SR 00-12 Dated 10/00

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases revised income computation policy for the adult categories of assistance. These changes are effective October 1, 2000, and include:

·      a revised earned income disregard (EID) policy for Old Age Assistance (OAA) cases;

·      simplification of the EID policy for non-applicant spouse cases;

·   elimination of the employment expense disregard (EED) for all adult eligibility determinations and use of the EED only in the post eligibility determination of nursing facility cost of care determinations; and

·      use of the appropriate adult category EID for all adult category eligibility determinations.

AAM Chapter 600 has been revised accordingly. In addition, a related policy clarification has been added to FAM and AAM PART 511, COMMON TYPES OF INCOME, to indicate that the Aid and Attendance Allowance is added to net income as the last step when determining the cost of care for applicants for and recipients of nursing facility, HCBC-ECI, and HCBC–DD/ABD services. A related technical correction to AAM 603 has been made to replace references to the Individual Written Rehabilitation Plan (IWRP) with Individualized Plan For Employment (IPE). The name change reflects current state and federal vocational rehabilitation terminology. Costs approved on an Individualized Plan For Employment may be included in the calculation of the EID for ANB individuals.

An unrelated policy clarification has been added to AAM Section 311, Relative’s Ability to Contribute, to provide additional examples of exceptional expenses that can be used to reduce a legally liable relative’s gross income when determining the relative’s contribution. Examples of allowable expenses are those associated with natural disasters such as floods, fires, earthquakes and hurricanes; and expenses due to man made occurrences such as theft of clothing, food, money, eviction and loss of an owned residence.

Two unrelated technical corrections have been made to the FAM and AAM:

AAM Section 311.05, Legal Action Against Liable Relatives, has been revised to indicate that the Chief of Legal Services, Office of Program Support, is the individual to whom the District Office may refer cases when the legally liable relative refuses to contribute support or refuses to adequately provide information regarding their ability to contribute.

AAM 625.05, Allowable Medical Expenses, has been revised to indicate that the current rates of reimbursement for medical transportation may be found in Chapter 900 of the Medical Assistance Manual.

POLICY

Revised Family Assistance Manual Topics

PART 511 COMMON TYPES OF INCOME - VA Aid and Attendance Allowance (VA A&A)

Revised Adult Assistance Manual Topics

Section 311.01 Relative's Ability to Contribute

Section 311.05 Legal Action Against Liable Relatives

PART 511 INCOME TYPES - VA Aid and Attendance Allowance

Section 603.01 Earned Income Disregard

Section 603.03 Employment Expense Disregard

PART 615 BUDGETING: Independent Living, RCF, CR, QMB, QDWI, SLMB, SLMB135, and SLMB175

PART 617 GRANT DETERMINATION

PART 619  BUDGETING: Nursing Facility

Section 619.01 Cost of Care: Nursing Facility

Section 621.01 HCBC-ECI Financial Assistance

Section 621.03 HCBC-ECI Medical Assistance

Section 623.01 HCBC-DD Financial Assistance

Section 623.03 HCBC-DD Medical Assistance

Section 624.01 HCBC-ABD Financial Assistance

Section 624.03 HCBC-ABD Medical Assistance

Section 625.05 Allowable Medical Expenses

The sections below detail the revised EID policy for adult categories of assistance and address related changes, including elimination of the EED for all adult category eligibility determinations and its inclusion in all nursing facility post-eligibility cost of care calculations. No special District Office action is required to implement these changes, as New HEIGHTS programming for these changes will take effect October 1, 2000. See the SYSTEMS CHANGES section of this SR for further details.

Revised OAA/QMB/SLMB/SLMB135/SLMB175/QDWI Earned Income Disregard

The EID for the OAA program has been revised. The revised EID also applies to all QMB, SLMB, SLMB135, SLMB175, and QDWI income eligibility determinations as of the effective date of this SR. The EID's for ANB and APTD remain the same and are noted in Section 603.01 of the Adult Assistance Manual.

When determining eligibility for HCBC-ECI, HCBC-DD, and HCBC-ABD financial or medical assistance, apply the EID appropriate to the category of assistance under which the application is being made. The employment expense disregard (EED) is no longer used to determine eligibility for HCBC services. See Employment Expense Disregard below.

