SR 97-44 Dated 01/98

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases the 2.1% increase to SSA/SSI and VA annual review benefits and related changes which become effective January 1, 1998. It also releases a new Protected Income Limit (PIL) for an assistance group of one, increases in certain spousal impoverishment limits and the standard of need for adults. This year there will be no increase in the Part B premium.

POLICY

The new maximum monthly SSI benefit levels are:

 $494 for an individual in an independent living arrangement, and

 $741 for a couple in an independent living arrangement

The Standard of Need for OAA, ANB and APTD cases in independent living arrangements increases for:

 1 person from $498 to $508,

 2 people from $727 to $742, and

 3 people from $956 to $976.

The PIL for an assistance group of one increases from $498 to $508. The PILs for all other group sizes remain the same.

The Medicare Part B monthly premium cost remains at $43.80

VA Annual Review cases (coded 130 and 148) will have a 2.1% cost of living increase.

The standards of need for residential care facilities and community residences increased:

Residential Care Facility - from $678 to $688

Community Residences

 Subsidized - from $560 to $570

 Non-Subsidized - from $620 to $630

 Enhanced Family Care - from $678 to $688

The Nursing Facility CAP remains at $1159.

Spousal Impoverishment limits increased:

 Maximum monthly maintenance allowance from $1,976 to $2,019

 Minimum resource standard from $15,804 to $16,152

 Maximum spousal resource allowance from $79,020 to $80,760

PROCEDURES

SSA Increase

EMS will still use the following computation methodology when applying the 2.1% increase to SSA benefits even though the Part B premium remains the same as last year.

 Net SSA (codes 142 and 144)

Example: $150.00 (old SSA net)

  43.80 (old Part B)

(old gross) $193.80 X SSA COLA 1.021=$197.8698 (new gross) to nearest cent = $197.87

$197.87 - $43.80 (new Part B) = $ 154.07 (cents dropped) = $154 mass change SSA net

 Gross SSA with No Part B Buy-In (Codes 141 and 143)

Example: $410.00 (old gross) X 1.021 (SSA COLA) = $ 418.61 (cents dropped) = $418

 Gross SSA When There Is Part B Buy-In (Codes 141 and 143)

When a case meets Buy-In criteria (See Adult Assistance Manual Part 709), the following calculation is used.

Example: $550 (old gross) X 1.021 (COLA) = $561.55(drop cents) - $43.80 (new part B) = $517.75 (cents dropped) = $517 + $43.80 = $560.80 (cents dropped) = $560 (new gross)

SSI Increase

January benefits are updated using the SDX tape for a crossmatch with SSI recipients on EMS. EMS will replace the SSI amount on the data base with the actual check amount listed on the SDX tape and will recompute benefits.

VA Increase

EMS will apply a 2.1% COLA increase to all VA benefits coded as 130 or 148 (annual review) and drop all cents. If a case has Aid and Attendance (A&A) benefits (income code 200) as well as codes 130 or 148, EMS will apply the 2.1% COLA to the A&A benefits and drop all cents.

In and Out Medical Assistance and Three Month Retroactive Medical Assistance Cases

In and Out Medical Assistance cases of one will use the new PIL amount for January spenddown. Note that group sizes larger than one did not change for 1998. The new PIL and adjusted benefit increases will be used for January for all In and Out Cases currently in a six month application period. Open cases in a six month spenddown may require review. In January, the Systems Support Unit (SSU) will send District Offices a listing of potentially affected In and Out cases. Three Month Retroactive MA eligibility determinations must use pre-mass change SON/PIL/CAP amounts for months prior to January 1, 1998. Those amounts are given below for reference.

PRE-MASS CHANGE (1997) SON/PIL/CAP AMOUNTS

Pickle Amendment Cases

The Pickle Amendment prevents SSA cases with a state supplement (ANB, APTD, OAA) from closing due to the COLA increase. EMS assigns deduction code 555 to the COLA amount. Then EMS subtracts the COLA amount in the categorically needy computation to determine if the case is still eligible as categorically needy. If Pickle status is retained, eligibility is determined as categorically needy. If the case is still over the categorically needy limits, the case is recomputed as medically needy.

 New Pickle Cases: Any adult case that loses AP eligibility due to the SSA COLA will automatically have Special Program Code 4 entered in field C-19 and income deduction code 555 (representing the difference between pre and post mass change SSA amounts) entered on the individual’s I-line.

 Current Pickle Cases: Any adult case with the 555 code and SSA income will have the 2.1% COLA applied and the difference added to the 555 deduction amount. EMS will recompute the case to determine if Pickle status is retained.

Note: Because of systems requirements in a mass change, EMS automatically enters a 555 code on all open cases with SSA income. Sometimes the 555 code will appear on cases not entitled to Pickle status. This does not mean the 555 amount was used in any computations. Only special program code 4 with the 555 code identifies a Pickle case.

