SR 11-27 Dated 07/11

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

DFA SIGNATURE DATE:	July 5, 2011
FROM:	OFFICE OF THE DIRECTOR, DFA Terry R. Smith
AT (OFFICE):	Division of Family Assistance
TO:	DFA Supervisors District Office Managers of Operations
SUBJECT:	Ineligibility for Aid to the Permanently and Totally Disabled (APTD) Cash Assistance When the Social Security Administration (SSA) Denies SSA-Related Benefits Due to the APTD Applicant or Recipient Not Meeting SSA Medical Disability Criteria
EFFECTIVE DATE:	July 1, 2011

SUMMARY

This SR releases a change in the eligibility criteria for receiving an Aid to the Permanently and Totally Disabled (APTD) cash assistance grant. APTD applicants and recipients who are denied Social Security Administration (SSA)-related benefits due to not meeting SSA medical disability criteria are also not eligible for an APTD cash grant. This change is a result of budget initiatives amending RSA 167:6,VI. The APTD medical assistance eligibility determination process is not impacted by these changes due to the maintenance of effort (MOE) requirements of the Affordable Care Act (PL 111-148), signed into law on March 23, 2010.

FORMER APTD CASH ELIGIBILITY POLICY

NEW APTD CASH ELIGIBILITY POLICY

Individuals could receive APTD financial assistance once all financial and medical program eligibility criteria had been met, as long as the individual verified that they had applied for all potential sources of income for which they might be eligible, were cooperating with the application process for these other benefits, accepted the benefit if eligible and, if denied for the benefit, were pursuing all appeal options.

Individuals are ineligible for APTD financial assistance if the individual is denied SSA-related benefits due to not meeting the SSA medical criteria. This new policy only applies to eligibility for APTD cash assistance and does not apply when determining eligibility for APTD medical assistance.

This new policy will be applied differently based on the individual's applicant or recipient status as of July 1:

� Individuals who apply on or after July 1, or begin to receive APTD cash assistance on or after July 1, will have APTD cash assistance end upon SSA denying SSA-related benefits due to not meeting the SSA medical criteria.

� Individuals who were receiving APTD cash assistance as of June 30, 2011 are ineligible for APTD financial assistance only after a second SSA finding of ineligibility for SSA-related benefits due to the APTD recipient not meeting SSA medical criteria. Meaning, individuals who were open and receiving APTD cash assistance as of June 30, 2011 and:

- have just applied for SSA-related benefits, will not have their APTD cash terminated unless SSA denies their SSA-related benefits due to not meeting SSA medical criteria, and the APTD recipient's subsequent appeal of SSA's decision results in SSA denying the APTD recipient again due to not meeting SSA medical criteria. If the recipient fails or refuses to appeal SSA's decision, however, APTD cash assistance must be terminated per current policy in all of AAM PART 315, DEVELOPING POTENTIAL SOURCES OF INCOME;

- have already been denied SSA-related benefits due to not meeting SSA medical criteria and are in their first appeal of this decision, will not have their APTD cash terminated unless SSA denies their appeal due to not meeting SSA medical criteria; or

- have been denied SSA-related benefits due to not meeting SSA medical criteria, have been denied a subsequent appeal for the same reason and are still appealing this decision pursuant to AAM PART 315, or have exhausted the appeal process, will have their benefits terminated immediately.

This new policy applies even if all APTD financial and medical program eligibility criteria have been met, the individual has verified applying for all potential sources of income for which they might be eligible, is cooperating with the application process for these other benefits, and will accept the benefit if eligible.

APTD recipients could continue to receive an APTD cash grant if the recipient was pursuing all appeal options for the potential source of income, and even after the recipient had exhausted all appeal options for the potential source of income.

