230.03 NHHPP - Medically Frail (NHHPP-M) SR 14-28, 08/14 (MAM-A)

New Hampshire Health Protection Program (NHHPP) applicants who answer yes to the following question on his or her application for medical assistance are considered medically frail, as defined in 42 CFR 440.315(f): Do you have a physical, mental, or emotional health condition that causes limitations in activities (like bathing, dressing, daily chores, etc) or live in a medical facility or nursing home?

• NHHPP recipients designated as medically frail may choose between two benefit plans: the Alternative Benefit Plan (ABP) or NH’s standard Medicaid plan.

• Both benefit plans offer very similar coverage with the following differences:

- the ABP does not offer access to long-term care (LTC) services unless the individual is receiving non-Medicare skilled nursing facility (SNF) services, whereas NH’s standard Medicaid plan does offer these LTC services. This means that if non-SNF LTC services are required, he or she can only get these services by choosing the standard Medicaid benefit plan, as long as he or she meets LTC level of care; and

- NH’s standard Medicaid Plan does not offer a substance use disorder benefit or chiropractic services, whereas the ABP does offer a substance use disorder benefit and chiropractic services. The ABP does not limit the number of visits for some services. This means that if the recipient requires help to stop using drugs or alcohol or needs chiropractic services, he or she can only get these services under the ABP.

• A “medically frail” determination occurs at application, redetermination, or whenever a change in medical health occurs and the individual requests a new determination because of the change.

• Individuals designated as “medically frail” have the right to switch back and forth from the ABP to the standard Medicaid plan at any time. NHHPP-M recipients are never “locked in” to their benefit plan. The effective date of any change in plan made during District Office business hours is the next calendar day. Any change in plan made during nonbusiness hours is effective the next business day following the date the information is entered or uploaded into New HEIGHTS. If, for example, an NHHPP-M recipient changes plans on Friday at 11 PM, the information will be uploaded into New HEIGHTS on Monday, and the change in plan will be effective Tuesday.

References: He-W 511-512, He-W 841.01, He-W 841.08, RSA 126-A:5,XXIII-XXVI, RSA 126-A:5-b, RSA 126-A:67, 42 CFR 435.119, 42 CFR 440.315(f), Section 1902(a)(10)(A)(i)(VIII) of the Social Security Act (SSA) [42 USC 1396a(a)(10)(A)(i)(VIII)], Section 1906 of the SSA [42 USC 1396e], Section 1937 of the SSA [42 USC 1396u-7]