211.19 Termination of MEAD SR 13-35 Dated 10/13

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Employment

Terminate MEAD eligibility if the individual becomes unemployed due to:

. voluntarily quitting or losing employment without good cause;

. deciding not to seek employment or return to work; or

. terminating employment to seek medical treatment which will not enable the individual to become re-employed.

MEAD eligibility automatically terminates:

. at the end of the first six-month extension; or

. if eligible for one additional six-month extension, at the completion of the second extension.

Terminate MEAD if an individual has 3 consecutive occurrences of becoming employed during the 5th month of an extension.

Premiums

Non-payment of premiums for 2 consecutive months without good cause as determined by OMBP, will result in termination of MEAD.

OMBP will enter appropriate sanctions into New HEIGHTS when the premium has not been paid without good cause.

MEAD coverage may be reinstated during the advance notice period following termination due to non-payment of premiums when:

. the participant furnishes proof of payment in full for the past due premiums or proof that a payment plan for past due premiums has been established; or

. it has been redetermined by OMBP staff that there is good cause for non-payment and the participant has exhausted all available resources with which to pay past due premiums.

Non-payment of premiums for 3 consecutive months with good cause as determined by OMBP, will result in termination of MEAD, unless a payment plan for past due premiums is established. If good cause exists for non-payment of premiums, a payment plan may be arranged between the client and OMBP.

The option of a payment plan is available to clients only once in a 2-year period.

OMBP will contact the District Office to request the lifting of nonpayment of premium sanctions when needed.

Administrative Appeals

Upon receiving a request for an administrative appeal on the basis of MEAD closing due to non-payment of premiums, notify OMBP so that a pre-hearing conference can be arranged between their representative and the client.

If the issue is not resolved at the pre-hearing conference, notify OMBP of the date and time of the administrative appeal.

OMBP represents DHHS at the administrative appeal.

References: He-C 5003, He-W 841.03, RSA 167:3-i, RSA 167:3-c,XII, RSA 167:6,IX, 42 CFR 435.914, 42 USC 1396a(a)(10)(A)(ii)(XV).