SR 22-14 Dated 03/22 |
STATE OF NEW HAMPSHIRE
DEPARTMENT OF HEALTH & HUMAN SERVICES – DIVISION OF ECONOMIC AND HOUSING STABILITY
Bureau of family assistance (bfa)
INTER-DEPARTMENT COMMUNICATION
FROM: |
The Bureau of Family Assistance (BFA) Administrator IV, Debra E. Sorli |
BFA SIGNATURE DATE: |
2/23/2022 |
FROM: |
The Director of Division of Medicaid Services (DMS) Henry Lipman |
DMS SIGNATURE DATE: |
2/23/2022 |
AT (OFFICE): |
Bureau of Family Assistance Division of Medicaid Services |
TO: |
All BFA Staff All DMS Staff All BES Staff |
SUBJECT: |
Release of Increased Income Limits for QMB, SLMB/SLMB135, GA, EMA, CM, PW MA, FPEC, QDWI, ECM, MEAD, and MOAD, ; Updated Resource Limits for MEAD and MOAD; Annual Income Limits for Legally Liable Relative; Updated 5% MAGI-Specific Income Deduction; Updated FANF Payment Standard; Updated Federal Tax Filing Threshold Requirements |
EFFECTIVE DATE: |
March 1, 2022 |
SUMMARY
This Supervisory Release (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:
· resource limits for MEAD and MOAD;;
· 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;
· 5% MAGI-specific income deduction;
· Financial Assistance for Needy Families (FANF) Payment Standard, which is also used for Refugee Cash Assistance; and
· federal tax filing requirement thresholds.
These increases are effective March 1, 2022 and are based upon the federal poverty guidelines (FPGs) published in the Federal Register, dated January 21, 2022 (87 FR 3315).
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).
Group Size |
2022 ≤ 100% FPG |
1 |
$1,133 |
2 |
$1,526 |
3 |
$1,920 |
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).
Group Size |
2022> 100% and ≤ 120% FPG |
1 |
$1,133 - $1,359 |
2 |
$1,526 - $1,831 |
3 |
$1,920 - $2,303 |
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).
Group Size |
2022> 120% and ≤ 135% FPG |
1 |
$1,359 - $1,529 |
2 |
$1,831 - $2,060 |
3 |
$2,303 - $2,591 |
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).
Group Size |
2022 ≤ 133% FPG |
1 |
|
2 |
$2,030 |
3 |
$2,553 |
4 |
$3,076 |
5 |
$3,599 |
6 |
$4,122 |
7 |
$4,646 |
8 |
$5,169 |
9 |
$5,692 |
10 |
$6,215 |
11 |
$6,738 |
12 |
$7,261 |
For each additional member, add: |
$524 |
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).
Group Size |
2022 ≤ 185% FPG |
1 |
$2,096 |
2 |
$2,823 |
3 |
$3,551 |
4 |
$4,279 |
5 |
$5,006 |
6 |
$5,734 |
7 |
$6,462 |
8 |
$7,189 |
For each additional member, add: |
$728 |
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).
Group Size |
2022 ≤ 196% FPG |
1 |
$2,220 |
2 |
$2,991 |
3 |
$3,762 |
4 |
$4,533 |
5 |
$5,304 |
6 |
$6,075 |
7 |
$6,846 |
8 |
$7,617 |
9 |
$8,388 |
10 |
$9,159 |
11 |
$9,930 |
12 |
$10,700 |
For each additional member, add: |
$771 |
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).
Group Size |
2022 ≤ 200% FPG |
1 |
$2,265 |
2 |
$3,052 |
3 |
$3,839 |
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).
Group Size |
2022 > 196%, but ≤ 318% FPG |
1 |
$2,220 - $3,602 |
2 |
$2,991 - $4,853 |
3 |
$3,762 - $6,103 |
4 |
$4,533 - $7,354 |
5 |
$5,304 - $8,605 |
6 |
$6,075 - $9,856 |
7 |
$6,846 - $11,107 |
8 |
$7,617 - $12,375 |
9 |
$8,388 - $13,608 |
10 |
$9,159 - $14,859 |
11 |
$9,930 - $16,110 |
12 |
$10,700 - $17,361 |
For each additional member, add: |
$771 - $1,251 |
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).
