SR 04-01 Dated 01/04

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases a 2.1% cost of living increase to SSA/SSI and VA Annual Review benefits effective January 1, 2004, and the updated:

·   SSI payment levels for individuals and couples;

·   adult Standards of Need for individuals in independent living arrangements, residential care facilities, and community residences;

·   Protected Income Limit (PIL) for an assistance group size of 1;

·   Medicare Part B premium amount;

·   spousal impoverishment figures and Nursing Facility CAP; and

·   Substantial Gainful Activity (SGA) income ceiling.

In addition, the following forms were revised to reflect the increased spousal impoverishment figures:

·   Form 798A, Resource Assessment for Institutionalized Individuals with Community Spouses;

·   Form 799, Spousal Income Protection; and

·   Form 799A, Income Computation Worksheet for Allocation of Income for Institutionalized Individuals.

This SR also releases:

·   new policy regarding the treatment of monthly Veterans Administration (VA) benefits to children with certain birth defects whose mothers are Vietnam veterans. This income is excluded when determining eligibility and benefit amount for all adult programs of assistance, TANF financial and medical assistance, the Food Stamp Program and Child Care Assistance;

·   an unrelated policy clarification regarding verification of alien status/citizenship for recipients of certain federal programs;

·   an unrelated technical correction regarding deeming; and

·   a related policy clarification regarding determining the nursing facility cost of care.

POLICY

COLA INCREASE

Based upon the 2.1% cost of living increase to SSA/SSI and VA Annual Review benefits, the SSI maximum monthly benefit levels for independent living arrangements increased as follows:

-   for an individual, from $552 to $564;

-   for an individual and a spouse or needy essential person, from $829 to $846; and

-   for a couple and needy essential person, from $1,106 to $1,128.

The adult Standard of Need for OAA, ANB, and APTD individuals increased as follows:

The Protected Income Limit (PIL) for an assistance group size of one increased from $566 to $578. The PIL’s for all other group sizes remained the same.

The Medicare Part B monthly premium cost will increase from $58.70 to $66.60. In some cases, the 2.1% COLA will be so low that it will not cover this increase. Procedures for processing these cases will be released at a later date under separate cover.

VA Annual Review cases will have a 2.1% cost of living increase.

The Nursing Facility CAP remains at $1,250.

Spousal Impoverishment limits increased:

·   Maximum monthly maintenance allowance from $2,267 to $2,319;

·   Minimum resource standard from $18,132 to $18,552; and

·   Maximum spousal resource allowance from $90,660 to $92,760.

SGA INCREASE

The Substantial Gainful Activity (SGA) income ceiling increased from $800 to $810. The SGA is used only during initial APTD eligibility determinations to determine earned income limits for working disabled individuals. To be eligible for APTD, working applicants must have an adjusted earned income of less than the SGA.

The SGA figure is adjusted annually in accordance with changes to the national average wage index per 20 CFR 416.974.

PROCEDURES

Mass Change procedures for New HEIGHTS are noted under the appropriate heading below.

Mass Change NOD

All cases experiencing a change during the January Mass change will receive the same standard NOD:

YOUR NEW SOCIAL SECURITY, SSI AND/OR VA BENEFIT WAS USED TO REFIGURE YOUR ELIGIBILITY FOR ALL TYPES OF AID. THE INCOME LIMITS FOR SOME MEDICALLY NEEDY MEDICAL ASSISTANCE CASES AND FOR OAA, ANB AND APTD FINANCIAL ASSISTANCE WERE ALSO INCREASED. THE ENCLOSED LETTER EXPLAINS THESE CHANGES.

FEDERAL LAW PROVIDES THAT IF YOUR QMB, SLMB, SLMB135, OR QDWI ELIGIBILITY WOULD END DUE SOLELY TO THE COST OF LIVING INCREASE, WE MUST KEEP YOUR CASE OPEN UNTIL THE NEW FEDERAL POVERTY GUIDELINES ARE AVAILABLE. IN MARCH WE WILL REFIGURE YOUR CASE AND NOTIFY YOU OF ANY CHANGE.

SSA/SSI Increase

SSA/SSI benefits are updated in January by crossmatching open SSA/SSI cases in New HEIGHTS against the BENDEX and SDX tapes using the individual’s Social Security Number (SSN). New HEIGHTS will conduct a pre-mass change crossmatch to determine the number of SSA/SSI cases in New HEIGHTS that are identified as having an SSN that differs from the BENDEX/SDX tapes. District Offices will be provided with a listing of cases with SSN discrepancies and a deadline for fixing them, under separate cover.

