SR 14-04 Dated 01/14

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases the following health care reform revisions to Medicaid and the Children’s Health Insurance Program (CHIP) eligibility requirements to incorporate Affordable Care Act (ACA) reforms as well as NH mandates and decisions related to the ACA:

·      Eligibility for cash assistance no longer results in automatic eligibility for medical assistance. The eligibility determination process for medical assistance is now autonomous from the financial assistance eligibility determination process.

·      Certain Medicaid eligibility groups now have eligibility determined using Modified Adjusted Gross Income (MAGI). MAGI is a new method for determining:

-     How income is counted;

-     Whose income is counted (the budget group); and

-     The income limit based on the size of the budget group.

·      The Medicaid eligibility categories that will use MAGI in the eligibility determination process are:

-     Children’s Medicaid: Children under age 20 [this includes Children’s Medicaid, what was formerly called Financial Assistance to Needy Families (FANF)-related medical assistance, and Children with Severe Disabilities (CSD)]. Children eligible for this category of medical assistance must have net income less than or equal to 196% of the federal poverty level (FPL);

-     Expanded Children’s Medicaid: Children under age 19 [this includes what was formerly called Children’s Expanded]. Children eligible for this category of medical assistance must have net income higher than 196% FPL, but no higher than 318% of the FPL;

-     Pregnant Women [this includes Medical Coverage for Pregnant Women (MCPW)]: Women eligible for this category must have net income less than or equal to 196% of the FPL;

-     Parents/Caretaker Relatives [this includes adults who were formerly covered under FANF-related categorically-needy medical assistance and now also includes the caretaker relative’s spouse, if residing with the caretaker relative]: Adults eligible for this category are a parent/caretaker relative of a dependent child, defined as a child under age 18, or under age 21 and a full time student in secondary school (or equivalent vocational or technical training). The child must meet FANF deprivation requirements. Net income must be less than or equal to a set income limit which is based on the FANF payment standard, not the FPL;

-     Former foster care children [this includes individuals who are currently under the age of 26 who were terminated from foster care when they turned 18]. Medicaid coverage is automatically provided to former foster children, defined as children who were in foster care and enrolled in Medicaid as of the age of 18, as confirmed by the Department of Children, Youth, and Families (DCYF). Individuals eligible for this category are now over age 18 but under age 26, and are not eligible for any other category of medical assistance. There are no income or resource tests for this group and these individuals are always a household size of one;

-     Family Planning Expansion Category, as described in SR 13-30, dated July 2013. Individuals eligible for this category must have net income less than or equal to 196% of the FPL; and

-     12-month extended medical assistance [these individuals lost Medicaid due to increased income]: Individuals eligible for this medical assistance must have net income less than or equal to whatever income limit for the category of assistance they were in when they lost Medicaid, in the 2nd 6-month period of eligibility.

·      DFA continues to administer Medicaid eligibility for non-MAGI groups as well as MAGI groups. Those groups continue to operate under the “old” non-MAGI eligibility requirements related to how income and resources count, whose income is counted, and household composition. The categories of Medicaid that are considered non-MAGI include the disabled and individuals needing long-term care (LTC) services, medically-needy categories, and In and Out medical assistance, including:

-     State Supplement Program (SSP) Medical Assistance: Aid to the Needy Blind (ANB), Aid to the Permanently and Totally Disabled (APTD), and Old Age Assistance (OAA);

-     Home and Community-Based Care (HCBC) services;

-     Home Care for Children with Severe Disabilities (HC-CSD);

-     Nursing Facility (NF) Services;

-     Medicare Savings Programs (MSP) (QMB, SLMB/SLMB135, QDWI);

-     Medicaid for Employed Adults with Disabilities (MEAD); and

-     Breast and Cervical Cancer (BCCP).

Note: MAGI groups are also eligible for LTC services (NF and HCBC). Since there are still pending issues about how LTC eligibility will be handled for the MAGI groups, policy will be released at a later date under separate cover, as needed.

·      The Medicaid eligibility determination process for the MAGI categories is still based on household size and income, but how household composition is determined, whose income counts in that household, and how income is treated, are based on IRS-defined concepts of income and household:

-     Household Composition: Medicaid eligibility for the MAGI categories is now always determined on an individual basis, meaning each individual within a household will have his or her household composition determined independently of other members within the same household, and each member could have a different household size. Determining who is included in an individual’s household is dependent upon the individual’s expected tax filing status, as follows:

1.    Tax filers are individuals who plan to file taxes and do not expect to be claimed as a dependent on another person’s income tax return. Joint filers are often the spouses of tax filers but could also be separated from the tax filer but still filing jointly with the tax filer. Joint filers are also considered tax filers when determining household composition. Note: Spouses are always included in one another’s Medicaid household if they are living together, even if they do not file joint taxes;

2.    Non-filers are individuals who do not plan to file taxes and do not expect to be claimed on another person’s income tax return; and

3.    Tax dependents are individuals who are claimed on another individual’s tax return, regardless of whether they file taxes themselves.

Once an individual’s tax filing status is determined, the individual’s household composition can then be determined using the following rules:

1.    Tax filer rules, which include the tax filer, the joint filer or spouse living with the tax filer, and all persons whom the tax filer expects to claim as a tax dependent; or

2.    Non-filer rules, which include:

§     For adults – the non-filer, and the non-filer’s spouse and children if living with the non-filer; or

§     For children – the child plus siblings and parents (including step-parents) if living with the child.

Three exceptions exist when determining household composition for tax dependents. If one of these exceptions exists, the tax dependent’s household composition will be determined using the non-filer rules. These exceptions are:

1.    The individual expects to be claimed as a tax dependent by someone other than a spouse or a biological, adopted, or step-parent;

2.    The individual is a child under age 20 living with both parents, expects to be claimed as a tax dependent by one parent, but the parents do not expect to file a joint tax return; or

3.    The individual is a child under age 20 who expects to be claimed as a tax dependent by a non-custodial parent.

Pregnant women will continue to include their fetuses in their household composition as well as in all households that would also include the pregnant woman.

-     Whose income counts: In general, the MAGI income of all members included in each individual’s MAGI household is counted when determining income eligibility for each individual, with certain exceptions for the income of children and the income of most other tax dependents. See the policy section for more information on these exceptions.

-     Treatment of income, income limits, and income deductions:

1.    Most income deductions have been eliminated and replaced with a flat higher income limit to incorporate the removal of the income deductions. E.g., there is no longer a 20%/50% earned income disregard for the former FANF groups, no $90 disregard, and no dependent care deduction. The deductions from income that are allowed for all MAGI categories: actual payments made for alimony/spousal support, student loan interest, IRA contributions, and payroll deductions or salary deferrals to certain accounts. Note: There is an additional income deduction, based upon 5% of the FPL, that is allowed in certain limited situations when determining MAGI eligibility only. See the policy section for more information on the specific use of that deduction.