Nursing Facility Cases

The nursing facility CAP remains at $1159. In November, the Office of Long Term Care, formerly OMS, instructed nursing facility administrators to send district offices Form 295, Notice of Change in Patient Resources, with the new SSA/VA amounts. SSA amounts differing from amounts on EMS must be verified through the Bendex Report or by contacting the nursing facility. VA amounts differing from EMS amounts must be reviewed to determine if the case is coded as an annual review. VA cases with both VA and Aid and Attendance (A&A) can be checked by manually computing the benefits as indicated in the "VA Increase" section of this SR. Contact the VA if benefit amount discrepancies cannot be resolved otherwise.

Prior Authorizations Report - This report was sent to District Offices in November. The report is separated by nursing facilities and contains an alphabetical listing of recipients in each facility. The case technician enters the new patient income amount on the report, according to OMS instructions. The completed, annotated Prior Authorizations Report must be submitted by January 16, 1998, to the Office of Long Term Care at 115 Pleasant Street, Annex 1, Concord, where it will be reviewed and forwarded to EDS. For any cases not annotated on the report by the January 16 deadline, complete Form 278.

QMB Cases on EMS

Federal law mandates that 1998 COLA increases cannot be used to determine QMB eligibility until after the annual federal poverty levels update is released April 1, 1998. Until the new figures are loaded on EMS, any QMB case which would close due to the COLA must be kept open. In order to prevent the case from closing, EMS uses special program code 9 in field C-19 and income deduction code 555 on the individual’s I-line for the QMB COLA amount. The deduction code will be removed when the 1998 poverty level figures are implemented on April 1, 1998.

Manually Determined QMB Cases

If the COLA amount is the only reason a case would close, manually determined QMB cases also must remain open until the new QMB income eligibility limits are implemented April 1.

EMS does not determine QMB eligibility for individuals in TANF AP/MA cases or in open MA cases with an MA Auto Eligible Code in C-21. When an MA case closes, QMB eligibility automatically closes, even if the individual continues to be QMB eligible. A report of closing MA with QMB cases will be sent to District Offices after the mass change in order to review eligibility and be opened as QMB only (Cat.6, Type 9), if necessary. See Case Action Order Handbook ITEM A.3 for manual QMB procedures.

Note: Remember to use the SSI income disregard of $20 for manually determined QMB and SLMB cases, and not the state standard income disregard of $13.

QMB Only Applicants Between January 1 and April 1

Any QMB only application dated between January 1 and March 30, with income over the QMB limit, must have the verified 1998 SSA monthly amount compared to the current QMB income limit. Eligible QMB only applications opened in January, February, or March must use special program code 9 and deduction code 555 for the COLA increase (difference between the 1997 and 1998 SSA amounts). Then the case will go through the April 1 poverty level income limits change and EMS will determine continued eligibility at that time.

Specified Low Income Beneficiaries (SLMB) Cases

SLMB cases are processed and maintained manually. As with QMB cases, SLMB cases must not close January 1 due solely to the SSA COLA. When the new poverty levels are released by SR on April 1, 1998, recompute eligibility to ensure that the case is still eligible.

Adult Category Recoupment

Any adult financial assistance case subject to recoupment must have the recoupment rate adjusted to reflect the new standard of need. Maximum recoupment rate is based on 10% of the standard of need for the appropriate household size. This must be accomplished no later than the next redetermination. District Offices can identify cases requiring recoupment amount adjustments by using Report HWE 206A, AP Payroll Adjustments Applied. Any adjusted cases must receive Form 205 revised to indicate the new recoupment period and amount.

Spousal Impoverishment Cases

The following procedures apply to the new maximum monthly maintenance allowance and minimum and maximum resource allowances for the community spouse.

The maximum monthly maintenance allowance increases from $1976 to $2,019 a month. When determining income allocated to the community spouse for months prior to January 1998, use the $1976 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 increase from $15,804 to $16,152 and from $79,020 to $80,760 respectively.

 The new figures apply only to applications after 12/31/97.

 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.

Rollbacks

 Financial Assistance: Rollbacks for benefits prior to January are automatically computed by EMS using the new standard of need. No adjustments are required. This will eliminate manual calculations and will not result in payment errors.

 Food Stamps: Cases affected by the mass change which require food stamp rollbacks prior to January must be adjusted to reflect pre-January income levels. Actual income received prior to January 1, 1998 must be used to compute eligibility and benefits.

 Open cases requiring corrective payment for months prior to January must be computed using pre-mass change standards of need. Retain for reference either a copy of the OES Desk Reference or AAM Chapter 600 with the pre-mass change amounts.

