SR 03-22 Dated 07/03

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases:

·   clarifications regarding developing potential sources of income in the TANF and adult categories of financial and medical assistance programs; and

·   for medical assistance-only applicants and currently open financial and medical assistance recipients, a revised timeframe, from 3 months to 30 days, in which application for these other benefits must occur.

It is a condition of eligibility that all applicants and recipients of TANF financial and medical assistance and the adult categories of financial and medical assistance, explore and apply for all potential sources of income or benefits for which they are entitled. The parameters for developing these potential sources of income and benefits have been clarified as follows:

POLICY

Effective July 1, 2003, the following clarifications to policy regarding developing potential sources of income will apply to all applicants and recipients of NHEP/FAP financial and medical assistance and the adult categories of financial and medical assistance.

Revised Application Timeframes for Developing Potential Sources of Income

An individual must provide verification of their application for other benefits for which they are potentially entitled:

·   before the application for NHEP/FAP, OAA, APTD, or ANB financial assistance can be processed; or

·   no later than 30 days after the referral for the other benefit was made, if:

-   a current recipient of TANF or adult category financial or medical assistance; or

-   applying for TANF or adult categories of medical assistance-only.

Exception: Medical assistance-only applicants and recipients do not have to apply for SSI benefits. Individuals should be encouraged to apply however, because if the individual is eligible for this benefit, it is additional income for the client.

If the individual is potentially eligible for a benefit and refuses or fails to apply for the benefit:

·   terminate medical assistance for all adults in the assistance group (children remain eligible); and

·   terminate, or do not open, financial assistance for the entire assistance group.

Exceptions: Women who are pregnant or are within the 60-day post-partum medical coverage period, cannot be terminated from medical assistance for failure or refusal to obtain third party medical coverage.

 TANF related extended medical assistance cannot be terminated for refusal or failure to apply for potential benefits. See FAM 173 for valid closing reasons.

Note: Individuals are required to explore and apply for all potential sources of income or benefits, if the income or benefit is potentially available to them. If not potentially entitled to the income/benefit, the individual is not required to apply for the income/benefit. For example, an individual with children may have a short-term injury, such as a broken leg, which meets the deprivation requirements for TANF incapacitated parent. This individual is not required to apply for SSA disability benefits. However, if the injury occurred at work, the individual is required to apply for worker’s compensation.

Cooperation Requirements for Developing Potential Sources of Income

As a condition of eligibility, all applicants and recipients of financial and medical assistance must cooperate in taking the necessary steps to obtain all benefits for which they are potentially entitled.

Cooperation with the requirements for developing potential sources of income means that the individual must:

·   provide all required information and verification required by the eligibility-determining agencies or individual(s) responsible for the other income/benefit;

·   complete all forms as required in the application process for the other income or benefit in the timeframes and manner required by the eligibility-determining agencies or individual(s) responsible for the other income/benefit; and

·   pursue all appeal options within the timeframes set by the eligibility determining agencies or individual(s) responsible for the other income/benefit, up to, but not including, court action, if found ineligible for the benefit due to medical reasons.

Deny or terminate financial assistance for the entire assistance group and terminate medical assistance for all adults in the assistance group, if any individual in the group refuses or fails to:

·   complete the application process for the other income or benefit;

·   provide information or verification to obtain the other income or benefit;

·   cooperate with the eligibility-determining agencies or individual(s) responsible for the other income or benefit; or

·   pursue all appeal options up to, but not including, court action, if found ineligible for the income or benefit due to medical reasons.

Good Cause Reason for Not Developing Potential Sources of Income

Medical assistance applicants and recipients are exempt from developing potential sources of income if good cause exists. Good cause exists if the individual verifies that a physical, mental, educational, or linguistic limitation prevented the individual from:

·   applying for the other income/benefit for which they are potentially eligible; or

·   taking the necessary steps to obtain the income/benefits.

