal impoverishment figures, pursuant to 42 USC 1396r-5(g);

·      Substantial Gainful Activity (SGA) income ceiling, per 20 CFR 404.1574(b), 20 CFR 404.1575(c), 20 CFR 404.1584(d), 20 CFR 416.974(b), and 20 CFR 416.975(c);

·      home equity limit used in the NF, HCBC, and HCBC-CFI service eligibility determination process pursuant to 42 USC 1396p(f)(1)(C);

·      Protected Income Level (PIL), pursuant to He-W 601.06 and He-W 658.04; and

·      Child Allocation deduction and the Parental Living Allowance related to parental deeming for ANB applicants and recipients under the age of 18, pursuant to 20 CFR 416.1165(d)(3)(i) and He-W 652.03(f).

The following forms and their associated instructions were revised to reflect the increased spousal impoverishment figures:

·      DFA Form 798A, Resource Assessment for Institutionalized Individuals with Community Spouses, and its associated New HEIGHTS-generated Form AE0020;

·      DFA Form 799, Spousal Income Protection, and its associated New HEIGHTS-generated Form AE0017; and

·      DFA Form 799A, Income Computation Worksheet for Allocation of Income for Institutionalized Individuals. Information found on this paper form has also been incorporated into the New HEIGHTS-generated Form AE0017.

POLICY

Based upon the 1.7% cost-of-living adjustment (COLA) 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 $721 to $733;

·   for an individual and either a spouse or needy essential person, from $1,082 to $1,100; and

·   for a couple and needy essential person, from $1,443 to $1,467.

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

The Nursing Facility CAP used to determine NF, HCBC, and HCBC-CFI categorically-needy services has increased to $2,199 (from $2,163).

The Income Disregard for HCBC or HCBC-CFI medically-needy recipients who were receiving services as of 10/1/08 is:

·      $252 for HCBC-CFI (formerly $288); and

·      the difference between the cost of services on 9/26/08 and the NF CAP of $2,199 for all other HCBC categories.

The Medicare Part B standard monthly premium cost remains the same at $104.90.

The Medicare Part D NH Low-Income Premium Subsidy Amount is $29.60 (from $27.78).

Maximum Co-Pays for Full Benefit Dual Eligible (FBDE) individuals:

·      Institutionalized Individuals      $0.00

·      Non-Institutionalized Beneficiaries

-     Up to or at 100% FPL

§     Generic/Preferred     $1.20

§     Other       $3.60

§     Above Out-of-Pocket Threshold $0.00

-     Over 100% FPL

§     Generic/Preferred      $2.65

§     Other       $6.60

§     Above Out-of-Pocket Threshold $0.00

Spousal Impoverishment limits are:

·      Maximum monthly maintenance allowance increased from $2,931 to $2,981;

·      Minimum resource standard increased from $23,448 to $23,844; and

·      Maximum spousal resource allowance increased from $117,240 to $119,220.

The Substantial Gainful Activity (SGA) income ceiling increased from $1,070 to $1,090. The SGA is used only during initial APTD eligibility determinations; working APTD applicants must have an adjusted earned income of less than the SGA.

The Home Equity Limit used in the financial eligibility determination process for NF, HCBC, and HCBC-CFI services is $552,000 (from $543,000). NF/HCBC services need to be denied or terminated if the applicant or recipient for NF/HCBC services has equity in the home that exceeds this figure.

The Protected Income Level (PIL) for all group sizes remains unchanged.

Parental Deeming for ANB applicants and recipients under the age of 18:

·      The Child Allocation deduction is the difference between the SSI Maximum Benefit for a couple and an individual. The 2015 Child Allocation deduction amount is $367 per child, (i.e. $1,100 - $733 = $367), as follows:

·      The Parental Living Allowance is the SSI maximum benefit for a couple (if there are 2 parents) or an individual (if there is one parent). The 2015 Parental Living Allowance:

-      Couple (2-parent): $1,100 (from $1,082)

-      Individual (1-parent): $733 (from $721)

NEW HEIGHTS SYSTEMS PROCEDURES AND IMPLEMENTATION

SSA/SSI COLA Increase

Using the individual’s Social Security Number (SSN), SSA/SSI benefits are updated during the January Mass Change by crossmatching open:

·      SSA cases against BENDEX and SVES; and

·      SSI cases against SDX.

For those cases that match, the SSA/SSI amount will be replaced with the actual check amount listed in the BENDEX/SVES/SDX files, and benefits will be recomputed. For those SSA individuals that do not match, New HEIGHTS will apply the 1.7% increase and round up to the nearest dollar. For SSI, New HEIGHTS will automatically update anyone whose current SSI amount is $721 to $733. For all others, HEIGHTS will apply the 1.7% increase and round up to the nearest dollar.

