808.07 Verification of Exemptions (FAM)

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District Offices are responsible for determining exemption status based on acceptable documentation and verification of the exemption claim.

Exception: Individuals claiming a medical exemption are referred to the Medical Exemption Unit (MEU). The MEU reviews the medical information provided and, if needed, works with the individual to make a determination regarding the NHEP activities in which the individual is able to participate.

Acceptable documentation must contain specific detail and address each item listed under the appropriate heading. General or incomplete statements that do not thoroughly address each specific item are considered unacceptable.

Do not grant an exemption if the individual fails to provide acceptable verification within 10 days of the request or fails to notify the District Office of difficulty in obtaining third-party documentation. Proceed with the referral to the New Hampshire Employment Program (NHEP) team after the verification time frame has elapsed.

Exception: Allow more than 10 days if notified by the individual of difficulty obtaining third-party documentation. Assist the individual, upon request, to identify sources of alternate documentation when documentation from the original source cannot be obtained.

Medical Exemption

Medical exemption based on the FANF applicant/recipient’s health condition

Individuals requesting an exemption from NHEP work requirements due to a health condition must have an authorized healthcare provider provide the information requested on BFA Form 752, Healthcare Provider Statement of Abilities for FANF Financial Assistance.

Medical exemption based on the health condition of the FANF applicant/recipient’s household member

Individuals requesting an exemption from NHEP work requirements due to caregiving they provide to a household member with a health condition must have their household member’s authorized healthcare provider provide the information requested on BFA Form 752HH, Healthcare Provider Statement of Necessary Care for a FANF Household Member.

For the purpose of this type of caregiving medical exemption, a household member is defined as:

• someone who lives in the same home as the adult who receives FANF; and

• is a relative; or

• is a member of the FANF assistance group.

Examples of caregiving relationships that meet the definition of a household member:

• Jane receives FANF for herself and her child. She lives with her father, who is disabled; Jane provides significant caregiving for him. Jane may be eligible for a medical exemption based on this caregiving because she and her father live in the same home and they are related to one another.

• Mary receives FANF for herself and her son. She also has a daughter with her boyfriend. All four people live together. Mary’s boyfriend has an accident and she becomes his caregiver. Because Mary’s boyfriend is a counted member of the assistance group and they live together, Mary may be eligible for a medical exemption based on this caregiving.

Examples of caregiving relationships that do not meet the definition of a household member:

• John receives FANF for himself and his child. He also lives with a roommate who is disabled, and John helps to care for his roommate. Because the roommate is not related to John, nor is the roommate a member of the assistance group, John is not qualified for this type of medical exemption.

• Jane receives FANF for herself and her child. She also lives with her boyfriend, and she provides significant caregiving to him due to his serious illness. Although Jane does live with her boyfriend, he is not a member of the FANF assistance group (they do not have a child in common), and she therefore is not eligible for this type of medical exemption.

• Jane receives FANF for herself and her child. Her father, who lives next door, is disabled, and Jane provides significant caregiving for him. Jane is not eligible for this type of medical exemption because she and her father do not live in the same home.

BFA Form 752A, Authorization for Release of Protected Health Information for FANF Financial Assistance, serves two purposes:

• The front side of this document informs FANF applicants and recipients (and their household member, if applicable) of the process that must be followed when claiming a medical exemption;

• The back side of this document, when properly filled out and signed by a healthcare provider’s patient, allows for release of protected health information from a healthcare provider to DHHS, including contract staff.

All individuals requesting a medical exemption should be given BFA Form 752A; however, some healthcare providers may prefer to have their patients fill out the healthcare providers’ own release document in order to share the health information that is requested on BFA Form 752 or 752HH.

The back of BFA Form 752A is for the healthcare provider and does not need to be returned to the MEU. However, give a copy of the front page of BFA Form 752A to the individual because it contains important information about the medical exemption process, and the original of this form is going to go to the healthcare provider.

The types of healthcare providers authorized to provide the information requested on BFA Forms 752 and 752HH are:

• Physicians;

• Physician Assistants;

• Advanced Practice Registered Nurses;

• Psychologists (board certified);

• Pastoral Psychotherapists;

• Alcohol and Drug Counselors (Master Licensed Alcohol and Drug Counselors only);

• Independent Clinical Social Workers;

• Clinical Mental Health Counselors; and

• Marriage and Family Therapists.

All Other Exemptions

Accept any documentation that reasonably establishes the individual’s exemption status.

References: He-W 606.30; He-W 606.32; He-W 637.04; RSA 167:82, II