During the January mass change, all open SSA/SSI cases will be re-crossmatched against the BENDEX and SDX tapes. For those cases that match, the SSA/SSI amount will be replaced with the actual check amount listed on the BENDEX/SDX tape and benefits will be recomputed. For those SSA/SSI cases that do not match, New HEIGHTS will apply the 2.1% increase and round up to the nearest dollar.

VA Increase

New HEIGHTS will apply a 2.1% COLA increase, dropping all cents, to all VA benefits with an annual review indicator. If a case with an annual review indicator also has Aid and Attendance (A&A) benefits, the 2.1% COLA will also be applied to the A&A benefits, dropping all cents.

Widows and children of veterans are entitled to a COLA only through an Act of Congress. This type of increase is referred to as a Periodic Legislative Increase (PLI) since their benefits do not automatically increase with the January COLA. Congress recently authorized a 2.1% PLI for these individuals, effective January 1, 2004. Any cases that have an annual review indicator on New HEIGHTS will have the 2.1% COLA applied to their benefits during the mass change.

$2 Minimum Grant Cases

Certain cases currently eligible for adult category cash assistance, but not actually receiving the grant because the amount is under $2 per month, may now qualify to receive a grant due to the increase in the SON.

·   For cases in which New HEIGHTS has sufficient information to provide the Benefit Issuance type (Electronic Benefit Transfer, Electronic Funds Transfer, or paper check), the standard mass change reason message will be added to the NOD informing the client of the change in benefit issuance status.

·   It is anticipated that all $2.00 minimum grant cases will already have benefit issuance information since this data is required in New HEIGHTS. Any cases that do not have sufficient Benefit Issuance information at the time of the Mass Change will appear on the "MC Exception" report (NMC550RA) with the Reason for Exception listed as "Cash/FS need benefit issuance information." District Offices must rerun eligibility, supplying the missing Benefit Issuance information when that screen appears in the driver flow. NOTE: these cases should be contacted prior to confirmation to identify whether the client wishes EBT or EFT as the cash benefit issuance type and to explain the processes required to establish either issuance type. When the benefit issuance type has been chosen and entered, confirm the case.

Medically Needy Cases that Become Categorically Eligible

All open adult category medically needy medical assistance (MA) assistance groups (AG’s) will be part of the Mass Change. Because the SON is also the categorically needy income limit, if a medically needy AG’s income is now below the SON, and resources do not exceed the limit for categorically needy MA, New HEIGHTS will change their AG type to categorically needy. In addition, District Offices need to be aware that affected AG’s may now be eligible for adult category cash assistance, subject to the $2 minimum grant requirement. Affected AG’s desiring cash assistance must file an application and meet all eligibility requirements.

Individuals who make inquiry regarding this possibility must be informed of:

·   the requirement to file an application for cash assistance;

·   the State’s right to recover the cost of adult category OAA and APTD financial assistance provided; and

·   the State’s right to file a lien against real property as part of the recovery process.

In and Out Medical Assistance

In and Out Medical Assistance cases of one will use the new PIL amount for the January spenddown. Note that the PIL for group sizes larger than one did not change for 2004. The new PIL and adjusted benefit increases will be used for all January In and Out cases currently in a six-month application period.

If a medically needy assistance group (AG) currently in "deductible status" has income over the old PIL, but less than or equal to the new PIL for a group size of 1, New HEIGHTS will open medical assistance. The standard mass change reason message will be included in the NOD issued as a result of this calculation.

Three-Month Retroactive Medical Assistance Cases

Three-Month Retroactive MA eligibility determinations must use pre-mass change SON/PIL amounts for months prior to January 1, 2004. For cases in New HEIGHTS, this will happen automatically.

Pickle Amendment Cases

The Pickle Amendment prevents SSA cases with a state supplement (ANB, APTD, OAA) from closing due to the COLA increase. New HEIGHTS Pickle Amendment cases are processed automatically. The calculations and COLA deduction for cases that would lose cash payment are invisible to DO staff. Questions about the calculations or COLA deduction on New HEIGHTS Pickle cases should be directed to the New HEIGHTS Help Desk, which can access the database tables for these cases.