If good cause exists, the medical assistance applicant or recipient is exempt from developing potential sources of income until the individual’s next redetermination, at which time the exemption must be reviewed and, if good cause continues to exist, the exemption may be extended until the next regularly scheduled redetermination.

NEW HEIGHTS PROCEDURES

All information regarding the benefits or income for which the individual has applied, must be:

·   entered into the "Benefit Applied for Outside of New HEIGHTS" screen. Note: Income or benefits for which a child must apply, must be entered under the adult’s name in the assistance group, not the child’s name. Use the casehead’s name if the child is part of a two-parent household; and

·   updated any time new information regarding the status of the individual’s application for other benefits is received.

Denial/Closure of Assistance for Failure of the Individual to Apply, Cooperate, or Accept Benefit

If an individual in the assistance group refuses or fails to apply for or accept benefits, or fails to cooperate during the application process for the benefits, choose "Refused/Failed to Verify" in the verification section of the "Benefit Applied for Outside of New HEIGHTS" screen. This will automatically deny or terminate financial assistance for the entire assistance group, and:

·   terminate medical assistance for all adults in the SSP assistance group; or

·   terminate medical assistance for the non-compliant individual in the TANF assistance group; children will remain eligible for medical assistance.

Workaround for 2-Parent TANF cases: Because New HEIGHTS currently closes TANF medical assistance for the non-compliant individual only, rather than all adults in the assistance group, FSS must take the following additional steps to ensure that all adults in the case are correctly terminated for medical assistance:

·   On the "Program of Assistance" (POA) Screen, set the "Medical Assistance Request" at the case level to "yes".

·   At the individual level, enter "yes" for the medical assistance request for the non-compliant adult and all children. For the other adult(s), set the request to "No" and select the reason "Failed to Provide/Verify Information."

·   On the "Benefits Applied for Outside New HEIGHTS" screen, enter "Refused/Failed to Verify" under "Benefit Application Date" for the non-compliant adult.

New HEIGHTS will then deny medical assistance for the non-compliant adult for failure to develop potential sources of income, will also deny the other adult(s) in the assistance group for failure to provide/verify information based upon the information provided on the POA screen, and the children in the case will remain open for medical assistance. Systems changes to automatically close medical assistance for all adults in the case are in process. Upon completion, District Offices will be notified under separate cover.

Denial of Benefits Other Than SSI/SSA Benefits

If an individual is denied benefits other than SSI or SSA benefits, review the reason for denial and determine if the individual is still eligible for DFA assistance. Update the "Benefit Applied for Outside of New HEIGHTS" screen, and enter a note of explanation on the "Case Notes" screen.

Denial of SSI/SSA Benefits – Non-Medical Reasons

If an individual is denied SSI or SSA benefits for non-medical reasons, review the reason and compare with DFA policy to determine if the individual is still eligible for assistance.

Examples of Non-Medical SSI/SSA Denial Reasons

SSA: Individuals must have been employed for the 40 months immediately prior to the onset of disability in order to be considered "insured" for SSA eligibility purposes. If the individual was unemployed for a year prior to the onset of disability, the individual would not be considered "insured" for SSA purposes and would, therefore, not be eligible for SSA. The SSA denial reason would be "not in insured status." The individual, however, would remain eligible for DFA programs.

SSI: An individual may be denied SSI for transferring assets for less than fair market value. Review the transfer to determine whether a penalty would apply to the individual’s financial assistance or medical assistance eligibility.

SSI: If an individual is denied SSI for excess resources or income, re-evaluate the individual’s finances to verify that the individual is within eligibility limits.

Denial of SSA/SSI Benefits – Medical Reasons

Denial of SSA Benefits – Medical Reasons

When an application for SSA has been denied for medical reasons, the individual must appeal SSA’s decision. There are four levels of SSA appeal, the last being Federal court review. The individual is not required to appeal to the fourth level, however the individual must appeal to the first three levels. If the individual refuses to appeal an SSA medical denial, terminate financial assistance for the entire assistance group and terminate medical assistance for all adults in the assistance group for failure to cooperate in developing potential sources of income. Assistance continues if the individual cooperates with the appeal process, as long as the individual is otherwise eligible.