2.    The following types of income no longer count in determining MAGI-related eligibility: child support, Veterans Affairs (VA), awards or fellowship grants used for education purposes and not for living expenses, and worker’s compensation income. Income that continues to count in MAGI: wages, salaries, and self-employment income, tips, gratuities, and bonuses, unemployment benefits, canceled/forgiven debt, alimony received, pensions, and annuities.

3.    Depreciation and expenses and business losses allowed by the IRS for self-employment are now allowed for the MAGI categories of medical assistance.

·      Resource limits. Resource tests no longer apply to the MAGI categories of medical assistance. Resource limits continue to apply for the Non-MAGI categories of medical assistance.

·      The Medicaid enrollment process for the MAGI categories has been vastly simplified:

-     Verification relies primarily on electronic crossmatches with various data resources, self-attestation for certain information, and paper verification, if required, is provided post-eligibility;

-     No personal interview is required, and eligibility is determined in “real time;” and

-     All changes that may impact eligibility must still be reported within 10 calendar days of the change occurring, per current policy, but eligibility for children is “locked in” for the 12-month eligibility period, regardless of changes, unless the child ceases to be a state resident or the family requests termination.

·      Post-eligibility paper verification is required for discrepancies in any electronic data-matching crossmatches and for certain self-attestations made by the client at application. Specifically:

-     At the time of application and based on the information provided by the applicant, electronic verification will occur for: income, age/date of birth (DOB), social security number (SSN), citizenship/immigration status, receipt of Medicare, and incarceration status.

-     Citizenship/immigration status verification remains unchanged; if electronic verification cannot confirm citizenship/immigrations status, the applicant is given a reasonable opportunity to provide proof;

-     If income that was reported by the applicant is within 10% of the verified amount via crossmatching with electronic databases, or the difference in income exceeds 10% but the difference would not affect eligibility in any way, the information is considered reasonably compatible, and the information is immediately used in the eligibility determination process with no further verification required;

-     Self-attestation at the time of application with no further proof required, will occur for: residency, household composition/tax filing status, pregnancy, caretaker relative status, and application for other benefits.

-     Post-enrollment paper verification is required for:

1.    discrepancies that occur during the crossmatch with the electronic databases for income, such as wages and unemployment compensation benefits (UCB), age/DOB, receipt of Medicare, citizenship/immigration status, and SSN; and

2.    medical child support cooperation and deprivation of parental care, if applicable.

·      The establishment of a federally-operated Federally Facilitated Marketplace (referred to as the “Marketplace” or “FFM”) through which health coverage eligibility data will be exchanged during either of the following situations:

-     Individuals applying for medical assistance through the FFM: Individuals who apply for health coverage through the FFM are assessed at the FFM level. If the FFM assesses that the individual may be eligible for a NH Medicaid program, the FFM sends certain data to NH and NH DHHS makes the Medicaid eligibility determination; or

-     Individuals found ineligible for NH Medicaid programs (or who open for In and Out medical assistance): Individuals who apply for health coverage through NH DHHS, through NH EASY, on a paper application, or over the phone, will have an eligibility determination made by NH DHHS. If NH DHHS determines the individual ineligible for Medicaid or if the individual is only eligible for In and Out medical assistance, New HEIGHTS is programmed to send certain data about these individuals to the FFM so that the FFM can determine whether these individuals are eligible for other federally subsidized health insurance affordability programs.

To support the changes described above, the following New HEIGHTS-generated forms were created:

·   New HEIGHTS-generated CM0030, SSN Good Cause Letter;

·   New HEIGHTS-generated CM0031, Immigration Status Letter;

·   New HEIGHTS-generated CM0032, Referral to FFM Letter;

·   New HEIGHTS-generated DX0012, 10% Threshold Test Failure – Wages; and

·   New HEIGHTS-generated DX0013, 10% Threshold Test Failure – NH UCB.

Several DFA forms required revisions as well. Those forms that have not already been released in other SRs will be released under separate cover at a later date, to control the size of this SR.

BACKGROUND

On March 23, 2010, the President signed into law a comprehensive health reform measure, the Patient Protection and Affordable Health Care Act, PPACA (PL 111-148). In addition, on March 30, 2010, the President signed a corrections measure, the Health Care and Education Reconciliation Act (PL 111-152) which made several major changes to the PPACA. These two laws are collectively referred to as the Affordable Care Act of 2010 (ACA). Some of the goals of the ACA are to:

·   address the affordability of health insurance coverage for low-income individuals;

·   address health insurance company policies that may be obstacles for low-income individuals obtaining health insurance; and

·   address availability of private health insurance coverage for low-income individuals.

As of January 1, 2014, most New Hampshire citizens are required to have health coverage:

·   People already covered by Medicare, Medicaid, or most job-based health coverage do not need to buy new coverage.

·   New Hampshire citizens without health insurance coverage, who are not Medicaid eligible, are able to:

-   Buy health insurance coverage through the New Hampshire Health Insurance Marketplace (FFM) operated by the federal government by going to https://www.healthcare.gov/ or by calling 1-800-318-2596 TTY: 1-855-889-4325 (a representative is available 24/7); or

-     Buy individual health insurance coverage in the private market (outside the FFM).

-     People using the FFM can apply for advance premium tax credits (APTC) and cost-sharing reductions (CSR) to help in the costs for paying for health insurance.

-     People buying coverage outside of the FFM do not have access to this cost assistance.

From October 1, 2013 to December 31, 2013, an open enrollment period was provided for NH citizens to apply for Medicaid coverage under the new MAGI rules with coverage to begin January 1, 2014.

ACA also mandated Medicaid-funded health coverage for a new Adult Group for non-disabled, non-pregnant individuals who have no dependents, are between the ages of 19-64, and who are not entitled to or enrolled in Medicare Part A or B, with income less than or equal to 133% of the FPL (what NH is referring to as the Medicaid Expansion group). However, due to a US Supreme Court decision that changed that mandate, states were allowed to voluntarily elect to cover this group. At this time, NH has not opted to expand Medicaid eligibility to this adult group.

POLICY

Eligibility requirements for Medicaid and the Children’s Health Insurance Program (CHIP) have been revised to incorporate Affordable Care Act (ACA) reforms as well as NH mandates and decisions related to the ACA. In general:

·      the medical assistance eligibility determination process is now autonomous from the eligibility determination process for DFA-administered cash assistance; and

·      certain medical assistance groups will now use the Modified Adjusted Gross Income (MAGI) method, which uses IRS-defined concepts of income and household, when eligibility is determined. Each applicant for a MAGI category of Medicaid will always be reviewed individually for eligibility, and household composition and whose income counts will be determined based on tax filing status of the applicant.

MAGI and the New Medicaid Categories

MAGI is the new method for determining:

·      How income is counted, using IRS-defined concepts of income;

·      Whose income is counted (the budget group), using IRS-defined concepts associated with federal tax filing status of the applicant; and

·      The income limit based on the size of the budget group, with most income limits for the MAGI-related medical assistance groups based on federally set poverty levels (FPL).

