230.07 NHHPP/NHHPP-M: Employer Sponsored Insurance (ESI) and the NH Health Insurance Premium Payment (NH HIPP) Program SR 16-03, 09/15 (MAM-A)

All NHHPP/NHHPP-M recipients are automatically placed in the Alternative Benefit Plan (ABP). However, if the NHHPP/NHHPP-M applicant or recipient has access to employer sponsored insurance (ESI) either directly, as an employee, or indirectly, through another individual who is eligible for it, and the NH Health Insurance Premium Payment (HIPP) program determines it is cost-effective for the applicant or recipient and his or her spouse and dependents to enroll in ESI, the NHHPP/NHHPP-M applicant and recipient, and his or her spouse and dependents, are required to enroll in the ESI or maintain ESI coverage. All NHHPP/NHHPP-M applicants and recipients must cooperate with NH HIPP and respond to all requests and deadlines provided by NH HIPP or NHHPP/NHHPP-M coverage ends.

NH HIPP pays for the employee’s share of any costs associated with the enrollment in ESI. In NH HIPP, the employer deducts the employee’s share of the insurance premium from the employee’s paycheck, and NH HIPP pays the employee’s share of the premium to the employee. Co-pays and deductibles are paid to the individual only if the individual paid those expenses out-of-pocket, otherwise NH HIPP reimburses the provider.

NH HIPP determines if enrollment in ESI is more cost-effective for NH when compared to enrollment in NH Medicaid Care Management (MCM).

• The NHHPP/NHHPP-M recipient is required to tell DHHS if he or she has access to ESI at the time of application and at any other such time as coverage becomes available. Questions about access to other health insurance is already a part of the application and redetermination process and the federal application for medical assistance, via DFA Form 800MA or DFA Form 800 Insert as well as in NH EASY. However, NH HIPP sends a separate NH HIPP application to referred individuals.

• Cost-effectiveness is evaluated at application, redetermination, whenever a change in employment status occurs in which the individual’s or the household member’s access to ESI is impacted, and whenever an employer changes the ESI or ESI components to which the individual or household member has access. Collection of information needed about ESI and cost-effectiveness of ESI is the responsibility of NH HIPP, whereas reporting changes in employment or ESI status is the responsibility of the NHHPP/NHHPP-M recipient. Any information needed by the District Office workers regarding eligibility for NHHPP/NHHPP-M because of the recipient’s failure or refusal to comply with NH HIPP requirements without good cause will be passed to the worker from NH HIPP via New HEIGHTS.

• As is current policy with every category of assistance, NHHPP/NHHPP-M recipients must report all changes in circumstances which affect eligibility or any changes that impact NH HIPP eligibility such as, but not limited to, changes in health insurance coverage, within 10 days of the date the change occurs.

• All NHHPP/NHHPP-M recipients referred to NH HIPP receive Fee for Service Medicaid until such time as the NH HIPP cost-effectiveness is determined. If determined not cost-effective, recipients receive the NH Medicaid Care Management (MCM) Health Plan Selection package. Those NHHPP/NHHPP-M recipients who provide ESI information after being enrolled in an MCM Health Plan, remain enrolled in the MCM Health Plan until such time as the NH HIPP assessment and enrollment process is complete.

Per RSA 126-A:5,XXIII(c)(3), the Health Insurance Premium Payment Program is subject to cancellation upon notice.

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, 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]