Problem Cases and Manual Issuances

In order to process January and subsequent benefits for cases affected by changes in this SR and which require manual checks or manual food stamp issuances, the case technician must:

1. Determine the new SSA/VA benefits using the same computation formula as EMS (or use Bendex when received);

2. Verify the new SSI amount by using the SDX report or by contacting SSA;

3. Manually recompute grant amounts using the new standard of need; and

4. Insure that if a manual issuance is sent, the income used to determine the benefit reflects the post-mass change SSA/SSI/VA amount.

Categorically Eligible Food Stamp Households

Food stamp policy in FAM Part 231 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. Any AP and/or SSI related food stamp cases that are closed as a result of the January mass change must be assessed under the categorical eligibility policy.

SYSTEM CHANGES

1. The cut-off for the mass change is December 31, 1997 and the mass change will be run that night. There will be a daily production run on that day. The food stamp cut-off for the January major run is December 31, 1997.

2. An EMS mass change will update all cases based on those affected by the 2.1% COLA. This includes all adult financial assistance cases in independent living arrangements and adult categorically needy MA cases, all residential care facility and community residence individuals.

3. Form 801 will be generated for all cases having SSA/SSI income, all adult category cases, and all categories of medically needy cases with a group size of one. Turnaround 801’s should be available for delivery by January 6, 1998.

4. AP increases and decreases will take place on the 1/15 payroll. The last check for AP closings will be for the 12/31/97 payroll.

5. The following MASS CHANGE NOD reason messages will be generated by EMS:

For all cases except Pickle and QMB:

YOUR NEW SOCIAL SECURITY AND/OR SSI BENEFIT WAS USED TO REFIGURE YOUR ELIGIBILITY FOR ALL TYPES OF AID. THE INCOME LIMITS FOR SOME MEDICALLY NEEDY MEDICAL ASSISTANCE CASES AND FOR OAA, ANB AND APTD FINANCIAL ASSISTANCE WERE ALSO INCREASED. THE ENCLOSED LETTER EXPLAINS THESE CHANGES. ADULT AND FAMILY ASSISTANCE CHAPTERS 600.

For new Pickle and QMB cases:

THE PICKLE AMENDMENT PROVIDES THAT IF YOUR MONEY PAYMENT ENDS DUE TO THE SSA COST OF LIVING INCREASE, YOUR ELIGIBILITY FOR CATEGORICALLY NEEDY MEDICAL ASSISTANCE WILL BE REFIGURED WITHOUT COUNTING THE SSA INCREASE. OTHER CHANGES IN YOUR CIRCUMSTANCES COULD STILL MAKE YOU INELIGIBLE FOR MEDICAL ASSISTANCE. ADULT ASSISTANCE CHAPTER 100.

FEDERAL LAW PROVIDES THAT IF YOUR QMB ELIGIBILITY WOULD END DUE SOLELY TO THE COST OF LIVING INCREASE, WE MUST KEEP YOUR CASE OPEN UNTIL THE NEW FEDERAL POVERTY GUIDELINES ARE AVAILABLE. IN MARCH WE WILL REFIGURE YOUR CASE AND NOTIFY YOU OF ANY CHANGE. ADULT ASSISTANCE CHAPTER 100.

6. Ten day advance notice periods will be given to all AP and MA cases with a negative action resulting from the mass change. Food stamps decreasing or closing as a result of the mass change will only receive an advance notice if any other case program receives one.

NOTE: If a case is already in suspense for a negative action due to affect February’s benefits, the mass change will terminate the current advance notice period and recompute benefits using the most current information known to the system. If no advance notice period is given in the mass change, the information which was to be used in February will be used in January. This problem cannot be fixed. As a result it can cause confusion and errors in benefits. Case technicians must compute and issue supplemental benefits to any negatively affected recipient who requests them.

7. IS Display - Mass Change Transactions: The IS display will use a special batch number, 971231, to show that a case has been updated by the mass change.

8. Discrepancy Reports

 Bendex Discrepancy Report: The tolerance on the Bendex Discrepancy Report is $5. District Offices should receive the Report about January 13.

 SDX Discrepancy Report: The SDX Report will be sent to District Offices about January 13.

CLIENT NOTIFICATION

Client letters will be sent with NOD’s to individuals whose benefits have changed. A copy of the letter is attached for reference. In mid January, notification letters will be sent to the community spouse, institutionalized spouse, and copies of both letters to the nursing facility administrators, to inform them of the new spousal impoverishment limits. Copies of both spousal letters are attached.

TRAINING

No training is planned.

POSTING INSTRUCTIONS

Remove and Destroy Insert

Family Assistance Manual

Adult Assistance Manual

Posting Instructions continued

Forms Manual

DISPOSITION

You may destroy this SR after noting its contents and carrying out its posting instructions.

DISTRIBUTION

This SR only will be distributed according to the narrative distribution list for the FAM/AAM, and Forms Manual. This SR and pages will be forwarded to all holders of the FAM/AAM and Forms Manual. Forms 798A ,799 and 799A will be sent by E-Mail to all District Offices.

DTA/md/s

Attachments