The Medicaid eligibility categories that will use MAGI in the eligibility determination process are:

·      Children’s Medicaid: Children under age 20 [this includes Children’s Medicaid, what was formerly called FANF-related medical assistance, and CSD]. Children eligible for this category of medical assistance must have net income less than or equal to 196% of the federal poverty level (FPL);

·      Expanded Children’s Medicaid: Children under age 19 [this includes what was formerly called Children’s Expanded]. Children eligible for this category of medical assistance must have net income higher than 196% FPL, but no higher than 318% of the FPL;

·      Pregnant Women [this includes Medical Coverage for Pregnant Women (MCPW)]: Women eligible for this category must have net income less than or equal to 196% of the FPL;

·      Parents/Caretaker Relatives [this includes adults who were formerly covered under FANF-related categorically-needy medical assistance]: Adults eligible for this category are a parent/caretaker relative of a dependent child, defined as a child under age 18, or under age 21 and a full time student in secondary school (or equivalent vocational or technical training). The child must meet FANF deprivation requirements. Net income must be less than or equal to a set income limit which is based on the FANF payment standard, not the FPL. Note: The caretaker relative’s spouse is now also covered under this category, if the spouse is residing with the caretaker relative;

·      Former foster care children [this includes individuals who are currently under the age of 26 who were terminated from foster care when they turned 18]. Medicaid coverage is automatically provided to former foster children, defined as children who were in foster care and enrolled in Medicaid as of the age of 18, as confirmed by DCYF. Individuals eligible for this category are now over age 18 but under age 26, and are not eligible for any other category of medical assistance. There are no income or resource tests for this group and these individuals are always a household size of one;

·      Family Planning Expansion Category. Individuals eligible for this category must have net income less than or equal to 196% of the FPL; and

·      12-month extended medical assistance [these individuals lost Medicaid due to increased income]: Individuals eligible for this assistance must have net income less than or equal to the income limit for the category of assistance in which they were in prior to losing coverage, in the 2nd 6-month period of eligibility.

MAGI Eligibility: Tax Filing Status, Household Composition, and Whose Income Counts

Medicaid eligibility for the MAGI categories is now always determined on an individual basis, meaning each individual within a household will have his or her household composition determined independently of other members within the same household, and each member could have a different household size. Determining who is included in an individual’s household is dependent upon the individual’s expected tax filing status, as follows:

·      Tax filers are individuals who plan to file taxes and do not expect to be claimed as a dependent on another person’s income tax return. Joint filers are often the spouses of tax filers but could also be separated from the tax filer but still filing jointly with the tax filer. Joint filers are also considered tax filers when determining household composition. Note: Spouses are always included in one another’s Medicaid household if they are living together, even if they do not file joint taxes;

·      Non-filers are individuals who do not plan to file taxes and do not expect to be claimed on another person’s income tax return; and

·      Tax dependents are individuals who are claimed on another individual’s tax return, regardless of whether they file taxes themselves. Tax dependents can be a tax filer’s child (natural, step, adopted, or foster), parent, brother, sister, niece, nephew, or grandchild.

Once an individual’s tax filing status is determined, the individual’s household composition can then be determined using the following rules:

·      Tax filer rules, which include the tax filer, the joint filer or spouse living with the tax filer, and all persons whom the tax filer expects to claim as a tax dependent; or

·      Non-filer rules, which include:

-     For adults – the non-filer, and the non-filer’s spouse and children if living with the non-filer; or

-     For children – the child plus siblings and parents (including step-parents) if living with the child.

Three exceptions exist when determining household composition for tax dependents. If one of these exceptions exists, the tax dependent’s household composition will be determined using the non-filer rules. These tax dependent exceptions are:

·      The individual expects to be claimed as a tax dependent of someone other than a spouse or a biological, adopted, or step-parent;

·      The individual is a child under the age of 20 living with both parents, expects to be claimed as a tax dependent by one parent, but the parents do not expect to file a joint tax return; or

·      The individual is a child under the age of 20 who expects to be claimed as a tax dependent by a non-custodial parent.

Pregnant women will continue to include their fetuses in their household composition as well as in all households that would also include the pregnant woman.

In general, the MAGI income of all members included in each individual’s MAGI household is counted when determining income eligibility for each individual.

·      Exception for the income of children:

-     Unless a child is expected to be required to file a federal income tax return, his or her income does not count toward household income if the child is included in the household of his or her parent. This means that in this circumstance, the child’s income does not count for purposes of evaluating the child’s eligibility or the eligibility of other household members. This also applies for adult children who are tax dependents of their parent.

-     If a child does not live with his or her parent and is not claimed as a tax dependent by his or her parent, then the child’s household will not include the parent. In this case, the child’s income will count for his or her own eligibility and the eligibility of the child’s other household members, such as their siblings, regardless of whether the child’s income is high enough to require a tax return to be filed.

·      Exception for the income of most other tax dependents:

-     The income of a tax dependent is included in the household income of the person who is claiming them only if the tax dependent is expected to be required to file a tax return.

-     The income of a tax dependent is included in the household income of any household where both that tax dependent and his or her claiming tax filer are present, only if the tax dependent is expected to be required to file a tax return.

-     This exception does not apply to a tax dependent’s income when determining the household income of any household where the tax dependent’s parent and the tax dependent’s claiming tax filer are not part of that household. In this circumstance, the tax dependent’s income counts toward household income regardless of whether or not he or she is expected to be required to file a federal income tax return.

New HEIGHTS is automated to determine if an individual is required to file taxes based on the income that is entered for that individual, and programmed to count tax dependent's income per the policy above.

Examples:

Example 1: Mom and dad are married, expect to file taxes, have child 1 and child 2 in common, who are both under the age of 18, and they expect to claim as dependents. Mom also has child 3, who is a 19 year old full time student, and is expected to be claimed as a tax dependent on the non-custodial parent’s taxes.

Step 1: Determine each individual’s tax filing status:

-     Mom is the tax filer;

-     Dad is the joint filer (also considered as a tax filer);

-     Child 1 and child 2 are tax dependents, and do not fall under one of the tax dependent exceptions;

-     Child 3 is a tax dependent, but falls under one of the tax dependent exceptions;

Step 2: Determine household composition for each individual:

-     Mom follows tax filer rules and will include the following people in her household composition: herself, dad, child 1, and child 2;

-     Dad follows tax filer rules and will include the following people in his household composition: himself, mom, child 1, and child 2;

-     Child 1 and child 2 follow tax filer rules and will include the following people in their households: child 1, child 2, mom, and dad;

-     Child 3 follows non-filer rules and will include the following people in his or her household: himself/herself, mom, dad, child 1, and child 2.

Example 2: Mom does not expect to file taxes, and lives with her two children both under the age of 18. Child 1 is claimed on the non-custodial parent’s tax return, and child 2 is not claimed as a tax dependent.

Step 1: Determine each individual’s tax filing status:

-     Mom is a non-filer;

-     Child 1 is a tax dependent, but falls under the tax dependent exception for being claimed as a tax dependent by a non-custodial parent;

-     Child 2 is a non-filer;

Step 2: Determine household composition for each individual:

-     Mom follows non-filer rules and will include the following people in her household composition: Mom, child 1, and child 2;

-     Child 1 follows non-filer rules and will include the following people in his or her household composition: himself/herself, child 2, and mom;

-     Child 2 follows non-filer rules and will include the following people in his or her household composition: himself/herself, child 1, and mom.