Denial of SSI Benefits – Medical Reasons

When an application for SSI has been denied for medical reasons, the individual must appeal SSA’s decision through the first three levels of appeal. The individual is not required to appeal to the fourth level of appeal involving the Federal court review. If the individual refuses to appeal an SSI medical denial, terminate financial assistance for the entire assistance group. Do not terminate medical assistance. Encourage the individual to appeal the SSI denial, but if the individual does not appeal the SSI denial, refer the denial information to the Disability Determination Unit (DDU) for a review of the original DHHS medical approval.

Assistance continues if the individual cooperates with the appeal process, as long as the individual is otherwise eligible.

Denial of SSI/SSA Benefits – Appeal Process

Once it has been determined that an individual has been denied SSI or SSA benefits (at application and subsequent denials at the first and second levels of appeal), because they do not meet the medical criteria for the program, send the individual the notice that was attached to the Director’s Memo dated March 25, 2003, subject line "Procedures Regarding Requirements for Developing Potential Sources of Income Monitoring the SSA/SSI New HEIGHTS Data Exchanges."

This notice alerts the individual that DHHS has been informed that the individual has been denied SSI/SSA because of not meeting the medical criteria for SSI/SSA. The letter will advise the individual that cash assistance will be terminated in 30 days unless the individual provides verification that the SSA decision has been appealed. The letter also provides the individual with information regarding NH Legal Assistance’s ability to assist with the appeal.

If the individual provides verification within 30 days that the SSI/SSA denial has been appealed, update the information on the "Benefit Applied for Outside of New HEIGHTS" screen. Take no action to terminate benefits. Follow up on the SSI/SSA appeal no later than the next redetermination.

If the individual fails to appeal the SSI/SSA denial within 30 days or fails to verify that the denial has been appealed, terminate assistance in accordance with policy for failure to cooperate in developing potential sources of income.

If the individual is denied for medical reasons after the third level of appeal, refer the case to the DDU and request a medical re-review, per the instructions in the Director’s Memo dated March 25, 2003. The DDU will review the disability status and notify the DO of the results of the assessment.

Refer potential overpayment of benefits to the Office of Special Investigations (OSI).

POLICY MANUAL REVISIONS

Revised Family Assistance Manual Topics

Section 317.01    Potential Sources of Income

Section 317.03    Requirements for Developing Potential Sources of Income

Section 317.05    Application Requirements for Developing Potential Sources of Income

Section 317.07    Cooperation Requirements for Developing Potential Sources of Income

Section 317.09    Good Cause for Not Developing Potential Sources of Income

PART 511    COMMON TYPES OF INCOME: SSDI BENEFITS

PART 511    COMMON TYPES OF INCOME: SUPPLEMENTAL SECURITY INCOME (SSI) BENEFITS

Revised Adult Assistance Manual Topics

PART 315    DEVELOPING POTENTIAL SOURCES OF INCOME

Section 315.01    Requirements for Developing Potential Sources of Income

Section 315.03    Application Requirements for Developing Potential Sources of Income

Section 315.05    Cooperation Requirements for Developing Potential Sources of Income

Section 315.07    Good Cause for Not Developing Potential Sources of Income

PART 511    INCOME TYPES: SSDI BENEFITS

PART 511    INCOME TYPES: SSI BENEFITS

IMPLEMENTATION

The policy released by this SR is effective beginning July 1, 2003.

CLIENT NOTIFICATION

A public hearing regarding the changes released in this SR was held on May 16, 2003. No additional client notification is planned.

TRAINING

No training is planned for this change.

DISPOSITION

This SR may be destroyed or deleted after its contents have been noted and the revised manual topics released by this SR have been posted to the On-line manuals.

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/DHHS/DFA/LIBRARY, effective August 1, 2003.

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

DFA/JBV:s