SR 14-28 Dated 08/14

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases two new categories of medical assistance, the New Hampshire Health Protection Program (NHHPP) and the New Hampshire Health Protection Program - Medically Frail (NHHPP-M), which use modified adjusted gross income (MAGI) in the eligibility determination process. The purpose of these programs is to offer medical assistance to low-income NH residents who are US citizens or qualified aliens, and who meet the following eligibility requirements:

�      the applicant must be at least age 19 but no older than age 64;

�      net income must be less than or equal to 133% of the federal poverty guidelines;

�      if female, she must not be pregnant at the time of application; and

�      the applicant cannot:

-     be a parent or caretaker relative living with a child under age 19 unless the child receives Medicaid or has health insurance;

-     otherwise qualify for or be enrolled in a mandatory Medicaid coverage group; or

-     otherwise be entitled to or enrolled in Medicare Part A or Part B benefits.

Note: If the individual has applied for another non-MAGI category of Medicaid but has not yet been determined eligible for that program, the individual may receive NHHPP/NHHPP-M, if eligible, while the eligibility determination is pending for this other non-MAGI category of assistance. Once the individual opens for the other category of Medicaid, however, NHHPP/NHHPP-M ends.

�      As with all MAGI categories of medical assistance, there is no resource test and 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.

Additional NHHPP/NHHPP-M program eligibility criteria:

�      Individuals who have access to employer sponsored insurance (ESI), either directly as an employee or indirectly through another individual, are required to participate in the NH Health Insurance Premium Program (NH HIPP), if it is determined to be cost-effective by NH HIPP. Individuals who do not have access to ESI or if NH HIPP determines ESI is not cost-effective, must enroll in the Bridge program with coverage provided under Medicaid Care Management.

�      Termination of NHHPP/NHHPP-M for the individual results when the applicant or recipient:

-     fails or refuses without good cause to provide within 30 days of NH HIPP's request:

1.    the information necessary to determine the availability and cost-effectiveness of enrolling in ESI, if the individual has access to it either directly as an employee or indirectly through another individual who is eligible for it; or

2.    the good cause reason for not providing the information;

-     fails or refuses to:

1.    enroll in ESI within 15 days of NH HIPP's notification to the client that ESI is cost-effective; or

2.    provide verification of enrollment in ESI;

-     disenrolls from ESI after NH HIPP has determined that ESI is cost-effective; or

-     fails or refuses to enroll in the Marketplace Premium Assistance Program (PAP), once it becomes available in 2016.

Exception: Medical assistance will not be terminated for a child or a spouse who cannot enroll in ESI due to the household member with access to ESI failing to cooperate with NH HIPP program requirements.

�      Unemployed individuals who qualify under the Bridge program are referred to NH Employment Security (NHES) to receive help in finding employment and to file for unemployment benefits, if eligible.

�      Individuals are eligible for NHHPP/NHHPP-M for up to 12 months, at which point the individual must participate in a redetermination of eligibility either online or by completing a paper reapplication. As with all MAGI categories of MA, no interviews are required for either initial or ongoing eligibility.

�      NHHPP/NHHPP-M applicants are entitled to retroactive medical assistance, if eligible, but only back to August 15, 2014, the start date of the programs. Retroactive medical assistance is not available for NHHPP/NHHPP-M prior to August 15, 2014. For example, if a NHHPP/NHHPP-M applicant applies on August 31, 2014, retroactive medical assistance is available back to August 15, 2014 only, if eligible.

�      In and Out medical assistance is not offered for NHHPP/NHHPP-M. If an individual is determined ineligible for NHHPP/NHHPP-M due to being over income, he or she will be referred to the Health Insurance Marketplace (formally known as the Federally Facilitated Marketplace or FFM) for a determination of eligibility for the cost-affordability plans offered there. If, however, the individual is categorically eligible as medically-needy for any other In and Out medical assistance offered in NH, the individual may choose to be covered under that other In and Out medical assistance category.

�      Qualified hospitals (QHs) and qualified entities (QEs) who have been trained by DHHS may make presumptive eligibility decisions for NHHPP/NHHPP-M on or after August 15, 2014.