Example 3: The father of child 1 in example 2, expects to file taxes, lives alone, and also applies for MA.

Step 1: Determine each individual’s tax filing status:

-     Father of child 1 is a tax filer;

Step 2: Determine household composition for each individual:

-     Father of child 1 follows tax filer rules and will include the following people in his household composition: himself/herself, and child 1.

The father of child 1 does not qualify for MA under a MAGI-related category, and must be evaluated for eligibility as a non-MAGI related group. He cannot include child 1 in his household composition, as non-MAGI eligibility does not follow tax-filer rules. There are no MAGI households under this example, therefore no chart is included for this example.

Example 4: Mom is over the age of 19 and pregnant with one fetus, expects to file taxes, and lives with her child and her mother, whom she expects to claim as tax dependents.

Step 1: Determine each individual’s tax filing status:

-     Mom is a tax filer;

-     Child is a tax dependent;

-     Mom’s mother is a tax dependent, but falls under one of the tax dependent exceptions;

Step 2: Determine household composition for each individual:

-     Mom follows tax filer rules and will include the following people in her household composition: herself, her mother, child, and fetus;

-     Child follows tax filer rules and will include the following people in his or her household composition: himself/herself, mom’s mother, mom, and mom’s fetus;

-     Mom’s mother follows non-filer rules and will include the following people in her household composition: herself.

Example 5: Mom and dad live together and have a child in common who is 20 and a full time student in secondary school. Mom and dad are not married. Both mom and dad plan to file their own taxes. Dad claims the child as a dependent on his taxes.

Step 1: Determine each individual’s tax filing status:

-     Mom is a tax filer;

-     Dad is a tax filer;

-     Child is a tax dependent.

Step 2: Determine household composition for each individual:

-     Mom follows tax filer rules and will include the following people in her household composition: herself;

-     Dad follows tax filer rules and will include the following people in his household composition: himself and child;

-     Child follows non-filer rules and will include the following people in his or her household composition: himself/herself, mom, and dad.

MAGI Eligibility: Treatment of Income, Income Limits, & Deductions

For the MAGI categories of medical assistance:

·      most income deductions have been eliminated and replaced with a flat higher income limit to incorporate the removal of the income deductions. The only deductions from income that are allowed for all MAGI categories of medical assistance are actual payments made for alimony/spousal support, student loan interest, IRA contributions, and payroll deductions or salary deferrals to certain accounts.

·      the following types of income no longer count in the eligibility determination process: child support, VA, awards or fellowship grants used for education purposes and not for living expenses, and worker’s compensation income.

·      there are a few special income circumstances:

-     Depreciation and expenses and business losses allowed by the IRS for self-employment are now allowed for the MAGI categories of medical assistance. Note: When self-employment income is “Landlord/Rental income,” it does not matter for the MAGI categories of medical assistance whether the property is self-managed or not because either way this type of income is counted as self-employment and not unearned income. However, because New HEIGHTS codes this type of income differently, always answer “Yes” to this type of self-employment income being “self-managed” (even if it is not), so that New HEIGHTS properly counts this income for the MAGI categories;

-     an amount received as a lump sum is counted as income only in the month received; and

-     certain distributions, payments, and student financial assistance for American Indians/Alaska Natives are excluded from income.

·      5% FPL deduction: This deduction is only applied if an individual applies for a MAGI category of assistance or is a current recipient of MAGI medical assistance, is categorically eligible for the MAGI category of assistance, but is determined ineligible for being over income. In these circumstances only, and before determining In and Out medical assistance, the 5% FPL deduction appropriate to the household size is applied in the income computation to redetermine eligibility. If the individual becomes income-eligible with the 5% FPL deduction subtracted from household income, the individual will open for the specific MAGI category of assistance. If the individual is not eligible after using the 5% FPL deduction, determine the individual’s eligibility for In and Out medical assistance, and the appropriate referrals will be made to the FFM.

·      Income protection: This concept is time limited and applies only to recipients of Children’s Medicaid, Expanded Children’s Medicaid, and Parents Caretaker Relative categorically-needy medical assistance:

-     Individuals who have a redetermination scheduled between January and March 2014 are allowed “income protection” until March 31, 2014, at which point the new MAGI methodology will be applied. Individuals with redeterminations scheduled after March 31, 2014 and on or before December 31, 2014, will have the new MAGI methodology applied at their next regularly scheduled redetermination.

-     Children who would lose Medicaid eligibility on January 1, 2014 due to the elimination of disregards under the new MAGI-based methodologies, will remain automatically eligible for a 12-month period until the child’s next redetermination in 2015. At that subsequent redetermination in 2015, the new MAGI methodology must be used.

New HEIGHTS will run monthly reports through December 31, 2014 listing the children impacted. The following manual process will need to occur for those children listed on the report:

1.    Calculate eligibility for the individuals listed on the report to determine if the non-MAGI eligibility rules had been applied using the various income disregards and deductions, e.g. $90 per employed individual and dependent care expenses, the individual would have remained eligible;

2.    If the child would have remained eligible, the total amount of the deductions that would have been allowed using the old non-MAGI rules must be entered into the “Other – MAGI Only” deduction field;

3.    End-date the deduction to align with the child’s 2015 redetermination date 12 months later, and then rerun eligibility;

4.    When eligibility is rerun, New HEIGHTS will apply this deduction with the new MAGI rules, and medical assistance will be reopened with no break in service; and

5.    At the 2015 redetermination, nothing more needs to occur as the deduction is end-dated and New HEIGHTS will evaluate the individual’s eligibility using straight MAGI methodology.

The income limits for the new MAGI groups, and the 5% FPL deduction are listed below.

Children’s Medicaid (CM), Pregnant Women MA, Family Planning Medical Assistance (FPMA), and Children with Severe Disabilities (CSD)

Monthly net income limits for CM, Pregnant Women MA, FPMA, and CSD are based on 196% of the FPL.

Expanded Children’s Medicaid - 318%

Monthly net income must be higher than 196% of the FPL, but no higher than 318% of the FPL.

Parent/Caretaker Relative

Monthly net income limits for the Parent/Caretaker Relative group are based on the payment standard and are not based on the poverty guidelines.

5% FPL Deduction

Applied only if the applicant or recipient meets all categorical eligibility requirements for the MAGI category of medical assistance except is over income. At that point, redetermine eligibility by subtracting the 5% FPL deduction from the individual’s income based on household size. If still ineligible for the MAGI category of medical assistance, determine In and Out medical assistance.

Eligibility Resource Limits

Resources are not counted in the eligibility process for the MAGI categories of medical assistance.

Eligibility Verification Process

For the MAGI categories of medical assistance:

·      the application has been streamlined (see DFA SRs 13-06, dated October 2013 and DFA SR 14-08, dated January 2014, for more information);

·      interviews are no longer required;

·      verification relies primarily on electronic crossmatching with various data resources, self-attestation for certain information, and paper verification, if required, is provided post-eligibility;

·      eligibility is determined in “real time;”

·      all changes in circumstances that may impact eligibility must continue to be reported within 10 calendar days of the change occurring, but eligibility for children is locked in for the 12-month eligibility period, regardless of changes during the eligibility period, unless the child ceases to be a state resident or the family requests termination.