For OAA/QMB/SLMB/SLMB135/SLMB175/QDWI single person cases with earned income, the EID is as follows:

 the first $65 of the individual’s earned income; and

 ½ of the remaining income.

Exception: For OAA recipients who are receiving an IRWE deduction at the time their case is transferred from APTD to OAA due to the recipient turning age 65, continue to allow an amount for Impairment Related Work Expenses (IRWE) as if they were still receiving APTD. For these individuals, the EID is the first $65.00 of the individual’s monthly gross earned income, the IRWE amount, and one-half of the remaining earned income. This exception only applies to APTD recipients with IRWE’s who are open and receiving assistance at the time of the change in program of assistance from APTD to OAA. Individuals whose APTD case closes prior to age 65, and who subsequently apply for OAA, receive the OAA EID (i.e., $65.00 plus ½ of the remaining amount).

Note: It is important that District Offices ask employed APTD individuals if they have IRWE’s at their initial interview, at redetermination and whenever the client reports changes in employment or self-employment. If the District Office enters an IRWE on HEIGHTS for an employed APTD individual, HEIGHTS will automatically carry over the IRWE deduction to the individual’s OAA case when individual’s case is transferred to OAA at age 65.

Two or Three Person Cases with a Non-Applicant Spouse/Needy Essential Person

The treatment of income eligibility for non-applicant spouse/needy essential person cases has been simplified by using the combined countable earned income of the applicant and non-applicant spouse/needy essential person and subtracting only the EID appropriate to the applicant’s category of assistance. Note that the EID’s for ANB and APTD cases remain unchanged, but the EID is applied differently for non-applicant spouse/needy essential person cases.

For all two or three person cases with a non-applicant spouse/needy essential person, the EID is calculated as follows:

1. determine the combined countable earned income of the applicant and nonapplicant spouse/needy essential person;

2. subtract the first $65 (for OAA or APTD) or the first $85 (for ANB) of the combined earned income;

3. subtract Impairment Related Work Expenses (IRWE’s) for APTD applicants, or subtract ½ of the remaining income for ANB; and

4. subtract ½ of the remaining income for APTD, or the ANB allowable amount for IPE, incurred by the applicant only, for ANB applicants.

Employment Expense Disregard (EED)

The EED has been eliminated from all Independent Living, RCF, CR, QMB, QDWI, SLMB, SLMB135, SLMB175, HCBC-ECI, HCBC-DD, and HCBC-ABD and Nursing Facility income eligibility determinations. It is now used only in the post-eligibility determination of nursing facility (NF) or HCBC cost of care. The EED remains the same ($18 or actual expenses, whichever is higher). Elimination of the EED means that the EID is now used in all eligibility determinations, and this changes the manner in which OAA and ANB net income is determined.

Revised Nursing Facility Cost of Care Calculation

The nursing home cost of care calculation is a separate calculation and no longer begins with the net income determined in the eligibility calculations. The steps for calculating cost of care are as follows:

1. determine the applicant or recipient’s total gross earned income;

2. subtract the employment expense disregard;

3. add the individual's total unearned income;

4. subtract allowable deductions;

5. subtract either the VA $90 nursing facility pension or the $50 personal needs allowance;

6. subtract income allocated to a spouse or dependents;

7. subtract unreimbursed medical expenses;

8. subtract any continuing SSI benefits;

9. if a physician has verified the stay in the nursing facility is to be temporary (3 months or less) and the individual is expected to return home, subtract the NHEP/FAP shelter payment allowance; and

10. add the VA aid and Attendance Allowance.

Cost of care calculation procedures for HCBC-ECI, DD, and ABD remain unchanged.

SYSTEMS CHANGES

Changes will be programmed into New HEIGHTS to take effect on October 1, 2000. On the evening of September 29, New HEIGHTS will run a mass change to implement the income computation changes released by this SR. Cases selected for recomputation will be all non-HCBC adult category financial and medical assistance cases with earned income, and all nursing facility cases with earned income.

Note: Since SLMB175 cases are not automated on New HEIGHTS, they will not be selected to go through the EID mass change. There are currently no SLMB175 cases statewide. Beginning October 1, 2000, any new SLMB175 applications must be processed using the revised OAA EID.

