157.01 Timely Notice SR 16-10, Dated 08/16 (MAM-A)

SR 16-10 Dated 08/16

Previous Policy

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Inform each individual that on a regularly scheduled basis, his or her eligibility for continued medical assistance (MA) is reviewed.

Based on household circumstances and the category of medical assistance received, notify individuals that at those regularly scheduled reviews, some MA cases may:

·         have their eligibility automatically renewed;

·         be required to participate in a face-to-face redetermination as a condition of continued eligibility; or

·         be required to complete an online or mail-in redetermination/renewal as a condition of continued eligibility.

MAGI Renewals

Automatic Renewals (Passive MAGI Renewal)

For the categories of medical assistance (MA) that use modified adjusted gross income (MAGI) in the eligibility determination process, the regularly scheduled renewal period is automatically advanced another 12 months if all eligibility factors for the MAGI MA case can be verified by electronic crossmatching at that regularly scheduled renewal. This is referred to as a “passive MAGI renewal.” For passive MAGI renewals:

·         Notification of the new renewal date, via New HEIGHTS-generated CS0006, MAGI Mail-In Rede Letter, or New HEIGHTS-generated CS0030, MAGI Online Rede Letter, is generated to the casehead by the 15th of the month prior to the month of the scheduled renewal along with the case information that DHHS used to renew eligibility.

·         The CS0006/CS0030 includes a request that the casehead contact DHHS to report any corrections that need to be made to the information that DHHS used to renew eligibility, but this information is assumed to be correct and it is not expected that corrections will be returned. The return of this information is not required in the passive MAGI renewal process.

Online or Mail-In Renewals (Non-Passive MAGI Renewal)

If all MAGI MA eligibility factors for the case cannot be verified by electronic crossmatching, the case's regularly scheduled renewal period is not automatically advanced 12 months. This is referred to as a “non-passive MAGI renewal.” For non-passive MAGI renewals:

·         Eligibility factors for the MAGI MA case that cannot be verified by DHHS through electronic cross-matching include such situations as when reported wages or unearned income are not able to be electronically verified by DHHS (there is no electronic cross-match available, no response is received in the electronic crossmatch process, or the response from the crossmatch is not within the 10% threshold), and/or the case includes self-employment income, and/or the case includes an individual receiving Parent/Caretaker Relative MA and needs to verify deprivation.

·         Notification that eligibility could not be automatically renewed is generated to the casehead via the CS0006 or *CS0027, Online Rede Letter, along with the following: 1) a list of proofs that the case must provide for DHHS to determine continued eligibility and the date when these proofs are due, and 2) case information that DHHS used in the determination that the automatic (passive) renewal could not occur.

-         The casehead is notified in the CS0006/*CS0027 that the list of required proofs must be provided to DHHS by the 15th day of the month following the date on the CS0006/*CS0027. Failure to provide the proofs requested within timeframes results in termination of MAGI medical assistance. Exception: If medical assistance is terminated due to failure to provide the verification requested in the CS0006/*CS0027 within the original timeframes, and the casehead subsequently provides all requested verification within 90 days of the date of the termination of his or her coverage, eligibility must be reinstated back to the date of termination by the 30th business day following the date the last piece of verification was provided.

-         The CS0006/*CS0027 also includes the case information that DHHS used to determine that eligibility could not be renewed automatically (passive MAGI renewal). * Non-passive MAGI MA renewal cases must correct the case information in the CS0006/CS0027, sign and date the information, and return or electronically submit this packet of information along with all required verifications as a condition of continued eligibility for MAGI MA. Failure to return or electronically submit the signed and dated information with corrected information and all required verification within MAGI MA renewal timeframes results in termination of the MAGI MA case.

The CS0006/*CS0027 renewal package generated includes:

·         DFA Form 811R, Application: Your Rights and Responsibilities;

·         a postage-paid business reply envelope; and

·         DFA Form 720, Determination of Incapacity Status, if a MAGI case member is receiving Parent/Caretaker Relative MA and deprivation is due to incapacity.