Post-eligibility paper verification is required for discrepancies in any electronic data-matching crossmatches and for certain information provided by the client at application. Specifically:

·      at the time of application and based on the information provided by the applicant, electronic verification will occur for: income, age/DOB, SSN, citizenship/immigration status, receipt of Medicare, and incarceration status;

·      citizenship/immigration status verification remains unchanged; if electronic verification cannot confirm citizenship/immigration status, the applicant is given a reasonable opportunity to provide proof;

·      if income that was reported by the applicant is within 10% of the verified amount via crossmatching with electronic databases, or the difference in income exceeds 10% but the difference would not affect eligibility in any way, the information is considered reasonably compatible, and the information is immediately used in the eligibility determination process, with no further verification required;

·      Self-attestation at the time of application with no further proof required will occur for: residency, household composition/tax filing status, pregnancy, caretaker relative status, and application for other benefits.

·      Post-enrollment paper verification is required for:

-     discrepancies that occur during the crossmatch with the electronic databases for income, such as wages and UCB, age/DOB, receipt of Medicare, citizenship/immigration status, and SSN; and

-     medical child support cooperation and deprivation of parental care, if applicable.

Health Benefit Federally Facilitated Marketplace (FFM)

The FFM is an online marketplace where individuals are able to purchase health insurance. Using the FFM, low and moderate-income people are able to obtain payment assistance to help them buy health insurance:

·   Some people may also get reductions on deductibles and other cost-sharing. Substantial subsidies are available through the FFM for those at 100% - 400% of the FPL. Premiums are on a sliding scale based on income.

·   People with access to employer coverage cannot receive a subsidy through the FFM unless the employer coverage is unaffordable or insufficient.

·   People can also use the FFM to apply for Medicaid.

Small businesses will eventually be able to use a separate marketplace called the SHOP Exchange, once the FFM is fully functional, to provide health insurance to employees and to see if the business qualifies for a small business tax credit.

·   Small employers (under 50 employees) will have no penalty for not offering coverage and may get a tax credit if they use the SHOP Exchange;

·   Large employers (50 or more employees) will experience penalties, starting in 2015:

-     For not offering coverage, the penalty will be $2,000 per employee;

-     For offering unaffordable or insufficient coverage, the penalty will be $3,000 per employee receiving a subsidy;

-     There will be no penalty for employees that qualify for Medicaid.

Beginning in December 2013, NH Medicaid and the FFM began the process of communicating with one another regarding new applications for Qualified Health Plans, Medicaid, and other insurance affordability programs. When NH DHHS receives an application for health care coverage and determines the individual is not eligible for Medicaid, or that the individual is eligible for In and Out medical assistance, the application information is forwarded electronically to the FFM to determine if the individual is eligible for other insurance affordability programs. Similarly, if the FFM receives an application for enrollment in a Qualified Health Plan, but assesses that the person may be eligible for NH Medicaid, the application information is forwarded to NH DHHS. NH DHHS, not the FFM, determines eligibility for NH Medicaid programs. NH’s Marketplace is operated by the Centers for Medicare & Medicaid Services (CMS) in accordance with federal standards. Note that the following impacts the information that will be sent from NH to the FFM:

·   If the District Office worker "withdraws" the application in Client Registration, New HEIGHTS displays a mandatory drop down menu requesting a reason why the application was withdrawn. If the District Office worker picks a “non-procedural” option, such as "over income," "over resources," or "no eligible member" from the drop down menu, New HEIGHTS will refer the individual to the FFM. Drop down menu options chosen that are procedural, such as "client walked out," “failed to provide,” “failed to rede,” or “closed at recipient request” will not trigger a referral to the FFM.

·   If the District Office worker has taken the application from Client Registration into Application Entry, do not "deny" the application from the “Program of Assistance” (POA) screen with a reason of "withdrawn" if the client is withdrawing his or her application due to being over income/resources or because no program is available. Doing so will not allow the application to be referred to the FFM, and these applications should be referred to the FFM. Instead the District Office worker must select the actual reason on the POA screen as to why the client is withdrawing. Doing so will ensure that the individual’s information is shared with the FFM for assessment of eligibility for other affordable coverage options.

All applicants who are denied NH Medicaid for over income/resources or because no program is available, or who are opened for In and Out medical assistance, and whose information is then successfully transferred to the FFM the same evening of the denial/open for In and Out, will receive the following information on their NOD:

SPECIAL MESSAGE FOR INDIVIDUALS DENIED MEDICAL ASSISTANCE

[Name of Client] may be eligible for coverage through a Qualified Health Plan (QHP) or for other insurance affordability programs, including advance payment of the premium tax credit (APTC) or cost-sharing reductions (CSRs). To apply for these programs or to find out more, visit HealthCare.gov or call 1-800-318-2596 TTY: 1-855-889-4325 (a representative is available 24/7).

Those individuals in which the transmission of information to the FFM failed that night will instead receive the new New HEIGHTS-generated CM0032, Referral to FFM Letter, once the transmission is successful. Text in the CM0032 is similar to the text that will be populated on the NOD for immediately successful transmissions. This letter will be released under separate cover at a later date by New HEIGHTS.

NEW HEIGHTS SYSTEMS PROCEDURES AND IMPLEMENTATION

The policies described in this SR have been coded into New HEIGHTS for October 1, 2013, to meet CMS open enrollment deadlines. See the System Alert dated 9/30/13, and entitled Affordable Care Act Related Changes, for more information about the New HEIGHTS changes that were made.

Additionally, the following New HEIGHTS-generated forms were created to support the ACA changes:

·   New HEIGHTS-generated CM0030, SSN Good Cause Letter;

·   New HEIGHTS-generated CM0031, Immigration Status Letter;

·   New HEIGHTS-generated CM0032, Referral to FFM Letter;

·   New HEIGHTS-generated DX0012, 10% Threshold Test Failure – Wages; and

·   New HEIGHTS-generated DX0013, 10% Threshold Test Failure – NH UCB.

These new New HEIGHTS-generated letters will be released under separate cover at a later date by New HEIGHTS.

DESCRIPTION OF REVISIONS MADE TO FORMS

Due to the large number of forms impacted by this change, all revisions to forms that have not been released in other ACA-related SRs will be released under separate cover at a later date.

