SR 14-21 Dated 07/14

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases the annual July updates to the following spousal impoverishment figures used to determine the amount of income institutionalized individuals may give to their community spouses:

�      the maximum income standard (MIS); and

�      the excess shelter deduction (ESD).

DFA Forms 799, Spousal Income Protection, and 799A, Income Computation Worksheet for Allocation of Income for Institutionalized Individuals, and the associated New Heights-generated Form AE0017, have been updated accordingly.

POLICY

In accordance with the spousal impoverishment provisions of Section 1924(d)(2)-(4) of the Social Security Act, the maximum income standard (MIS) and excess shelter deduction (ESD) figures used to determine the amount of income an institutionalized individual may give to a community spouse must be updated annually to reflect the federal poverty income guidelines. Based upon the income guidelines published in the Federal Register dated January 22, 2014:

�      the MIS has increased from $1,939 to $1,967 per month; and

�      the ESD has increased from $582 to $591 per month.

NEW HEIGHTS SYSTEMS PROCEDURES AND IMPLEMENTATION

Effective July 1, 2014, New HEIGHTS will modify the allocation of income functions for community spouses of institutionalized individuals and dependents who live with community spouses of institutionalized individuals so that the maximum income standard and excess shelter deduction reflect the 2014 amounts.

DESCRIPTION OF REVISIONS MADE TO FORMS

Electronic DFA Forms 799, Spousal Income Protection, and 799A, Income Computation Worksheet for Allocation of Income for Institutionalized Individuals, and the associated New Heights-generated Form AE0017, have been revised to include the maximum income standard and the excess shelter deduction increases. Copies of DFA Forms 799 and 799A are attached to this SR for reference.

With new spousal applications July 1, 2014 or later, use the updated forms which replace DFA Forms 799 and 799A released by SR 14-01/January 2014. However, prior to detaching the new versions, rename and retain the January 2014 electronic versions of DFA Forms 799 and 799A, in case rollbacks are required.

The new versions of DFA Forms 799 and 799A will be electronically transmitted to each District Office with the electronic release of this SR. Contact Linda White, DFA State Office, at 271-9474 with any questions related to transferring the electronic versions of these forms to your PC.

Since there are no changes associated with the use of these forms, their instructions did not require revisions and will not be re-released with this SR.

POLICY MANUAL REVISIONS

Revised Adult Assistance Manual Topics

Section 627.03  Allocation to a Community Spouse

Section 627.05  Allocation to Dependents Who Reside with the Community Spouse

Revised Medical Assistance Manual Topics

Section 627.03  Allocation to a Community Spouse

Section 627.05  Allocation to Dependents Who Reside with the Community Spouse

IMPLEMENTATION

The new figures are effective July 1, 2014. New HEIGHTS will update all reference tables and use the new amounts for any cases computed or recomputed on or after that date. When determining how much income can be allocated to the community spouse for months before July 2014, the January 2014 figures and versions of Forms 799 and 799A must be used.

CLIENT NOTIFICATION

In early July, DFA State Office will generate a mailing to all institutionalized individuals with community spouses and their community spouses to inform these individuals of the spousal-related increases. A copy of this July 2014 Spousal Letter is attached to this SR for reference.

TRAINING

No special training is planned due to the procedural nature of the changes.

FORMS MANUAL POSTING INSTRUCTIONS

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 June 23, 2014. 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 and Medical Assistance Manuals.

DFA/JDH:s