SR 97-07 Dated 04/97

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases mandatory income eligibility limit increases for Qualified Medicare Beneficiaries (QMB), Specified Low-Income Medicare Beneficiaries (SLMB), Poverty Level Pregnant Women and Poverty Level Children (PLP/PLC), and Twelve Month Extended Medical Assistance (EMA). These increases reflect the 1997 Federal Poverty Income Guidelines published in the Federal Register of March 10, 1997.

This SR also includes special manual procedures for certain QMB cases, all SLMB cases, and includes a copy of the Interim Enrollment Memo used to transmit SLMB case openings and closings to the Bureau of Data Management.

POLICY

The new monthly net income limits for QMB, SLMB, PLP/PLC, and 12 Month EMA are effective as of the first of April. All amounts are rounded up to the nearest dollar.

QMB

QMB net income limits are based on 100% of the 1997 poverty income guidelines.

SLMB

Net income limits for SLMB are set at 120% of the 1997 federal poverty income guidelines.

PLP/PLC and 12 Month EMA

Net income limits for PLP and PLC and 12 Month EMA are based on 185% of the current federal poverty income guidelines.

PROCEDURES

Special Procedures - QMB ONLY

All QMB cases with special program code 9 and income deduction code 555 are compared to the new QMB eligibility limits and will be closed if case income is over the new limits. The following NOD reason message will be used for QMB cases that are closing.

THE NEW FEDERAL POVERTY GUIDELINES BECAME EFFECTIVE 4/1/97. YOUR NET INCOME EXCEEDS INCOME LIMITS SET FOR THIS PROGRAM. WE COUNTED YOUR SSA BENEFIT USING THE COST OF LIVING INCREASE RECEIVED IN JANUARY. FAMILY AND ADULT ASSISTANCE CHAPTER 600.

For QMB cases that remain open, EMS will remove special program code 9 and deduction code 555. District Offices will find closing QMB cases listed on the NOD print list. These cases should be reviewed for any of the special circumstances listed below.

QMB Only Cases That Close Due to Excess Income must be reviewed if net income falls between $658.01 and $665. These cases must be allowed the federally mandated $20 income disregard, not the state disregard of $13, and therefore are still QMB eligible. To reopen on EMS, use deduction code 564 for the $7 difference between the EMS income disregard of $13 and the federal income disregard of $20.

OAA/ANB/APTD QMB Cases with Earned Income That Close Due to Excess Income

 OAA related QMB cases with earned income that close due to excess income must be manually recalculated using the revised APTD disregard because APTD methodology is the same used for SSI. See Adult Assistance Manual Section 603.01. OAA/QMB cases which then become QMB eligible must be reopened on EMS by entering deduction Code 564 (Other Deduction AP/MA) for the difference between the amount of the disregards EMS currently calculates for OAA and the amount of the APTD disregard.

 ANB related QMB cases with earned income that close due to excess income do not require any further review because current methodology is more liberal than SSI methodology. Remember that approved Individual Written Rehabilitation Plans are excluded for ANB cases and are not entered on EMS.

 APTD related QMB cases with earned income that close due to excess income are already being processed on EMS using correct SSI methodology. No manual procedures for recalculating APTD-related QMB eligibility are necessary.

 TANF (formerly AFDC) related QMB cases with earned income that close due to excess income must be reviewed and recalculated using correct SSI methodology.

Note that QMB cases with both earned and unearned income must receive the appropriate disregards for both types of income.

Potential SLMB Eligibility for QMB Cases That Close

A list of closing QMB cases will be sent to D.O.’s and must be manually reviewed for SLMB eligibility if the case net income is at or under the SLMB limits released here (120% of federal poverty levels). See Adult Assistance Manual Part 213.

SLMB Only Cases - Replacement Interim Enrollment Form and Manual Procedures

SLMB cases are not automated on EMS, so District Offices must determine if a closing QMB case is SLMB eligible by doing manual calculations to determine if case net income is under or at 120% of the federal poverty levels. If a case is SLMB eligible, the Department pays for the Part B Medicare premium for SLMB individuals in that case. When a case is no longer SLMB eligible, the Department stops paying for the Medicare Part B premium. Cases requiring SLMB enrollment are opened manually using the Interim Enrollment Memo included with SR 93-41. An extra copy is attached to this SR for information and/or photocopying purposes. In addition, this is used to delete SLMB cases are no longer eligible. The Memo is photocopied, completed and sent to the Bureau of Data Management, attention Phyllis Binning.

Unless SLMB cases fall within the possible exceptions given below, SLMB cases whose verified 1997 income is over the new program limits must be closed with the following reason message:

THE NEW FEDERAL POVERTY GUIDELINES BECAME EFFECTIVE 4/1/97. YOUR NET INCOME EXCEEDS INCOME LIMITS SET FOR THIS PROGRAM. WE COUNTED YOUR SSA BENEFIT USING THE COST OF LIVING INCREASE RECEIVED IN JANUARY. ADULT ASSISTANCE CHAPTER 600.

SLMB Cases That Close Due to Excess Income

SLMB cases that are over the new net income limits must be reviewed if net income falls between $789.01 and $796 before a manually prepared closing NOD is sent. These cases must be allowed the federally mandated $20 income disregard, and will still be SLMB eligible if excess income is the only factor in the ineligibility. In manually recalculating, be sure to use the $20 income disregard. If a SLMB case closes due to a combination of earned and unearned income, use the appropriate disregards for both types of income.

SLMB Cases with Earned Income That Close Due to Excess Income

When a SLMB case with earned income closes due to excess income, it must be recalculated using the APTD methodology for earned income disregards, The amount of the difference should be used as a deduction from earned income. Cases found eligible under the new methodology will remain open and no further action is required.

SYSTEMS CHANGES AND IMPLEMENTATION

Changes to the eligibility limits will be programmed into EMS the night of March 31 for an effective date of April 1. After March 31, the new amounts will be used in determining eligibility. Cases with special program code 9 and deduction code 555 will be compared to the new poverty level income limits for QMB. Those with income still over the new limits will receive closing NOD’s.

CLIENT NOTIFICATION

QMB and SLMB clients whose benefits are terminated as a result of the April Mass change will be notified through their automated or manually prepared Notices of Decision. No other client notification is planned.

TRAINING

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

POSTING INSTRUCTIONS

DISPOSITION

This SR may be destroyed after its contents have been noted and its posting instructions carried out.

DISTRIBUTION

This SR only will be distributed according to the narrative distribution list for the AAM and the FAM. This SR and pages will be distributed to all holders of the AAM and FAM.

OES/MGD:s