POLICY MANUAL REVISIONS

Revised Family Assistance Manual Topics

Introduction

Section 105.03  Eligibility Reviews

Section 123.01  Initiation of Medical Assistance

Section 127.01  Interview Sites

Section 127.03  Failure to Appear for an Interview

PART 141  ADVANCE NOTICE PERIOD (ANP)

Section 141.03  No ANP Required

PART 153  CHANGES THAT DECREASE BENEFITS

PART 161  REDETERMINATION/RECERTIFICATION

Section 161.07  Termination at Redetermination/Recertification

PART 167  TERMINATION OF MEDICAL ASSISTANCE

PART 169  EXTENDED MEDICAL ASSISTANCE DUE TO INCREASED CHILD OR SPOUSAL SUPPORT

Section 169.01  Determining the Four-Month Coverage Period

Section 169.03  Changes During the Four-Month Coverage Period

Section 169.05  Redetermination of Eligibility During the Four-Month Coverage Period

PART 171  EXTENDED MEDICAL ASSISTANCE DUE TO EMPLOYMENT

Section 171.01  Determining the Coverage Period

Section 171.03  Termination Due to Employment of an Incapacitated Parent

PART 173  ELIGIBILITY CRITERIA FOR 12-MONTH COVERAGE

Section 173.01  Definition of a Complete Form 890

Section 173.03  Financial Eligibility

Section 173.05  Ineligibility Reasons

Section 173.07  Determining Good Cause

Section 173.09  Reinstatement After Termination

Section 173.11  Changes During the 12-Month Coverage Period

Section 173.13  Changes in Assistance Group Composition

Section 173.15  Scheduled Redeterminations of Eligibility

Section 173.17  Required Verification for 12-Month Coverage

PART 175  EXTENDED MEDICAL ASSISTANCE DUE TO SECTION 1619 STATUS

Section 175.01  Open Individuals Who Report New or Increased Earning

Section 175.03  Individuals Who Request Assistance Due to Section 1619 Status

PART 201  PROGRAM REQUIREMENTS

PART 203  FINANCIAL ASSISTANCE TO NEEDY FAMILIES (FANF)

Section 203.05  Unemployed Parent (UP) Medical Assistance Program

Section 203.07  Families with Older Children (FWOC)

Section 203.09  Interim Disabled Parent (IDP)

PART 205  TANF-RELATED MEDICAL ASSISTANCE

Section 205.01  Children Up To Age 19

Section 205.03  Pregnant Women

Section 205.05  Severely Disabled Children

Section 207.07  Dependent Children Who Are Students

Section 207.13  Verification

Section 209.07  Continued Absence of a Parent: 30-Day Continued Absence Period

Section 209.11  Incapacity: 30-Day Incapacity Requirement

Section 209.13  Family Services Specialist (FSS) Determines Incapacity

Section 209.17  Incapacity: Increased Earnings by an Incapacitated Parent

Section 209.37  Verification of Deprivation

Section 211.01  Who Must Be Members

PART 213  UP ELIGIBILITY

Section 213.01  Unemployment of the Principal Wage Earner

Section 213.03  UP: Definition of Unemployed

Section 213.05  UP: Eligibility by Work and Education History

Section 213.07  UP: Eligibility by Unemployment Compensation History

Section 213.09  UP: NH Employment Security

Section 213.11  UP: Refusing an Offer of Employment or Training

Section 213.13  UP: Good Cause Reasons for Refusing an Offer of Employment or Training

Section 213.15  UP: Ineligibility for UC Benefits

Section 213.17  Termination of UP and Eligibility for Other Programs

Section 213.19  Verification of UP Eligibility

Section 213.21  Special Verification of Employment Requirements for Refugees

PART 215  TANF MEDICAL ASSISTANCE-ONLY GROUP COMPOSITION

Section 215.01  Who Must Be Members

Section 215.03  Who May Be Members

Section 215.05  Who Is Not A Member

PART 217  SEPARATE MEDICAL ASSISTANCE GROUPS

Section 217.01  When Separate Medical Assistance Groups Are Required

Section 217.03  Actions Affecting Separate Medical Assistance Groups

PART 219  CHILDREN UP TO AGE 19

Section 219.01  Medical Assistance Group Composition

Section 219.03  Required Verification

PART 221  PREGNANT WOMEN

Section 221.01  Medical Assistance Group Composition

Section 221.03  Continuation of Medical Assistance Following Pregnancy

Section 221.05  Required Verification

PART 222  FAMILY PLANNING MEDICAL ASSISTANCE (MA)

Section 222.01  Family Planning MA Eligibility Criteria

Section 222.03  Family Planning MA Application Process

Section 222.05  Family Planning MA Income Requirements

Section 222.07  Family Planning MA Resource Requirements

Section 222.09  Family Planning MA Allowable Deductions

Section 222.11  Family Planning MA Covered and Non-Covered Services

Section 222.13  Family Planning MA Retroactive Medical Assistance

Section 222.15  Family Planning MA In and Out Medical Assistance

Section 222.17  Family Planning MA Third Party Liability (TPL)

Section 222.19  Family Planning MA Length of Eligibility

Section 222.21  Family Planning MA Determining Presumptive Eligibility (PE)

Section 222.23  Family Planning MA Required Verification

PART 223  CHILDREN WITH SEVERE DISABILITIES

Section 223.01  Medical Assistance Group Composition

Section 223.03  Required Verification

Section 223.05  Three-Month Temporary Adjustment Period

Section 223.07  CSD Children Turning 18 Years Old

PART 225  HOME CARE FOR CHILDREN WITH SEVERE DISABILITIES (HC-CSD)

Section 225.01  Medical Assistance Group Composition

Section 225.03  Required Verification

Section 225.05  Three-Month Temporary Adjustment Period

Section 225.07  HC-CSD Children Turning 18 Years Old

Section 227.03  Striker Eligibility

PART 241  HOME AND COMMUNITY-BASED CARE FOR THE DEVELOPMENTALLY DISABLED

Section 241.01  Assistance Group Composition (HCBC-DD)

Section 241.02  Required Verification

PART 242  HOME AND COMMUNITY-BASED CARE FOR IN-HOME SUPPORTS (HCBC-IHS)

Section 242.01  Assistance Group Composition (HCBC-IHS)

Section 242.02  Required Verification (HCBC-IHS)

PART 243 HOME AND COMM-BASED CARE FOR INDIVIDUALS WITH AN ACQUIRED BRAIN DISORDER (HCBC-ABD)

Section 243.01  Assistance Group Composition (HCBC-ABD)

Section 243.03   Required Verification

PART 247  REFUGEE CASH ASSISTANCE (RCA)

Section 247.01  RCA Application Process

Section 247.03  Completing an Application for RCA

Section 247.05  RCA Application Processing Time Frame

Section 247.07  RCA Eligibility Criteria

Section 247.09  Who Is Not Eligible for RCA

Section 247.11  RCA Length of Eligibility

Section 247.13  Changes During the RCA Eligibility Period

Section 247.15  Treatment of Grants Received by RCA Applicants

Section 247.17  Work Requirements of RCA Recipients

Section 247.19  Termination of RCA

Section 303.09  Out-of-State Recipient Moves into New Hampshire

Section 303.15  Medicaid-Only Residency

Section 303.17  Medicaid-Only Residency: Individuals Placed Out-of-State

Section 303.19  Medicaid-Only Residency: Institutionalized Individuals under Age 21

Section 303.21  Medicaid-Only Residency: Incompetent Individuals Age 21 or over

Section 303.23  Medicaid-Only Residency: Transient Individuals

Section 307.01  Eligibility Within Institutions

Section 307.03  Individuals In Designated Receiving Facilities

Section 307.05  Medical Assistance: Institutions for Tuberculosis or Mental/Emotional Disorder

Section 307.07  Financial Assistance: Public Institutions (New Hampshire Hospital)

Section 307.09  How to Verify

Section 307.11  Medical Assistance: Inmates

Section 309.01  SSN Eligibility and Applicant Notification Requirement

Section 309.07  Verification

Section 311.07  Assignment to DHHS of Rights to Support Income

Section 313.01  Medical Assistance Cases: Who Is Liable for Support?