Except as described above for APTD recipients open and receiving cash assistance as of June 30, 2011, APTD applicants or recipients are ineligible for a cash grant during the SSA appeal process when the individual has been denied SSA-related benefits due to not meeting SSA medical criteria. APTD applicants and recipients must still continue to pursue these SSA-related benefits by appealing SSA's decision; all developing potential sources of income policy described in the whole of AAM PART 315, DEVELOPING POTENTIAL SOURCES OF INCOME, is still a condition of eligibility for continued receipt of medical assistance.

If any APTD applicant or recipient files an administrative appeal of the Department's decision to terminate APTD cash benefits because the individual has been denied SSA-related benefits due to not meeting SSA medical criteria, the individual is not eligible for continued receipt of the APTD cash grant, even if the individual requested an appeal during the 10-day advance notice period (ANP). Any APTD cash benefits provided erroneously will be subject to recoupment, per AAM 631, RECOUPMENT OF FINANCIAL ASSISTANCE.

POLICY

Aid to the Permanently and Totally Disabled (APTD) applicants and recipients who are denied Social Security Administration (SSA)-related benefits due to not meeting SSA medical disability criteria are also not eligible for an APTD cash grant. Eligibility for APTD medical assistance remains unchanged.

This new policy is applied differently based on the individual's applicant or recipient status as of July 1, 2011:

� For individuals who apply on or after July 1, 2011 or begin to receive APTD cash assistance on or after July 1, 2011: APTD cash assistance ends upon SSA denying SSA-related benefits due to not meeting the SSA medical criteria.

� For individuals who were open and receiving APTD cash assistance as of June 30, 2011: APTD cash assistance ends only after a second SSA finding of ineligibility for SSA-related benefits due to the APTD recipient not meeting SSA medical criteria. Meaning, individuals who were open and receiving APTD cash assistance as of June 30, 2011 and:

- have just applied for SSA-related benefits, will not have their APTD cash terminated unless SSA denies their SSA-related benefits due to not meeting SSA medical criteria, and the APTD recipient's subsequent appeal of SSA's decision results in SSA denying the APTD recipient again due to not meeting SSA medical criteria. If the recipient fails or refuses to appeal SSA's initial decision to deny SSA-related benefits, however, APTD cash assistance must be terminated per current policy in all of AAM PART 315, DEVELOPING POTENTIAL SOURCES OF INCOME;

Policy applies even if all APTD financial and medical program eligibility criteria have been met, the individual has verified applying for all potential sources of income for which they might be eligible, is cooperating with the application process for these other benefits, and will accept the benefit if eligible.

Verifications Needed for the New APTD Cash Grant Policy

Although the Department participates in an electronic crossmatch with the SSA on a regular basis, the Social Security Administration has indicated that they are unable to provide the following information to us electronically. As such, effective July 1, 2011, verification requirements will change for APTD applicants and recipients.

Applicants for any category of cash assistance, per current policy, will still need to:

� verify that they have applied for all potential sources of income for which they might be eligible, including SSA-related benefits, as a condition of eligibility. Until that proof of application for other benefits has been provided, cash assistance cannot be processed per current policy at AAM 315.01/FAM 317.03, Requirements for Developing Potential Sources of Income, and AAM 315.03/FAM 317.05, Application Requirements for Developing Potential Sources of Income; and

� cooperate in applying for, and pursuing receipt of, the potential sources of income, per current policy at AAM 315.05/FAM 317.07, Cooperation Requirements for Developing Potential Sources of Income.

New verification requirements for individuals who apply for APTD cash assistance on or after July 1, 2011 or begin to receive APTD cash assistance on or after July 1, 2011

All individuals who apply for APTD cash assistance on or after July 1, 2011 or begin to receive APTD cash assistance on or after July 1, 2011 will now additionally have to provide a copy of the SSA letter which describes why the individual was denied SSA-related benefits by SSA, if their application for those benefits is subsequently denied.

APTD cash will end when:

� the proof the individual provides to the Department indicates that SSA denied the individual SSA-related benefits because the individual did not meet the SSA medical disability criteria;

� the individual does not provide the proof from SSA to the Department within timeframes, which is within 10 days of getting the letter from SSA; or

� it is discovered through other means that SSA has denied the individual SSA-related benefits due to not meeting the SSA medical disability criteria.