�      All NHHPP/NHHPP-M recipients will receive coverage under the Alternative Benefit Plan (ABP).

�      Applicants or recipients who answer yes to the following question on his or her application for medical assistance are considered medically frail, as defined in 42 CFR 440.315(f): Do you have a physical, mental, or emotional health condition that causes limitations in activities (like bathing, dressing, daily chores, etc) or live in a medical facility or nursing home?

-     All recipients designated as medically frail (NHHPP-M) may choose between two health plans: the ABP or NH's standard Medicaid plan.

-     Both plans offer very similar coverage with the following differences:

1.    the ABP does not offer access to long-term care (LTC) services unless the individual is receiving non-Medicare skilled nursing facility (SNF) services, whereas NH's standard Medicaid plan does offer these LTC services. This means that if the recipient designated as NHHPP or NHHPP-M requires non-SNF LTC services, he or she can only get these services through NH's standard Medicaid plan as long as he or she meets LTC level of care; and

2.    NH's standard Medicaid Plan does not offer a substance use disorder benefit or chiropractic services, whereas the ABP does offer a substance use disorder benefit and chiropractic services. The ABP does not limit the number of visits for some services. This means that if the recipient designated as NHHPP or NHHPP-M requires help to stop using drugs or alcohol or needs chiropractic services, he or she can only get these services under the ABP.

Due to feedback from the Centers for Medicare and Medicaid Services (CMS), this SR also releases the following unrelated policy changes:

�      Formerly children had to be under the age of 20 to be eligible for Children's Medicaid (CM), including Children with Severe Disabilities (CSD). Now, per feedback from CMS, children must be under the age of 19 to meet the age requirement for CM and CSD medical assistance;

�      Formerly one of the eligibility requirements for Parent/Caretaker Relative medical assistance (MA) was that an individual had to be a parent or caretaker relative of a dependent child, which was defined as a child under the age or 18 or under age 21 and a full time student in secondary school (or equivalent vocational or technical training). Now, per feedback from CMS, a dependent child for Parent/Caretaker Relative MA is defined as a child under the age of 18, or under age 19 and a full time student in secondary school (or equivalent vocational or technical training); and

�      Formerly when assessing how tax dependent exceptions were applied when determining MAGI household composition, the child had to be under the age of 20 to use the non-filer rules. Now, per feedback from CMS, the age of the child for these exceptions has changed. If the individual is a child under the age of 19, or under age 21 and a full time student in secondary school (or equivalent vocational or technical training), the age requirements for the tax dependent exceptions have been met.

BACKGROUND

The Affordable Care Act (ACA) and implementing regulations at 42 CFR 435.119, mandated Medicaid-funded health coverage for a new adult group of non-disabled, non-pregnant individuals who were between the ages of 19-64, and who were not entitled to or enrolled in Medicaid or Medicare Part A or B, with income less than or equal to 133% of the FPL. However, due to a US Supreme Court decision that removed the authority to mandate coverage of this group, states were allowed to voluntarily elect to cover this group. NH recently opted to temporarily cover this group as described in this SR and as authorized by Senate Bill 413 (SB413), 2014 session, which amended RSA 126-A:5 by adding new paragraphs XXIII-XXVI, and promulgation of administrative rules at He-W 841.08 and He-W 511-512. When authorizing coverage for this new group through SB413, the fiscal note for the senate bill assumed 50,000 NH citizens would become eligible for coverage, with approximately 15,000 of those individuals mandatory for the NH Health Insurance Premium Payment (NH HIPP) program.

From July 1, 2014 to August 14, 2014, an open enrollment period is being provided to NH citizens to apply for NHHPP/NHHPP-M with coverage to begin August 15, 2014, and enrollment in NH Medicaid Care Management, as appropriate, to be effective September 1, 2014.

Item 9 of Senate Bill 413 also mentioned the suspension of the Breast and Cervical Cancer Program (BCCP). However, changes to the BCCP require approval from CMS. If any subsequent changes are made to this program, they will be released under separate cover at a later date. As of this time, there are no changes to the BCCP, and it continues to operate under current policy.