Face-To-Face Redetermination – Non-MAGI Categories

The New HEIGHTS-generated CS0001, Rede Interview, is generated to non-MAGI MA cases that are required to participate in a face-to-face redetermination/recertification as a condition of continued eligibility. The CS0001 is generated by the 15th of the month prior to the month the redetermination/recertification is due.

The CS0001 advises the individual:

·         of the date and time of the eligibility interview;

·         that the individual must call to reschedule the interview if unable to attend the appointment and the individual wishes to continue receiving benefits; and

·         the effect that the individual's failure to attend may have on the recipient's benefits.

The CS0001 face-to-face package generated to the individual includes:

·         DFA Form 775, Rental Verification Request; and

·         DFA Form 756, Employment Verification.

For a face-to-face redetermination, the individual must:

·         complete DFA Form 800, Application for Assistance, DFA Form 800MA, Application for Health Coverage & Help Paying Costs, or Form 800HR, New HEIGHTS-generated Application for Assistance; and

·         participate in a face-to-face interview.

Online or Mail-In Redetermination – Non-MAGI MA Categories

Mail-In Redetermination for Non-MAGI MA Categories

The appropriate mail-in redetermination package is generated to eligible non-MAGI MA cases by the 15th of the month prior to the month the redetermination is due and includes:

·         New HEIGHTS-generated CS0005, Mail-In Rede Letter;

·         a postage-paid business reply envelope;

·         the appropriate application as follows:

-         DFA Form 771A, Nursing Facility Care Renewal, if the individual resides in a nursing facility; or

-         DFA Form 800R, Application for Continued Eligibility for Financial, Medical, Child Care, and Food Stamp Benefits, and DFA Form 811R, Application: Your Rights and Responsibilities, for all other cases.

Exception: QMB, QDWI, SLMB, and SLMB135 redeterminations for New Hampshire Housing Authority (NHHA) residents, or ServiceLink-assisted individuals who are applying for these programs, may continue to be submitted on DFA Form 800Q, Assisted Application For Help With Medicare Costs Through the Medicare Savings Program.

Individuals are notified in the CS0005 that by the 15th day of the last month of the redetermination period, he or she must:

·         complete and return DFA Form 800R with all needed verifications; or

·         complete and return DFA Form 771A, with all needed verifications.

Online Redetermination for Non-MAGI MA Categories

Non-MAGI MA cases with NH EASY accounts who are scheduled for what would usually be considered a mail-in redetermination are eligible to complete their redetermination online.

If the NH EASY account holder's redetermination method is "online," the online redetermination package is generated by the 15th of the month prior to the month the redetermination is due and includes:

·         New HEIGHTS-generated CS0027, Online Rede Letter; and

·         a postage-paid business reply Central Scanning Unit (CSU) envelope for the recipient to provide their verifications.

Individuals are notified in the CS0027 that:

·         the non-MAGI MA case must complete the online Redetermination Application and send in all needed verifications by the 15th day of the following month;

·         if the non-MAGI MA case does not complete the online redetermination process and/or provide all needed verifications by the due date, it will result in a termination of benefits;

·         the non-MAGI MA case may opt out of the online redetermination process and return to a mail-in redetermination process; and

·         the non-MAGI MA case should contact the District Office if they have any questions.

MA cases eligible to participate in the automatic renewal, online, or mail-in redetermination process are not required to participate in a face-to-face interview. However, an interview must be granted if one is requested.

Exception: Require a face-to-face interview for non-MAGI MA cases that do not fully complete DFA Form 800R or do not complete the online Redetermination Application, if required, but at minimum provide their name, address, and a signature.

When verification is not sufficient or not provided in the online or mail-in redetermination process, send New HEIGHTS-generated AE0055, Proof Needed to Determine Your Assistance. If New HEIGHTS is unavailable, use paper backup DFA Form 808, Proof Needed to Determine Your Assistance.

 

References: He-W 606.01; He-W 606.100-606.101; He-W 844.01; He-W 883.01; He-W 884.01-.02; RSA 161:4-a, X(a) & (g); 42 CFR 435.914(a); 42 CFR 435.916; 45 CFR 206.10(a)(9)