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 321   INELIGIBILITY FOR FRAUDULENT RECEIPT OF MULTIPLE BENEFITS

PART 403  RESOURCE LIMITS

PART 409  COMMON TYPES OF RESOURCES: ANNUITIES

PART 409  COMMON TYPES OF RESOURCES: INACCESSIBLE RESOURCE

PART 409  COMMON TYPES OF RESOURCES: LUMP SUM PAYMENT: NONRECURRING (RESOURCES)

PART 409  COMMON TYPES OF RESOURCES: REAL PROPERTY

PART 409  COMMON TYPES OF RESOURCES: SPECIAL NEEDS TRUSTS

PART 409  COMMON TYPES OF RESOURCES: TRUSTS USING THE ASSETS OF OTHER PARTIES

PART 409 COMMON TYPES OF RESOURCES: TRUSTS USING THE ASSETS OF THE INDIVIDUAL OR SPOUSE

PART 411  LESS COMMON TYPES OF RESOURCES: MEAD PROTECTED EARNED INCOME (EI) RESOURCES

PART 411 LESS COMMON TYPES OF RESOURCES: SUSAN WALKER V. BAYER CORP ET AL, 96-C 5024 (N.D. III) PAYMENTS

PART 415  TRANSFER OF PROPERTY

Section 415.09  Penalty for Transferring Resources

PART 509  VERIFICATION

PART 511  COMMON TYPES OF INCOME: ALLOCATED INCOME

PART 511  COMMON TYPES OF INCOME: DEEMED INCOME

PART 511  COMMON TYPES OF INCOME: LUMP SUM INCOME (INCOME)

PART 511  COMMON TYPES OF INCOME: SPOUSAL SUPPORT

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

PART 511  COMMON TYPES OF INCOME: VA AID AND ATTENDANCE ALLOWANCE (VA A&A)

PART 513  LESS COMMON TYPES OF INCOME: GERMAN REPARATION PAYMENTS

PART 601  INCOME LIMITS, PAYMENT STANDARDS, AND ALLOTMENTS

PART 601, Table B FANF Basic Maintenance Payment Allowance and Maximum Payment Standard

PART 601, Table C FANF Medical Assistance Net Income Limits and Percentages of Poverty Guidelines

PART 601, Table D Children with Severe Disabilities Resource Deduction

PART 603  DEDUCTIONS AND DISREGARDS

Section 603.01  Earned Income Disregards (EID)

Section 603.03  Employment Expense Deduction (EED)

Section 603.05  Child/Dependent Care Deduction

Section 603.09  Other Allowable Deductions

Section 603.09  Other Allowable Deductions: Court Ordered Child or Spousal Support Payments

Section 603.09  Other Allowable Deductions: Garnishments

Section 603.09  Other Allowable Deductions: Medical Deduction

Section 603.11  Verification of Deductions

Section 611.01  Computing Eligibility

Section 611.03  Deeming Principles

Section 611.04  Determining Budgetary Units for Medical Assistance Programs

PART 614  COST OF CARE: (HCBC-DD/ABD/IHS)

Section 614.01  Cost of Care: HCBC-DD/ABD

Section 614.03  Cost of Care: HCBC-IHS

PART 617  IN AND OUT MEDICAL ASSISTANCE

Section 617.01  One-Month Spenddown

Section 617.03  Six-Month Spenddown

Section 617.05  Offsetting the Spenddown

PART 623  RECOUPMENT OF MEDICAL ASSISTANCE

PART 625  RECOUPMENT: LEGAL ACTION

Section 717.01  Definition of Medicare

Section 717.03  Definition of Buy-In of Medicare Part A: QMB and QDWI

Section 717.07  Medicare Part B Eligibility

Section 717.09  Definition of Buy-In of Medicare Part B

Section 717.11  Who is Eligible for Part B Buy-In?

Section 717.13  When is Part B Buy-In Effective?

Section 717.15  How Is Part B Buy-In Terminated?

PART 801  PURPOSE AND LONG-TERM GOAL

PART 803  NOTIFICATIONS AT APPLICATION

Glossary  A-words

Glossary  B-words

Glossary  L-words

Glossary  O-words

Glossary  P-words

Glossary  S-words

Glossary  T-words

Revised Medical Assistance Manual Topics

Introduction

SRs Retained

Section 101.03  Individual Responsibilities

PART 113  APPLICATION PROCESSING TIME FRAMES

PART 123  INTERVIEWS

PART 201  GENERAL INFORMATION

PART 219  PARENTS CARETAKER RELATIVE MEDICAL ASSISTANCE

Section 219.01  Verification: Parents Caretaker Relative MA

Section 219.03  Family Assistance Program (FAP)

Section 219.05  Families with Older Children (FWOC)

Section 219.07  Interim Disabled Parent (IDP)

Section 219.09  Unemployed Parent (UP)

PART 221  FORMER FOSTER CARE CHILD MEDICAL ASSISTANCE

Section 221.01  Verification: Former Foster Care Child MA

Section 221.03  Pregnant Women

Section 221.05  Severely Disabled Children

PART 223  CHILDREN’S MEDICAID AND EXPANDED CHILDREN’S MEDICAID

Section 223.01  Verification: CM and Expanded CM

PART 225  PREGNANT WOMEN MEDICAL ASSISTANCE

Section 225.03  Required Verification: Pregnant Women MA

PART 227  FAMILY PLANNING MEDICAL ASSISTANCE (FPMA)

Section 227.01  Family Planning MA Eligibility Criteria

Section 227.05  Family Planning MA Income Requirements

Section 227.09  Family Planning MA Allowable Deductions

PART 229  CHILDREN WITH SEVERE DISABILITIES (CSD)

Section 229.01  Required Verification: CSD

PART 231  HOME CARE FOR CHILDREN WITH SEVERE DISABILITIES (HC-CSD)

Section 231.01  Medical Assistance Group Composition

Section 231.03  Required Verification: HC-CSD

PART 247  ASSISTANCE GROUP

PART 259  COMPOSITION OF MAGI ASSISTANCE GROUPS

Section 259.01  Determining Tax Filing Status for MAGI

Section 259.03  Tax Filer Rules and Non-Filer Rules for MAGI

Section 259.05  Tax Dependent Exceptions for MAGI

Section 259.07  MAGI: Whose Income Counts

PART 263  REFUGEE MEDICAL ASSISTANCE (RMA)

Section 263.01  RMA Application Process

Section 263.03  Completing an Application for RMA

Section 263.05  RMA Application Processing Time Frame

Section 263.07  RMA Eligibility Criteria

Section 263.09  Who Is Not Eligible for RMA

Section 263.11  RMA Length of Eligibility

Section 263.13  Changes During the RMA Eligibility Period

Section 263.15  Treatment of Grants Received by RMA Applicants

Section 263.17  Work Requirements of RMA Recipients

Section 263.19  Termination of RMA

Section 301.13  Verification of Residency

Section 307.03  Completing an Application for an SSN

Section 307.05  Verification

Section 315.03  Application Requirements for Developing Potential Sources of Income

PART 403  WHOSE RESOURCES COUNT?