QMB, QDWI, SLMB, and SLMB135 Cases

Federal law mandates that COLA increases for the year 2004 cannot be used to determine QMB, QDWI, SLMB, and SLMB135 eligibility until after the annual update to the federal poverty levels is effective April 1, 2004. Until the new figures are available, cases that would close due to the COLA will be kept open automatically by New HEIGHTS.

Adult Category Recoupment

For recoupment cases, New HEIGHTS will recompute the amounts when the case goes through the mass change. The notice of the revised amount will be generated automatically as well.

Spousal Impoverishment Cases

New HEIGHTS will handle spousal cases automatically.

Effective January 1, 2004, the maximum monthly maintenance allowance increases from $2,267 to $2,319 per month. When determining income allocated to the community spouse for months prior to January 2004, use the $2,267 amount. For example, if an individual applied for institutionalized care in January and requested retroactive medical assistance for December, the District Office would calculate the spousal allocation separately for December and January.

The minimum and maximum resource allowances for the community spouse are also increasing from $18,132 to $18,552 and from $90,660 to $92,760, respectively.

·   The new figures apply only to requests for resource assessments after 12/31/03.

·   Use amounts in effect when the individual applies, regardless of when the assessment was done.

·   These amounts do not affect individuals whose resource amount is between the minimum and maximum.

·   An individual could be resource ineligible in December but resource eligible in January due to the higher figures.

Rollbacks

New HEIGHTS will process rollbacks automatically and the correct values will be used for the pre-January amounts.

Patient Liability

Nursing facilities are automatically notified of the patient’s liability, the monthly amount the resident is expected to pay towards their care, through EDS-AIMS. Any time a new patient liability is created or a change is made to a current resident’s patient liability, New HEIGHTS will automatically generate client letter AE0009 for the nursing facility resident and/or the authorized representative. A copy of this client letter is attached to this SR for reference.

Categorically Eligible Food Stamp Households

Food stamp policy in FSM PART 231, CATEGORICALLY ELIGIBLE HOUSEHOLDS, states that certain public assistance and SSI households are categorically eligible for food stamps without regard to income or resources. To be considered categorically eligible, all members of the food stamp household must be included in an open public assistance and/or SSI case.

New HEIGHTS will calculate food stamp categorical eligibility automatically.

SYSTEM CHANGES

The New HEIGHTS mass change run date will begin after the daily run, the evening of December 26, 2003.

1. All reference table changes are effective starting January 1, 2004. This includes all adult financial assistance cases in independent living arrangements and adult categorically needy MA cases, all residential care facility and community residence individuals, and cases whose eligibility is based on the one person PIL.

2. Ten day advance notice periods will be given to all AP and MA cases with a negative action resulting from the mass change. Food stamps decreasing or closing as a result of the mass change will only receive an advance notice if any other case program receives one.

3. The standard MASS CHANGE NOD reason message will be generated for all cases with a change action. Cases that experience no change in benefits will receive no notice.

POST-MASS CHANGE REPORTS

The reports described below will be produced as a result of the Mass Change. These reports will be available on CADocView shortly after January 2, 2004.

NMC540RA: AG’s Affected by MC

This report lists all cases that the Mass Change ran successfully through confirmation. It contains the following information: DO, Worker Name, Client Name, and Case Number.

NMC550RA: MC Exception

This report lists cases that were selected for computation during the Mass Change, but were not confirmed due to some discrepancy in data. These cases require further District Office action. It contains the following information: DO, Worker Name, Client Name, Case Number, Reason for Exception, and Mass Change Type.

NMC810RA: MC PT Liab Override RPT

The Nursing Facility with Patient Liability Override report lists cases that contain a Patient Liability override and therefore the amount did not change. These cases require further District Office action. The report contains the following information: DO, Worker ID, Client Name, and Case Number.

NMC820RA: MC Skipped Cases RPT

The Unearned Income Type Unverified report lists cases that were not selected for computation during the Mass Change because there was an unverified SSA, SSI or VA income type or claim number or an unverified Part B premium amount. These cases require further District Office action. The report contains the following information: DO, Worker ID, Client Name, and Case Number.

NMC840RA: MC Part B Premium RPT

The Part B Premium report lists cases whose Part B premium was not updated to the new amount because their existing Part B premium amount was not $58.70. These cases require further District Office action. The report contains the following information: DO, Worker ID, Client Name, and Case Number.

