173.05 Ineligibility Reasons SR 11-30, 07/11 (FAM-A)

Terminate 12-month extended medical assistance (EMA) if one of the following situations occurs. Take action as indicated.

Reasons for ineligibility during the first 6 months are limited to the following:

• A dependent child is no longer in the home or no longer meets the *FANF age requirement. Remove this child from the case or terminate medical assistance if this is the only dependent child. No ANP is required.

• The assistance group (AG) no longer lives in New Hampshire. Terminate medical assistance.

• The parent/caretaker relative included requests that medical assistance be terminated. Terminate medical assistance.

Reasons for ineligibility at the end of the sixth month:

• Individual fails to file a complete Form 890 before the end of the first six-month period. Send a Notice of Decision at the end of the fourth month advising that failure to complete and return a Form 890 before the end of the 6 months will result in termination. Terminate medical assistance on the last day of the sixth month without an ANP if Form 890 has not been received.

Reasons for ineligibility during the second six-month period are limited to the following:

• The individual does not send a timely report and required verification by the 21st day of the seventh month, and good cause does not exist. Terminate medical assistance on the last day of the seventh month of the EMA period without an ANP.

• The individual does not send a timely report and required verification by the 21st day of the tenth month, and good cause does not exist. Terminate medical assistance on the last day of the tenth month of EMA without an ANP.

• The parent/caretaker relative is not employed for each month in the quarterly reporting period (months 4, 5, 6, 7, 8, and 9), and good cause does not exist. Terminate medical assistance without an ANP.

• The family’s gross monthly earnings minus necessary child care costs exceed 185% of the federal poverty income guidelines. See Part 601, Table C, FANF Medical Assistance Net Income Limits and Percentages of Poverty Guidelines. Terminate medical assistance without an ANP.

• A dependent child is no longer in the home or no longer meets the *FANF age requirement. Remove this child from the case or terminate medical assistance if this is the only dependent child. No ANP is required.

• The AG no longer lives in New Hampshire. Terminate medical assistance.

• The parent/caretaker relative included requests that medical assistance be terminated. Terminate medical assistance without an ANP.