SR 15-14 Dated 03/15

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);

·      New Hampshire Health Protection Program (NHHPP)/New Hampshire Health Protection Program - Medically Frail (NHHPP-M);

·      Children’s Medicaid (CM), which includes the income limits for Children with Severe Disabilities (CSD);

·      Pregnant Women Medical Assistance (MA);

·      Family Planning Expansion Category (FPEC);

·      Expanded Children’s Medicaid; 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 State Supplement Program (SSP) financial assistance;

·      resource limits for MEAD; and

·      the 5% MAGI-specific income deduction.

These increases are effective March 1, 2015 and are based upon the federal poverty guidelines (FPGs) published in the Federal Register, dated January 22, 2015.

POLICY

Qualified Medicare Beneficiaries (QMB)

For QMB, monthly net income must be less than or equal to 100% of the PG.

Specified Low-Income Medicare Beneficiaries (SLMB)

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

SLMB135

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

Qualified Disabled Working Individuals (QDWI)

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

New Hampshire Health Protection Program (NHHPP)/NH Health Protection Program – Medically Frail (NHHPP-M)

Monthly net income limits for NHHPP/NHHPP-M are based on 133% of the FPG.

Children’s Medicaid (CM), Children with Severe Disabilities (CSD), Pregnant Women Medical Assistance (MA), and Family Planning Expansion Category (FPEC)

Monthly net income limits for CM, CSD, Pregnant Women MA, and FPEC are based on 196% of the FPG.

Expanded Children’s Medicaid

Monthly net income limits for Expanded CM must be higher than 196% of the PG, but no higher than 318% of the PG.

Medicaid for Employed Adults with Disabilities (MEAD)

Income Requirements

The individual’s monthly net income, or the individual’s monthly net income combined with the spouse’s monthly net income if living together, cannot exceed 450% of the PG:

Resource Requirements

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

Annual Income Limits for Legally Liable Relatives

Income limits for legally liable relatives are based on 200% of the PG.

5% MAGI-Specific Income Deduction

This income deduction is only applied if the applicant or recipient meets all categorical eligibility requirements for the Modified Adjusted Gross Income (MAGI) category of medical assistance except is over income. At that point, redetermine eligibility by subtracting the 5% MAGI-specific income deduction from the individual’s income based on household size. If still ineligible for the MAGI category of medical assistance, determine In and Out medical assistance.

NEW HEIGHTS SYSTEMS PROCEDURES AND IMPLEMENTATION

New HEIGHTS will update all reference tables with the new income limits effective March 1, 2015, and will use the new amounts for any eligibility periods beginning on or after that date.

Due to the small numbers of cases that are affected by the updates released by this SR, the approximately 906 cases that will experience a change will be incorporated into the daily “mass changes” that will run the evening of February 17, 2015.

For QMB, SLMB, SLMB135, and QDWI cases that were kept open at the January 2015 mass change, New HEIGHTS will recalculate eligibility based upon current SSA/SSI income. Because these households will now have their current income 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 Pregnant Women MA, FPEC, and individuals who are open for 12-Month Extended Medical Assistance (EMA) cases are not affected by the new income limits. Similarly, children eligible for CM or expanded CM are also not affected by the new income limits, although some children eligible for expanded CM may, with the increase in the income limits, instead be eligible for regular CM. Even if this happens, though, there is no change in the coverage period or benefits the child receives, merely the category of assistance changes. However, rerun SFU and EDBC at the next change action so that the new case budgets reflect the new limits.

A few families who are eligible for In and Out medical assistance or who were denied medical assistance due to being over the medical assistance income limits even with the 5% MAGI-specific income deduction being applied, may now be eligible for medical assistance due to the increase in the income limits and/or the slight increase in the 5% MAGI-specific income deduction. Because the increase in the 5% MAGI-specific income deduction is so slight, it is anticipated that very few families will be newly eligible based on the newly increased deduction, only those families who were very close to the income limit at initial application. However, clients whose cases were denied due to being over the income limits, even with the application of the 5% MAGI-specific income deduction, may reapply at any time to determine whether the outcome of their case will be different now that the income limits and the 5% MAGI-specific income deduction have slightly increased. In and Out cases currently in spenddown status, however, will be run through the mass change, as described in more detail in the Notices section below.

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 March 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 that 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.

Individuals who had a prescription copay prior to the March MC because their income was greater than 100% of the FPG, but after being run through the MC will no longer have a copay due to the increased 2015 FPGs, will receive New HEIGHTS-generated AE0128, Copay Letter.

QMB, QDWI, SLMB, and SLMB135

Federal law mandates that the yearly January SSA/SSI COLA increase cannot be used to determine QMB, QDWI, SLMB, and SLMB135 eligibility until after the annual update to the federal poverty guidelines. 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 or close.

In and Out Medical Assistance

New HEIGHTS will run in and out medical assistance cases for any of the medical assistance categories that have experienced an income limit increase and 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 income limits, some individuals currently eligible for in and out medical assistance may become eligible for medical assistance under the appropriate category of assistance. If eligible for a different medical coverage, New HEIGHTS will send a trigger to MMIS alerting them of the eligibility for the category of medical assistance and will generate the regular “open for medical assistance” NOD to the client.

Currently open In and Out medical assistance cases who are receiving Medicaid because they have met the spenddown will not be run through the mass change. For open Medicaid In and Out medical assistance cases, rerun SFU and EDBC at the next change action so that the case budgets reflect the new limits.

Post Mass Change Reports

The two reports described below, generated on February 17, 2015 and available in New HEIGHTS as of February 18, 2015, will be produced as a result of the mass change. These reports will be located in the New HEIGHTS Reports folder under both the D.O. Daily Reports and Mass Change Reports folders.

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:

·      QDWI/QMB/SLMB cases, In and Out medical assistance cases in “deductible” status, 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 Adult Assistance Manual Topics

Section 311.01  Relative’s Ability to Contribute

Revised Medical Assistance Manual Topics

Section 407.01  Categorically Needy Medical Assistance

PART 601, Table C Qualified Medicare Beneficiary (QMB)

PART 601, Table D Specified Low Income Medicare Beneficiary (SLMB) and SLMB135

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

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

PART 601, Table G Medically Needy Medical Assistance Net Income Limits and Percentages of Poverty Guidelines

PART 601, Table J 5% MAGI Deduction

IMPLEMENTATION

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

CLIENT NOTIFICATION

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 March 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 that 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.

Individuals who had a prescription copay prior to the March MC because their income was greater than 100% of the FPG, but after being run through the MC will no longer have a copay due to the increased 2015 FPGs, will receive New HEIGHTS-generated AE0128, Copay Letter.

Notification of the change in the federal poverty guidelines was published in the Federal Register, Volume 80, Number 14, on January 22, 2015 and is available electronically on the Division of Family Assistance (DFA) webpage, under the Program Guidelines heading of the Policy and Guidelines section at: http://www.dhhs.nh.gov/dfa/publications.htm or online at the United States Department of Health and Human Services (US DHHS) website at: http://aspe.hhs.gov/poverty/index.cfm.

No other client notification is planned.

TRAINING

No special training is planned or needed.

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 March 2, 2015. 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 and Medical Assistance Manuals.

DFA/KD:s