701.01 Exchange of Information with the Federally Facilitated Marketplace (FFM) (MAM)

___________________________________________________________

DHHS and the FFM exchange information in either of the following situations:

. When an individual applies for medical assistance (MA) using the methods offered in NH to apply, such as NH EASY, the NH application, by telephone, etc., and:

- is found ineligible for the Medicaid programs offered in NH due to non-procedural reasons; or

- opens for In and Out MA; and

. When an individual applies for MA using the FFM. If the FFM assesses that the individual may be eligible for a NH Medicaid program, the FFM sends certain data to NH and NH DHHS makes the final Medicaid eligibility determination.

Exchange of Information when an Individual applies for MA using the methods offered in NH to apply

When an individual applies for MA using the methods offered in NH to apply, such as through NH EASY or by phone or by using a paper application that NH generates, referrals to the FFM are made for the following eligibility decisions:

. when the applicant opens for In and Out medical assistance; or

. when the applicant is denied NH Medicaid due to a non-procedural reason such as exceeding the income or resource limit, or because no NH program is available, or because there is no eligible member in the household. Note: Referrals to the FFM are not made when the denial is due to a procedural reason. Examples of procedural reasons are "client walked out," "client failed to provide," or "closed at recipient request."

When referrals are made to the FFM in the situations above, the referral to the FFM occurs as follows:

. If the referral information is successfully transferred to the FFM the same evening of the individual's denial/open for In and Out, the individual receives special information on his or her notice of decision (NOD) that he or she may be eligible for coverage through a Qualified Health Plan (QHP), or for other health insurance subsidies, including advance payment of the premium tax credit (APTC) or cost sharing reductions (CSRs). The individual is told that to apply for these programs or to find out more, visit www.healthcare.gov or call 1-800-318-2596 TTY: 1-855-889-4325, as a representative is available 24-hours a day, seven days a week.

. If the referral information is not successfully transferred to the FFM the same evening of the individual's denial/open for In and Out, the individual instead receives a New HEIGHTS-generated CM0032, Referral to FFM Letter, upon the successful transmission of the data to the FFM. It may take up to 30 days for the FFM to successfully accept the data that has been transmitted from NH DHHS, and the CM0032 is not generated until that date. The data is resent to the FFM nightly until the FFM accepts it. Text in the CM0032 is similar to the text that is populated on the NOD when referrals are immediately successful upon transmission.

Exchange of Information when an Individual applies for MA using the FFM

When an individual applies for MA through the FFM and is then referred to NH Medicaid, NH DHHS processes the application and determines eligibility for the applicant. NH DHHS then contacts the FFM with the eligibility decision:

. if NH opens the individual for NH Medicaid;

. if the applicant opens for In and Out MA; or

. if the applicant is denied NH Medicaid due to any reason, procedural or non-procedural.

In these situations:

. The FFM updates their account on the applicant with NH Medicaid's eligibility decision.

. If NH's eligibility decision matches the FFM assessment of being eligible, or if NH determines the applicant is ineligible due to a procedural reason, processing concludes. The FFM does not send any further notification to the client at this point because NH already sent the client notification.

. If NH determines the applicant is ineligible due to a non-procedural reason:

- The FFM asks the household contact to review the version of the application received from the State. If the household contact edits the application and submits changes, the FFM determines eligibility for enrollment in a QHP and for APTC/CSRs using the new information, otherwise the FFM uses the original information that the client provided to the State.

- The FFM notifies the household contact of the QHP/APTC/CSR eligibility determination.

Visit www.healthcare.gov for more information about the FFM.

References: 42 CFR 431.10-42 CFR 431.11