New verification requirements for individuals who were open and receiving APTD cash assistance on June 30, 2011

Individuals who were open and receiving APTD cash assistance on June 30, 2011 will be required to provide the following proof:

� the reason SSA denied their application for SSA-related benefits;

� how many times the individual has appealed SSA's decision to deny the SSA-related benefits; and

� the reason SSA has denied each of the appeals, if there has been more than one appeal.

The week of July 11, 2011, a letter will be generated to approximately 700 APTD recipients who are not receiving SSA-related benefits and are in an SSA appeal, to request the proof described above. These individuals will be given until July 29, 2011 to provide the proofs requested.

For these recipients, APTD cash assistance will end in the following circumstances:

� The APTD cash assistance recipient provides proof of having been denied SSA-related benefits due to failing to meet the medical criteria and the appeal of this denial was denied for the same reason;

� The APTD cash assistance recipient:

1. provides proof of having been denied SSA-related benefits due to failing to meet the medical criteria; and

2. has exhausted the appeal process with SSA; or

� The APTD cash assistance recipient fails or refuses to supply the proofs or the proof supplied is incomplete.

For the remaining recipients who were open and receiving APTD cash assistance on June 30, 2011, but had just started the SSA application process for SSA-related benefits, the same verification requirements above apply. For these recipients, APTD cash assistance will end in the following circumstances:

� The APTD cash assistance recipient fails or refuses to supply the proofs or the proof supplied is incomplete.

New verification requirements applicable to all APTD-eligible individuals whose APTD cash grant is denied or terminated because SSA denied SSA-related benefits due to the individual not meeting SSA medical criteria

APTD applicants or recipients whose APTD cash benefits have been denied or terminated based on the policy released in this SR may have their eligibility for APTD cash benefits reconsidered if the APTD cash applicant or recipient provides proof that their appeal of the SSA decision denying the SSA-related benefits due to not meeting the SSA medical criteria, has been successful. This proof should be apparent in that the individual has been determined by SSA to have met their medical criteria and the individual will now be receiving an SSA-related benefit. Individuals are ineligible for APTD cash assistance until proof that a SSA-related benefit has been approved is provided.

FSSU, NEW HEIGHTS, AND DISTRICT OFFICE PROCEDURES AND IMPLEMENTATION

District Offices must continue to follow current developing potential sources of income policy, preventing the confirmation of any cash assistance case that has not verified proof of application for other potential sources of income, and entering pertinent information, as it is provided by the applicant or recipient, into the "Developing Potential Sources of Income" and "Social Security Application" screens in New HEIGHTS. Until New HEIGHTS can further enhance these screens and processes, or SSA begins to share this information with the Department electronically, the Facilitated Social Security Unit (FSSU) at State Office will continue to be the primary resource for manually enforcing and tracking the policy released in this SR.

To assist in this manual process, New HEIGHTS created a new "worker-selected" reason message on the Program of Assistance (POA) screen in New HEIGHTS. The new reason message is "Did Not Meet SSA Medical Criteria for SSA-Related Benefits." When the FSSU or District Office worker chooses this reason message, the following text will be inserted onto the Notice of Decision (NOD) generated when the APTD cash benefits are denied or terminated:

You were denied benefits by Social Security. They said it was because you do not meet their medical criteria. We too cannot give you cash benefits for this same reason. Although you can appeal our decision, state law changes bar you from continuing to get your APTD grant during your appeal.

Approximately 700 APTD cash recipients who were open for APTD as of June 30, 2011, are not receiving SSA-related benefits, and are in appeal status with the SSA due to SSA having denied their application for SSA-related benefits, will receive a letter generated from State Office in mid-July. In the letter, the recipients will be provided with a July 29, 2011 deadline to provide proof of:

� the reason SSA denied their application for SSA-related benefits;

� how many times the individual has appealed SSA's decision to deny the SSA-related benefits; and

� the reason SSA has denied each of the appeals, if there has been more than one appeal.