VA Increase

New HEIGHTS will apply a 1.7% COLA increase, dropping all cents, to all VA benefits with an annual review indicator and certain VA beneficiaries, widows and children of veterans, who do not have an annual review indicator. If a case with an annual review indicator also has Aid and Attendance (A&A) benefits, the 1.7% COLA will also be applied to the A&A benefits, dropping all cents.

Individuals who are coded as “VA Nursing Facility Pension” or “VA Frozen Pension” are not entitled to the January COLA and will not see the COLA increase applied to their benefits.

Parental Deeming

Recipients who are still currently eligible for an ANB cash grant despite having parental income and resources deemed to their case, will be automatically run thru the mass change with all the other adult categories and will have their ANB grants redetermined.

ANB cash recipients who do not get a cash grant due to parental deeming, but are still eligible for MA, will not have their eligibility for a cash grant automatically redetermined. These individuals will have to formally apply for cash and ask to have their eligibility redetermined. Parental income and resource information must be reverified at that time.

Cases Newly Eligible for Cash

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.

Additionally, adult category medically needy medical assistance (MA) assistance groups (AGs) receiving SSA or VA may become newly eligible for a cash grant. Affected AGs 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, ANB, and APTD financial assistance provided; and

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

Three-Month Retroactive Medical Assistance Cases

New HEIGHTS will automatically use pre-mass change SON amounts for Three-Month Retroactive Categorically-Needy Medical Assistance eligibility determinations for months prior to January 1, 2015.

Pickle Amendment Cases

The Pickle Amendment prevents SSA cases receiving an adult category of 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.

Medicare Part B Premiums

FSS should not make any changes to the amounts displayed in New HEIGHTS unless the casehead provides verification that their Part B premium or benefit amount is different than displayed, or unless the individual’s case is placed on the discrepancy report after the mass change, at which point the individual will need to present verification of income or premium amount. New recipients will need to verify, as always, their premium, so that the FSS can enter the correct amount.

Spousal Impoverishment Cases

Effective January 1, 2015, the maximum monthly maintenance allowance increases from $2,931 to $2,981 per month. When determining income allocated to the community spouse for months prior to January 2015, use the $2,931 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 $23,448 to $23,844 and from $117,240 to $119,220, respectively.

·      The new figures apply to requests for resource assessments that are currently in process or being processed after 12/31/14.

·      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.

QMB, QDWI, SLMB, and SLMB135 Cases

Federal law mandates that COLA increases for the year 2015 cannot be used to determine QMB, QDWI, SLMB, and SLMB135 eligibility until after the annual update to the federal poverty levels is effective in the spring of 2015. Until the new figures are available, cases that would close due to the COLA will be kept open automatically by New HEIGHTS.

Reminder: New HEIGHTS adds a deduction called “QMB/QDWI/SLMB COLA Deduct” to the “Other Allowable Deduction” screen for these cases. Do not change the amount or end date the deduction; New HEIGHTS will automatically end date the deduction when the federal poverty levels become effective.

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.

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 MMIS. 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 the AE0009, Patient Liability Letter, to the nursing facility resident and/or authorized representative.

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

Mass Change Schedule

The January Mass Change, impacting approximately 54,036 cases, will be included in the daily run over the course of 15 days, as follows:

Mass Change NOD

Notices of decision (NOD) generated during the January Mass Change will contain special text messages which correlate to the change(s) that occurred in the case, as follows:

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. Your eligibility for medical assistance was refigured using the new benefit amount.

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 2015 standard Medicare Part B premium is $104.90. Your cost of care liability was refigured using your new benefit amount and this year’s Medicare Part B premium.

Group 3: All Cash Cases

The federal government increased Social Security, SSI, and some VA benefits to reflect an increase 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 $747 for a group size of one and $1,101 for a couple. For individuals living in a residential care facility or an enhanced family care residence, the income limit increased to $927. For individuals living in a subsidized community residence, the income limit increased to $809. For individuals living in a non-subsidized community residence, the income limit increased to $869.

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 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 the Bendex or SVES file has Medicare information and New HEIGHTS does not have information in the system for this individual, the Medicare information will be automatically entered into the pertinent fields in New HEIGHTS.

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 New Heights on December 24, 2014 with a report date of December 23, 2014.

NMC840RA: MC Part B Premium RPT

New HEIGHTS is not running the Part B Premium Report because the Part B Premium amount remained the same as last year.