FORMS REVISIONS

Form 798A, Resource Assessment for Institutionalized Individuals with Community Spouses, Form 799, Spousal Income Protection, and Form 799A, Income Computation Worksheet for Allocation of Income for Institutionalized Individuals, have been revised to include the increase in the spousal impoverishment limits. With new spousal applications January 1, 2004 or later, use the updated 2004 forms that replace Form 798A, released by SR 03-01/January, 2003 and Forms 799 and 799A, released by SR 03-17/July, 2003. However, rename and retain the PC templates for the 2003 versions of Forms 798A, 799, and 799A, for reference purposes.

The new versions of Forms 798A, 799, and 799A will be electronically transmitted to each District Office with the electronic distribution of the SR. Contact Linda White, DFA/State Office, at 271-4580 with any questions related to detaching the forms to the PC files.

NEW POLICY

Monthly benefits from the VA to individuals with certain birth defects who are natural born children of female veterans who served in the Republic of Vietnam from February 28, 1961 through May 7, 1975, are not counted when determining eligibility and benefit allotment amount for all adult programs of assistance, TANF financial and medical assistance, the Food Stamp Program and Child Care Assistance. FAM and FSM 511, COMMON TYPES OF INCOME: VA BENEFITS, and AAM 511, INCOME TYPES: VA BENEFITS, as well as FAM 933, INCOME, were revised accordingly.

RELATED AND UNRELATED POLICY CLARIFICATIONS AND TECHNICAL CORRECTIONS

Any individual who is currently receiving Social Security, Supplemental Security Income (SSI), or Medicare benefits at the time of application for benefits from DHHS, and who was approved for Social Security, SSI, or Medicare benefits on or after August 22, 1996, does not have to provide proof of his or her citizenship or alien status, per Director’s Memo dated November 10, 2003. AAM 305.15, Documentation of BCIS Status, and FAM 305.21, Documentation of BCIS Status, were revised accordingly.

In FAM 611.03, Deeming Principles, a correction was made to the calculation used when deeming income from parents to minor pregnant women applying for MCPW-only; the term "payment standard" was replaced with the term "payment allowance for unsubsidized housing."

Examples were added to AAM 619.01, Cost of Care: Nursing Facility, to clarify what is meant by currently obligated, unpaid prior medical debt in the calculation of the nursing facility cost of care.

Revised Family Assistance Manual Topics

Section 305.21  Documentation of BCIS Status

PART 511   COMMON TYPES OF INCOME: VA BENEFITS

PART 601, TABLE C  TANF Medical Assistance Net Income Limits and Percentages of Poverty Level

Section 611.03  Deeming Principles

PART 933   INCOME

Revised Adult Assistance Manual Topics

Section 167.03  COLA Adjustments Since 1977

PART 209    AID TO THE PERMANENTLY AND TOTALLY DISABLED

Section 209.03  SGA Adjustments Since 2000

Section 305.15  Documentation of BCIS Status

Section 419.03  Determining the Protected Resource Amount

PART 511   INCOME TYPES: VA BENEFITS

PART 601, TABLE A  INCOME LIMITS

PART 601, TABLE B  INCOME LIMITS FOR HCBC INDIVIDUALS

PART 617   GRANT DETERMINATION

Section 619.01  Cost of Care: Nursing Facility

Section 621.05  Cost of Care: HCBC-ECI Financial or Medical Assistance

Section 627.03  Allocation to a Community Spouse

Revised Food Stamp Manual Topics

PART 511   COMMON TYPES OF INCOME: VA BENEFITS

IMPLEMENTATION

The new VA benefit policy relating to female Vietnam veterans released by this SR is retroactively effective to December 1, 2001. Other changes identified in this SR will be implemented on January 1, 2004 for current cases, and will apply to any new cases processed on or after that date.

CLIENT NOTIFICATION

Client letters will be sent:

·   with Notices of Decision during the first week of January to adult category assistance recipients whose benefits have changed as a result of the mass change;

·   to institutionalized individuals and their community spouses in mid-January regarding the changes in the spousal impoverishment figures; and

·   to nursing facility residents and/or their authorized representative, via the New HEIGHTS-generated AE0009, any time a new patient liability is created or a change is made to a current resident’s patient liability.

Copies of all the letters are attached to this SR for reference.

TRAINING

No training is needed or planned due to the procedural nature of this SR.

DISPOSITION

This SR may be deleted or destroyed once its contents have been noted, its posting instructions carried out, 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 February 2, 2004.

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

DFA/DMS:s