Unless otherwise specified, cases with increases, decreases and closings will get a generic Notice of Decision (NOD) reason message with their action message. There will be two generic messages, one for ANB cases, and one for all other adult categories of assistance. The messages read as follows:

ANB

WE HAVE CHANGED THE WAY WE TREAT EARNED INCOME FOR WORKING INDIVIDUALS. WE USED TO ALLOW 2 SEPARATE DEDUCTIONS FROM EARNED INCOME, THE EARNED INCOME DISREGARD AND THE EMPLOYMENT EXPENSE DISREGARD. NOW WE ALLOW ONLY THE EARNED INCOME DEDUCTION. WE HAVE USED THIS DEDUCTION TO REFIGURE YOUR ELIGIBILITY FOR ASSISTANCE. ADULT ASSISTANCE CHAPTER 600.

OAA, APTD, QMB, SLMB, SLMB135, QWDI AND HCBC

WE HAVE CHANGED THE WAY WE TREAT EARNED INCOME FOR WORKING INDIVIDUALS. WE ALLOW CERTAIN DEDUCTIONS FROM THEIR EARNED INCOME WHEN FIGURING ELIGIBILITY AND BENEFITS FOR FINANCIAL AND MEDICAL ASSISTANCE. THE AMOUNT OF ONE DEDUCTION IS NOW DIFFERENT. WE HAVE USED THE NEW DEDUCTION FROM EARNED INCOME TO REFIGURE YOUR ELIGIBILITY FOR ASSISTANCE. ADULT ASSISTANCE CHAPTER 600.

The following cases will receive standard HEIGHTS messages, with no generic mass change message:

 medically needy In and Out cases with a deductible status whose spenddown amount changes;

 medically needy In and Out cases with a deductible status that no longer require a spenddown; and

 medically needy cases which become eligible as categorically needy.

Note: In and Out cases that have already met their spenddown will not be selected for computation for the mass change, because they are currently Medicaid eligible.

Cases that do not have sufficient Benefit Issuance information at the time of the Mass Change will appear on the Mass Change Exceptions Report (PCMC550-MC) with the Reason for Exception listed as "Cash/FS need benefit issuance information." Instructions for this report can be accessed in the New HEIGHTS Information Library, Hints and Tips, under a document titled Mass Change Exception Report Instructions. District Offices must rerun eligibility, supplying the missing Benefit Issuance information when that screen appears in the driver flow.

Note: If the client agrees to receipt of cash assistance, identify whether the client wishes EBT or EFT as the cash benefit issuance type and explain the processes required to establish either issuance type. Completion of Form 770, Reimbursement and Acknowledgement, is required in order for the client to receive adult category cash assistance. If Form 770 is not currently on file, require that the client complete it prior to confirming the case. When the benefit issuance type has been chosen and entered, and completed Form 770 is on file, confirm the case. $2 minimum grant cases confirmed after the mass change will only receive a standard opening message from HEIGHTS.

IMPLEMENTATION

The revised policy applies to all eligibility determinations made on or after October 1, 2000 for time periods beginning October 1, 2000 or later. Pending applications processed prior to October 1, 2000 must have the old policy applied to them. Currently open adult category financial and medical assistance cases will have their earned income automatically updated in the mass change detailed above.

For applications for retroactive medical assistance, use the policy in effect for the specific retroactive month for which medical assistance is being requested.

CLIENT NOTIFICATION

Electronic Data Systems (EDS) will generate notices to nursing facility providers though the Medicaid Management Information System (MMIS) when the client’s cost of care (patient liability amount) changes as a result of the mass change. Non-nursing facility clients whose benefits change will receive an NOD as part of the mass change. District Offices may advise other clients of the revised policy on an as needed basis.

TRAINING

No training is planned.

DISPOSITION

This SR may be deleted or destroyed once its contents have been noted, its Posting Instructions carried out, and the revised policy manual topics released by this SR have been posted to the On-Line Manual.

DISTRIBUTION

This SR will be distributed according to the electronic distribution list for Division of Family Assistance policy releases. This SR, and revised On-Line Manuals, will be available for agency staff in the On-Line Manual Library, and for public access on the Internet at http://www.dhhs.state.nh.us/PMIndex.htm, effective October 2, 2000.

This SR, and printed pages with posting instructions, will be distributed under separate cover to all hard copy holders of the Family and Adult Assistance Manuals.

DFA/SJC:s