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 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 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. Nursing Facility cases will be run on December 24 and 26, 2014. The report will be available to the field the first business day following its running, on December 26 and 27, 2014 respectively. This report will be rerun after the clean-up run on January 16, so another report will be available the next day, on January 17, 2014.

NMC850RA: HCBC Liab Override RPT

The HCBC Liability Override report lists cases that contain a CFI or HCBC liability override and therefore the amount did not change. These cases require further District Office action. The report contains the following information: RID #, Client Name, Case Number, Casehead Name, Case Status, Client Phone #, and CFI or HCBC type. CFI/HCBC cases will be run on December 24 and 26, 2014. The report will be available to the field the first business day following its running, on December 26 and 27, 2014 respectively. This report will be rerun after the clean-up run on January 16, so another report will be available the next day, on January 17, 2014.

DESCRIPTION OF REVISIONS MADE TO FORMS

DFA Forms 798A, Resource Assessment for Institutionalized Individuals with Community Spouses, DFA Form 799, Spousal Income Protection, and DFA Form 799A, Income Computation Worksheet for Allocation of Income for Institutionalized Individuals, and their associated New HEIGHTS-generated Forms AE0017 and AE0020, were revised to include the increase in the spousal impoverishment limits.

With new spousal applications dated January 1, 2015 or later, use the updated forms. However, prior to detaching the new versions, rename and retain the January/July 2014 electronic versions of DFA Forms 798A, 799, and 799A, in case rollbacks are required.

The new versions of DFA Forms 798A, 799, and 799A will be electronically transmitted to each District Office with the electronic release of this SR. Contact Linda White, DFA State Office, at 271-9474 with any questions related to transferring the electronic versions of these forms to your PC. All forms identified in this SR are also available electronically, for Department staff only, on the Lotus Notes Family Services Database.

Although there are no changes associated with the use of these forms, the instructions were revised to add federal and state authorities to the document and clearly articulate the workflow involved with using this form.

POLICY MANUAL REVISIONS

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

PART 411     COMMON TYPES OF RESOURCES: REAL PROPERTY

Section 415.27    Undue Hardship

Section 415.28    Required Documentation for an Undue Hardship Waiver Application

Section 419.03    Determining the Protected Resource Amount

PART 601, TABLE A   INCOME LIMITS

PART 601, TABLE B   SPECIAL INCOME LIMITS FOR CFI AND HCBC INDIVIDUALS

Section 615.01    ANB Parental Deeming Principles

Revised Medical Assistance Manual Topics

Section 161.03    COLA Adjustments Since 1977

Section 209.03    SGA Adjustments Since 2000

PART 411     COMMON TYPES OF RESOURCES: REAL PROPERTY

Section 415.29    Undue Hardship

Section 415.31    Required Documentation for an Undue Hardship Waiver Application

Section 419.03    Determining the Protected Resource Amount

PART 601, TABLE A   INCOME LIMITS

PART 601, TABLE B   SPECIAL INCOME LIMITS FOR CFI AND HCBC INDIVIDUALS

Section 627.03    Allocation to a Community Spouse

Note: The SGA limits in MAM PART 209, AID TO THE PERMANENTLY AND TOTALLY DISABLED, would normally be updated during this project at the same time that the SGA limits were being updated in AAM 209 listed above. However, due to an overlap in projects touching this same MAM page, the SGA limits in MAM 209 were updated during the revisions to this page associated with DFA SR 15-03, dated January, 2015.

IMPLEMENTATION

Changes identified in this SR are effective January 1, 2015 for current cases, and apply to any new cases processed on or after that date.

New HEIGHTS will run the January MC from December 26 through January 16 (see MC Schedule in the System Changes section of this SR).

Use the updated forms for any new spousal applications dated January 1, 2015 or later, However, prior to detaching the new versions, rename and retain the January/July 2014 electronic versions of DFA Forms 798A, 799, and 799A, in case rollbacks are required.

CLIENT NOTIFICATION

A one-time mailing, to notify all institutionalized individuals and their community spouses of the new spousal impoverishment figures, is scheduled to be generated from State Office on January 9, 2015. The 2015 Spousal Letter is attached to this SR for reference.

All individuals who experienced a change in their case due to the Jan MC updates will receive the appropriate NOD message as detailed in the Mass Change NOD section above.

No other client notification is planned.

TRAINING

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

FORMS MANUAL POSTING INSTRUCTIONS

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 www.dhhs.nh.gov/DFA/publications.htm, effective December 29, 2014. Additionally, this SR, and printed pages with posting instructions, will be distributed under separate cover to all internal hard copy holders of the Adult Assistance, Medical Assistance, and Forms Manuals.

DFA/KD:s