PART 407  RESOURCE LIMITS

Section 407.01  Categorically Needy Medical Assistance

PART 505  WHOSE INCOME COUNTS?

PART 509  VERIFICATION

Section 509.07  Lump Sum Income

PART 511  INCOME TYPES

PART 511  INCOME TYPES: ALLOCATED INCOME

PART 511  INCOME TYPES: CHILD SUPPORT

PART 511  INCOME TYPES: DISQUALIFIED MEMBER’S INCOME

PART 511  INCOME TYPES: DIVIDENDS AND INTEREST (INCOME)

PART 511  INCOME TYPES: EARNINGS OF CHILDREN WHO ARE STUDENTS

PART 511  INCOME TYPES: EDUCATIONAL INCOME

PART 511  INCOME TYPES: LUMP SUM UNEARNED INCOME (INCOME)

PART 511  INCOME TYPES: SELF-EMPLOYMENT

PART 511  INCOME TYPES: VA BENEFITS

PART 513  LESS COMMON INCOME TYPES: ALASKAN NATIVES

PART 513  LESS COMMON INCOME TYPES: AMERICAN INDIANS

PART 601, Table G Medically Needy Medical Assistance Net Income Limits and % of Poverty Guidelines

PART 601, Table I Parents/Caretaker Relatives Income Limit

PART 601, Table J 5% MAGI Deduction

Section 603.01  Earned Income Disregard (EID)

Section 603.05  Adult Standard Disregard

PART 605  DEDUCTIONS

PART 613  COMPUTING ELIGIBILITY

PART 617  BUDGETING: MAGI

Glossary  J-words

Glossary  N-words

Glossary  M-words

Glossary  Q-words

Glossary  T-words

Revised Adult Assistance Manual Topics

Due to the large amount of policy released in this SR, policy updates to the AAM associated with these ACA changes will be released under separate cover.

IMPLEMENTATION

Policy in this SR was implemented beginning October 1, 2013 for the federal open enrollment period, and effective January 1, 2014.

CLIENT NOTIFICATION

On October 1, 2013, the following new slider was added to the DHHS home page:

This slider was linked to the following page http://www.dhhs.nh.gov/dfa/aca.htm containing the text below:

The federal health care reform laws, the Patient Protection and Affordable Health Care Act, PPACA (PL 111-148), and the Health Care and Education Reconciliation Act (PL 111-152), are collectively referred to as the Affordable Care Act of 2010 (ACA). Some of the goals of the ACA are to:

·      Address the affordability of health insurance coverage for low-income individuals;

·      Address health insurance company policies that may be obstacles for low-income individuals obtaining health insurance; and

·      Address availability of private health insurance coverage for low-income individuals.

The ACA provides federal funding to states to expand their Medicaid programs to include non-disabled low-income individuals (income below 138% of the federal poverty line). It is up to each state to decide whether to accept these funds and participate in the expansion. New Hampshire is still in the process of making this decision, with a commission recommendation due October 15, 2013.

Whether or not the state expands Medicaid, new requirements will soon take effect under the ACA. As of January 1, 2014, most New Hampshire citizens will be required to have health coverage:

·      People already covered by Medicare, Medicaid, or most job-based health coverage will not need to buy new coverage.

·      New Hampshire citizens without health insurance coverage, who are not Medicaid eligible, will be able to:

-   Buy health insurance coverage through the New Hampshire Health Insurance Marketplace (Marketplace) operated by the federal government by going to https://www.healthcare.gov/ OR calling 1-800-318-2596 TTY: 1-855-889-4325 (a representative is available 24/7); or

-     Buy individual health insurance coverage in the private market (outside the Marketplace).

·      People using the Marketplace can apply for advance premium tax credits (APTC) and cost-sharing reductions (CSR) to help in the costs for paying for health insurance (a representative at 1-800-318-2596 will be able to assist you with this).

·      People buying coverage outside of the Marketplace will not have access to this cost assistance.

More information on the ACA is available on the Marketplace website and http://kff.org/. Beginning October 1, 2013, the Marketplace will show the health plans being offered, and provide a calculator you can use to see if you are eligible for assistance in affording coverage, based on your income. You can also enroll in coverage starting October 1, but the coverage will not take effect until January 1, 2014.

NH Citizens interested in seeing if they are eligible for health insurance coverage under the Medicaid program, can obtain information in a number of ways:

1.. Go to https://nheasy.nh.gov, to complete an application online;

2. Print out an Application for Health Coverage & Help Paying Costs (DFA Form 800MA), complete it, and mail or fax it to the address on the application.

3. Contact your local District Office to have an Application for Health Coverage & Help Paying Costs (DFA Form 800MA) mailed to you. To find the District Office that serves your area, please see Catchment Areas.

4. Call us at 1-800-852-3345 extension 9700 to apply over the phone.

If you have questions about private health insurance coverage, whether sold on the Marketplace or outside the Marketplace, you can also contact the New Hampshire Insurance Department:

http://www.nh.gov/insurance/

or call (603) 271-2261 or 1-800-852-3416 (Consumer Hotline)

Although the slider was removed in January 2014, the web page text, with some tweaks to change information to the present tense now that health care reform is in effect, is still available to the public.

Recipients of medical assistance have also been sent (and will continue to be sent) new DFA Form TAX INFO(T) at paper redeterminations. See SR 14-09, dated January 2014, for more information about that new form.

The following text was also added to the New HEIGHTS-generated CS0005, Mail-In Application for Redetermination, and the New HEIGHTS-generated CS0028, Online to Paper Rede Letter:

Important Information for People Who Get Medical Assistance

To continue to get medical assistance, you must tell us federal tax filing information for you and each member of your household who gets medical assistance. You may do this by filling out the colored piece of paper that came with your Redetermination Application. Send that form along with your other redetermination information in the envelope with this letter. If you do not do this by the date above, your medical assistance may end.

Finally, from December 1, 2013 and through December 31, 2014, the following text will be posted in the Useful Information section of all recipients’ NH EASY home page:

If you have not already told us this information, at your next redetermination you will need to tell us federal tax filing information for you and each member of your household who gets medical assistance.

No other client notification is planned.

TRAINING

Trainings occurred in all District Offices beginning September 18, 2013.

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 February 3, 2014 Additionally, this SR, and printed pages with posting instructions, will be distributed under separate cover to all internal hard copy holders of the Family Assistance and Medical Assistance Manuals.

DFA/JBV:s