SR 21-14 Dated 03/21

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION – Division of Family Assistance (BFA)

SUMMARY

This SR releases mandatory income limit increases for the following programs:

·       Qualified Medicare Beneficiaries (QMB);

·       Specified Low-Income Medicare Beneficiaries (SLMB and SLMB135);

·       Granite Advantage Health Care Program (GA);

·       12-Month Extended Medical Assistance (EMA);

·       Children’s Medicaid (CM);;

·       Pregnant Women Medical Assistance (PW MA);

·       Family Planning Expansion Category (FPEC);

·       Qualified Disabled Working Individuals (QDWI);

·       Expanded Children’s Medicaid (ECM);

·       Medicaid for Employed Adults with Disabilities (MEAD); and

·       Medicaid for Employed Older Adults with Disabilities (MOAD).

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 MOAD;

·       5% MAGI-specific income deduction;

·       Financial Assistance for Needy Families (FANF) Payment Standard, which is also used for Refugee Cash Assistance; and

·       tax filing thresholds for certain tax dependents.

These increases are effective March 1, 2021 and are based upon the federal poverty guidelines (FPGs) published in the Federal Register, dated February 1, 2021 (86 FR 7732).

POLICY

Qualified Medicare Beneficiaries (QMB)

For QMB, monthly net income must be less than or equal to 100% FPG, pursuant to 42 USC 1396d(p)(2)(C).

Specified Low-Income Medicare Beneficiaries (SLMB)

For SLMB, monthly net income must be greater than 100% FPG, but less than or equal to 120% FPG, pursuant to 42 USC 1396a(a)(10)(E)(iii).

SLMB135

For SLMB135, monthly net income must be greater than 120% FPG, but less than or equal to 135% FPG, pursuant to 42 USC 1396a(a)(10)(E)(iv).

Granite Advantage Health Care Program (GA)

For GA, monthly net income must be less than or equal to 133% FPG, pursuant to 42 USC 1396a(a)(10)(A)(i)(VIII) and 42 CFR 435.119(b)(5).

12-Month Extended Medical Assistance (EMA)

For the second 6 months of 12-Month EMA, monthly net income must be less than or equal to 185% FPG, pursuant to 42 USC 1396r-6(b)(3)(A)(iii)(III).

Children’s Medicaid (CM), Pregnant Women Medical Assistance (PW MA), and Family Planning Expansion Category (FPEC)

For CM, PW MA, and FPEC, monthly net income must be less than or equal to 196% FPG as described in the Medicaid state plan and pursuant to 42 CFR 435.118(c)(2)(ii) (for CM), 42 CFR 435.116(c)(2)(i) (for PW) and 42 CFR 435.214(c)(1) (for FPEC).

Qualified Disabled Working Individuals (QDWI)

For QDWI, monthly net income must be less than or equal to 200% FPG, pursuant to 42 USC 1396d(s)(2).

Expanded Children’s Medicaid (ECM)

For ECM, monthly net income must be higher than 196% FPG, but no higher than 318% FPG as described in the Medicaid state plan and pursuant to 42 CFR 435.229(c)(3).

Medicaid for Employed Adults with Disabilities (MEAD)

Income Requirements

For MEAD, the individual’s monthly net income, or the individual’s monthly net income combined with the spouse’s monthly net income if living together, must be less than or equal to 450% FPG, pursuant to He-W 641.03(a)(5).

Medicaid for Employed Older Adults with Disabilities (MOAD)

Income Requirements

For MOAD, the individual’s monthly net income, or the individual’s monthly net income combined with the spouse’s monthly net income if living together, must be less than 250% FPG, pursuant to 42 USC 1936a(a)(10)(A)(ii)(XIII) and RSA 167:3-m, III. However, there is an additional MOAD income disregard that is available when net income ranges from 250% FPG up to and including 450% FPG. The purpose of the additional MOAD disregard is to align the under 250% FPG net income limit of MOAD with the 450% FPG net income limit of MEAD.

Resource Requirements—MEAD and MOAD

To be eligible for MEAD or MOAD, the individual’s countable resources cannot exceed the following, pursuant to He-W 641.03(a)(6) [for MEAD; rules are pending for MOAD].

Annual Income Limits for Legally Liable Relatives for State Supplemental Program (SSP) Financial Assistance

Income limits to determine if a liable relative is able to contribute to the support of an applicant or recipient requesting SSP financial assistance are based upon 200% FPG, pursuant to He-W 622.01(d)(5).

