220.03 Eligibility Requirements SR 06-04, 03/06 (FAM-A)

To receive medical insurance under HKS, children must meet basic eligibility requirements applicable to other categories of assistance, such as citizenship/alien status, New Hampshire residency, providing certain documentation, and not being an inmate in a public institution or institution for mental diseases. Treatment of income and allowable deductions is the same as policy for HKG-185 and HKG-300.

Exceptions: For HKS, social security numbers (SSN) of children are not required, but may be provided voluntarily. See FAM 303.01, Residence for Eligibility. Verification requirements regarding citizenship and income are less restrictive than for HKG medical coverage. See FAM 220.13, Verification Requirements, and FAM 305.05, Verification of Citizenship.

Specific eligibility requirements that apply to HKS coverage are:

• Income Limit: over 185%, but less than or equal to 300%, of the federal poverty level;

• Age Limit: age 1 up to age 19;

• Payment of Monthly Premiums: $25 per month per child if net family income is over 185% but less than or equal to 250% of the federal poverty level, or $45 per month per child if net family income is over 250% but less than or equal to 300% of the federal poverty level;

• No current health coverage nor health coverage within the last 6 consecutive months (other than Healthy Kids-Gold, Medicare, Medicaid, or any coverage under NHHKC plans), unless good cause exists; and

• Not eligible for HKG for reasons other than failure to provide verification.

Income Limits

To qualify for HKS based on income, the family’s net monthly income must be greater than 185%, but less than or equal to 300% of the federal poverty level for the appropriate family size, as illustrated in the following table:

Resource Limit

There is no resource limit for HKS coverage.

Insurance Related Eligibility Requirements

Children are not eligible for HKS if they are currently insured, or were covered under private or public health insurance other than HKG, Medicare, Medicaid, or coverage that is currently available through the NHHKC, within the 6 calendar months prior to the month of application, unless at least one of the following good cause reasons exists:

• the health insurance was terminated due to involuntary loss of employment;

• the health insurance was terminated due to voluntary loss of employment, and the voluntary loss occurred for any of the good cause reasons specified in FAM 315.03, Good Cause for Voluntary Quit, and 808.31, Compliance Requirements;

• change of employment to an employer that does not allow the employee to enroll their dependent children under the employer’s health plan;

• death of the subscriber to the insurance policy;

• discontinuation of coverage to all employees by the employer;

• discontinuation of COBRA benefits after 18 months for job termination or 24 months after the death of the subscriber;

• the subscriber parent met other good cause reasons prior to accepting COBRA coverage;

• the insurer closes its operation in New Hampshire;

• an involuntary reduction in work hours that no longer allows the employee to enroll the employee’s dependent children under the employer’s health plan;

• the subscriber parent experiences loss of coverage or an inability to use current coverage due to family/domestic violence;

• a temporary insurance policy has ended and:

- the dependent children were not enrolled in a group or non-group health plan in the previous 6 months; or

- the subscriber parent would have met good cause reasons prior to enrolling in a temporary coverage policy;

• the subscriber parent leaves employment to become the primary caretaker of their dependent children who are 5 years of age or under; or

• the health insurance was terminated by a non-custodial parent subscriber and the loss of insurance was beyond the control of the custodial parent.

The District Office is responsible for determining good cause. The applicant must present third party documentation of good cause for termination or discontinuance of health insurance.

Clients must report all changes in circumstances, including subsequently obtaining health insurance. The child’s eligibility ceases at the end of the month in which other health insurance is obtained.

Monthly Premium Payments

A monthly premium is required for each child eligible for HKS, except for Native American Indians or Alaskan Natives, unless good cause exists.

• The premium is payable to NHHKC. NHHKC will contact the family to explain the premium process and requirements, collect and process the premium, determine good cause for failure to pay the premium, and notify the District Office when the premium has not been paid for 60 days without good cause.

• Payment is due by the last day of the month for the following month’s coverage.

• Failure to pay the premium for 60 days without good cause will result in termination of eligibility.

Good cause for failure to pay the premium exists when NHHKC determines that at least one of the following criteria is met:

• the recipient’s family experiences a temporary or unexpected loss of income which prevents the family from paying the premium; or

• the recipient’s family incurs an unexpected expense which prevents the family from paying the premium.

The amount of the required premium differs based on the family’s net monthly income. If net family income is greater than 185% but less than or equal to 250% of the federal poverty level, the required premium per child is $25 per month. The maximum monthly premium for families in this income group is capped at $100 per month, regardless of the number of children receiving HKS. If net family income is greater than 250% but less than or equal to 300% of the federal poverty level, the required premium per child is $45 per month. The maximum monthly premium for families in this income group is capped at $135 per month, regardless of the number of children receiving HKS.