The individuals receiving the letter have been directed to send the proof requested in the letter to the FSSU at State Office, and will be provided with Business Reply Envelopes with the State Office address displayed. The FSSU will terminate the APTD cash assistance in the following circumstances:

� The APTD cash assistance recipient:

1. provides proof of having been denied SSA-related benefits due to failing to meet the medical criteria; and

2. has exhausted the appeal process with SSA; or

� The APTD cash assistance recipient fails or refuses to supply the proofs by the July 29, 2011 deadline, or the proof supplied by the due date is incomplete.

On August 1, 2011, the FSSU will begin to apply the new policy to the 700 APTD recipients who were sent the letter. For those cases in which the APTD cash grant must be terminated, the FSSU will note the reasons the cash is being closed in case comments, and use the new reason message "Did Not Meet SSA Medical Criteria for SSA-Related Benefits" from the POA screen in New HEIGHTS. This will trigger APTD cash to end, and the following message wil autopopulate on the NOD: You were denied benefits by Social Security. They said it was because you do not meet their medical criteria. We too cannot give you cash benefits for this same reason. Although you can appeal our decision, state law changes bar you from continuing to get your APTD grant during your appeal.

District Office workers will need to carefully read case comments on APTD cash applicants to ensure that there is no history of the APTD cash applicant having been denied APTD cash assistance in the past for the reasons described in this SR. If it is discovered that the APTD cash applicant has been denied APTD cash assistance in the past due to SSA having denied the individual SSA-related benefits because the individual did not meet SSA medical criteria, the APTD applicant must supply proof from SSA that they have been approved for SSA-related benefits to be eligible for APTD cash.

DESCRIPTION OF REVISIONS MADE TO FORMS

The following text was added to the section entitled "How Is SSP Different From SSI?" in DFA Form 77C, NH Supplement Program, during updates to the form made in the release of DFA SR 11-26, dated July 2011: If you are denied these benefits due to not meeting the medical criteria, you will not be eligible for APTD cash benefits. The new version of the form will be sent to print when the current supply of Form 77C is exhausted. See DFA SR 11-26 for further information.

POLICY MANUAL REVISIONS

Revised Adult Assistance Manual Topics

Section 135.01 Administrative Appeal Requests and the ANP

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 315.09 APTD Verification Requirements for SSA Denial

Section 315.11 Denial or Termination of Assistance

IMPLEMENTATION

The policy released in this SR is effective July 1, 2011.

CLIENT NOTIFICATION

Two client mailings, as described below, will be generated to APTD applicants to notify them of the state law changes. Both letters have been attached to this SR for reference.

� The first week of July 2011, a one-time mailing will be generated to the approximately 1,340 APTD cash cases that are not receiving SSA-related benefits, to notify them of the state law changes described in this SR.

� The week of July 11, 2011, a second mailing will go out to the approximately 700 APTD cash cases that are not receiving SSA-related benefits and are in appeal status with the SSA. This second letter will request specific verifications and provide a deadline for providing the verifications to the FSSU. For any recipients whose benefits are terminated after the FSSU applies the new policies described in this SR, the following special message will be inserted on the NOD generated: You were denied benefits by Social Security. They said it was because you do not meet their medical criteria. We too cannot give you cash benefits for this same reason. Although you can appeal our decision, state law changes bar you from continuing to get your APTD grant during your appeal.

TRAINING

This policy change was discussed at the June 9, 2011 Supervisor's Meeting in Concord, NH. Additionally, the DFA Training Unit conducted a statewide training for Family Services Specialists (FSS) at the end of June 2011. No other special training is planned.

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 www.dhhs.nh.gov/DFA/publications.htm, effective August 1, 2011. Additionally, this SR, and printed pages with posting instructions, will be distributed under separate cover to all internal hard copy holders of the Adult Assistance Manual.

DFA/JBV:s