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) categories of medical assistance except if the individual 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, pursuant to 42 CFR 435.603(d)(4). If still ineligible for the MAGI category of medical assistance, determine In and Out medical assistance.

FANF Payment Standard

The FANF payment standard, used in determining eligibility and grant amount for FANF programs and refugee cash assistance, is equal to 60% FPG, pursuant to RSA 167:77-g.

Tax Filing Threshold for Certain Tax Dependents (for 2020 tax year, for filing in 2021)

The Tax Cuts and Jobs Act (TCJA), P.L. No 115-97, modified the tax filing threshold for single tax dependents who are under age 65 and not blind. Tax dependents who meet these criteria must file a federal tax return if any of the following apply for the tax year:

1.     Unearned income is more than $1,100

2.     Earned income is more than $12,400;

3.     Gross income is more than the larger of

a.     $1,100; or

b.     Earned income (up to $12,050) plus $350.

These thresholds are released by the IRS in January on the Form 1040 instructions (“Chart B—For Children and Other Dependents”) and are now being incorporated into the annual March mass change.

NEW HEIGHTS SYSTEMS PROCEDURES AND IMPLEMENTATION

New HEIGHTS will update all reference tables with the new income limits effective March 1, 2021, 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 3,885 cases that will experience a change will be incorporated into the daily “mass changes” that will run the evenings of February 16 and 17, 2021.

Note: Currently open PW MA, FPEC, and individuals who are open for 12-Month EMA cases are not affected by the new income limits. Similarly, children eligible for CM or ECM are also not affected by the new income limits, although some children eligible for ECM 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.

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 and FANF were updated effective March 1. Your eligibility or benefits, as shown in the old and new budgets below, were refigured using this or other changes that occurred in your case.

Individuals who had a prescription copay prior to the March mass change because their income was greater than 100% of the FPG, but after being run through the mass change will no longer have a copay due to the increased 2021 FPGs, will receive New HEIGHTS-generated AE0128, Copay Letter.

QMB, SLMB, SLMB135, and QDWI

Federal law mandates that the yearly January Social Security Administration/Supplemental Security Income (SSA/SSI) Cost of Living Adjustment (COLA) increase cannot be used to determine QMB, SLMB, SLMB135, and QDWI eligibility until after the annual update to the FPGs. 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. However, due to the national Public Health Emergency (PHE) for COVID-19, any cases that would normally close will NOT close until the end of the month in which the PHE ends.

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, New HEIGHTS will 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 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 eligibility category, contact each individual identified to obtain the recipient’s choice of eligibility category (i.e., SLMB135 or the Medicaid eligibility category for which he or she is currently open). Enter when the contact was made and the recipient’s choice of eligibility category in the case comments. However, due to the national Public Health Emergency (PHE) for COVID-19, any cases that would normally close will NOT close until the end of the month in which the PHE ends.

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             PIL, Granite Advantage, EMA, CM, Pregnant Women, FPEC, and Expanded CM

PART 601, Table J             5% MAGI Deduction

New Medical Assistance Manual Topics

PART 601, Table F-a           Medicaid for Employed Older Adults with Disabilities (MOAD)

Revised Family Assistance Manual Topics

PART 601, Table B             Maximum Payment Standard

IMPLEMENTATION

Changes identified in this SR are effective March 1, 2021 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 and FANF were updated effective March 1. Your eligibility or benefits, as shown in the old and new budgets below, were refigured using this or other changes that occurred in your case.

Individuals who had a prescription copay prior to the March mass change because their income was greater than 100% FPG, but after being run through the mass change will no longer have a copay due to the increased 2021 FPGs, will receive New HEIGHTS-generated AE0128, Copay Letter.

Notification of the updated FPGs was published in the Federal Register on February 1, 2021 (86 FR 7732). The updated FPGs are available on the Bureau of Family Assistance (BFA) webpage, under the “Policy and Guidelines” heading, and under the “Program Guidelines” subheading: http://www.dhhs.nh.gov/dfa/publications.htm or online at the United States Department of Health and Human Services (US DHHS) website at: https://aspe.hhs.gov/poverty-guidelines.

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 Bureau of Family Assistance policy releases. The 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 1, 2021.

DMS/JSC:s