Group Size |
2022 ≤ 450% FPG |
1 |
$5,097 |
2 |
$6,867 |
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.
Group Size |
2022 < 250% FPG |
1 |
$2,832 |
2 |
$3,815 |
MEAD and MOAD – Resource Limits
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].
Group Size |
2022 |
1 |
$32,471 |
2 |
$48,704 |
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).
Group Size |
2022 ≤ 200% FPG (annual) |
1 |
$27,180 |
2 |
$36,620 |
3 |
$46,060 |
4 |
$55,500 |
5 |
$64,940 |
6 |
$74,380 |
7 |
$83,820 |
8 |
$93,260 |
9 |
$102,700 |
10 |
$112,140 |
11 |
$121,580 |
12 |
$131,020 |
For each additional member, add: |
$9,440 |
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.
Group Size |
2022 5% FPG |
1 |
$57 |
2 |
$77 |
3 |
$96 |
4 |
$116 |
5 |
$136 |
6 |
$155 |
7 |
$175 |
8 |
$195 |
9 |
$214 |
10 |
$234 |
11 |
$254 |
12 |
$273 |
For each additional member, add: |
$20 |
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.
Group Size |
2022 60% FPG |
1 |
$679 |
2 |
$915 |
3 |
$1,151 |
4 |
$1,387 |
5 |
$1,623 |
6 |
$1,859 |
7 |
$2,095 |
8 |
$2,331 |
9 |
$2,567 |
10 |
$2,803 |
11 |
$3039 |
12 |
$3,275 |
For each additional member, add |
$236 |
Federal Tax Filing Requirement Thresholds (for 2021 tax year, for filing in 2022)
Tax Filing Requirements for Most Taxpayers
The federal tax filing requirement thresholds are set by the Internal Revenue Service (IRS). These thresholds are released annually by the IRS in Publication 501 Dependents, Standard Deduction, and Filing Information and are now incorporated in the annual March mass change.
If your filing status is |
Age at the End of 2021 |
Must File a Return if Gross Income Exceeds: |
Single |
Under 65 65 or Older |
$12,550 $14,250 |
Head of Household |
Under 65 65 or Older |
$18,800 $20,500 |
Marred Filing Jointly |
Under 65 (both spouses) 65 or Older (one spouse) 65 or Older (both spouse) |
$25,100 $26,450 $27,800 |
Married Filing Separately |
Any Age |
$5 |
Qualifying Widow(er) |
Under 65 65 or Older |
$25,100 $26,450 |
Tax Filing Requirements for Children (up to age 19) and Other Single Dependents
These thresholds are released annually by the IRS in Publication 929, Tax Rules for Children and Dependents and are now being incorporated into the annual March mass change.
If your filing status is |
Age at the End of 2021 |
Must File a Return if ANY of the Following Apply: |
Single Dependent |
Under 65 and Not Blind |
- $1,110; or - Earned income (up to $12,200) plus $350 |
Single Dependent |
65 or Older or Blind |
- $2,800 ($4,500 if 65 or older and blind); or - Earned Income (up to $12,200) plus $2,050 ($3.750 of 65 or older and blind). |
NEW HEIGHTS & NH EASY SYSTEMS PROCEDURES AND IMPLEMENTATION
New HEIGHTS will update all reference tables with the new income limits effective March 1, 2022, 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 6,318 cases that will experience a change will be incorporated into the daily “mass changes” that will run the evenings of February 16, 17 and 18, 2022.
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 2022 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 during the PHE.
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.
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 during the PHE.
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 F-a Medicaid for Employed Older Adults with Disabilities (MOAD)
PART 601, Table G PIL, Granite Advantage, EMA, CM, Pregnant Women, FPEC, and Expanded CM
PART 601, Table J 5% MAGI Deduction
PART 601, Table K Federal Tax Filing Requirement Thresholds
Revised Family Assistance Manual Topics
PART 601, Table B Maximum Payment Standard
IMPLEMENTATION
Changes identified in this SR are effective March 1, 2022 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 2022 FPGs, will receive New HEIGHTS-generated AE0128, Copay Letter.
Notification of the updated FPGs was published in the Federal Register on January 21, 2022 (87 FR 3315). 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, 2022.
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