POLICY

The New Hampshire Health Protection Program (NHHPP) and the New Hampshire Health Protection Program - Medically Frail (NHHPP-M)

The New Hampshire Health Protection Program (NHHPP) and the New Hampshire Health Protection Program - Medically Frail (NHHPP-M) offer medical assistance to low-income NH residents who are US citizens or qualified aliens. The purpose of NHHPP/NHHPP-M is to:

�      provide health insurance coverage to more of NH's low-income citizens;

�      provide access to private health insurance options;

�      improve population health;

�      increase provider reimbursement; and

�      reduce uncompensated care costs.

All general, categorical, technical, and financial factors related to the modified adjusted gross income (MAGI) categories of medical assistance apply to NHHPP/NHHPP-M. To be eligible for NHHPP/NHHPP-M:

�      the applicant must be at least age 19 but no older than age 64. Note: Although there could be overlap of this age group and the age group of other categories of categorically-needy medical assistance, such as Parent/Caretaker Relative MA or Foster Care Child MA, eligibility for NHHPP/NHHPP-M is explored only if the individual is not eligible for the other categories of medical assistance, excluding In and Out medical assistance and Family Planning Expansion Category (FPEC) medical assistance;

�      net income must be less than or equal to 133% of the FPL. Apply the 5% MAGI-specific income deduction for those individuals who otherwise meet the NHHPP/NHHPP-M program requirements but fail the 133% income limit test, per current policy for all categories of MAGI medical assistance. The NHHPP/NHHPP-M income limits will be updated every March when the income limits for the other medical assistance programs based upon the FPL are also updated. The monthly NHHPP/NHHPP-M income limits as of this date are as follows:

�      if female, she must not be pregnant at the time of application;

�      the applicant cannot be a parent or caretaker relative living with a child under age 19 unless the child receives Medicaid or has health insurance, cannot otherwise qualify for or be enrolled in a mandatory Medicaid coverage group, and cannot be entitled to or enrolled in Medicare Part A or Part B benefits. Note:

-     If the individual has applied for another non-MAGI category of Medicaid, such as APTD MA, but has not yet been determined eligible for that program, the individual may receive NHHPP/NHHPP-M, if eligible, while the eligibility determination is pending for this other non-MAGI category of assistance. Once the individual opens for the other category of Medicaid, however, NHHPP/NHHPP-M ends; and

-     Although an individual cannot be pregnant at the time of application for NHHPP/NHHPP-M, if an NHHPP/NHHPP-M recipient becomes pregnant, the woman continues to receive NHHPP/NHHPP-M and will not be transitioned to Pregnant Women Medical Assistance.

�      As with all MAGI categories of medical assistance, there is no resource test and 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.

Additional NHHPP/NHHPP-M program eligibility criteria:

�      Individuals eligible for NHHPP/NHHPP-M will be enrolled in either:

-     the NH Health Insurance Premium Program (NH HIPP). Under NH HIPP, individuals who have access to employer sponsored insurance (ESI) must enroll in ESI or maintain EIS coverage if NH HIPP determines ESI to be cost-effective. If determined to be cost-effective, the employer deducts the employee's share of the insurance premium from the employee's paycheck, and NH HIPP pays the employee's share of the premium to the employee. Co-pays and deductibles are paid to the individual only if the individual paid those expenses out-of-pocket, otherwise NH HIPP will reimburse the provider; or

-     the Bridge Program. Individuals who do not have access to ESI through an employer, or for whom ESI is not determined cost-effective will be enrolled in the Bridge Program. Under the Bridge Program, the household chooses one of the Health Plans offered under NH Medicaid Care Management (MCM). The Health Plan covers the 10 essential health benefits required under the ACA, and the Bridge Program provides additional "wrap" benefits, such as coverage for non-emergency medical transportation and early periodic screening diagnostic and treatment (EPSDT) for ages birth to 21.

�      If the NHHPP/NHHPP-M applicant or recipient has access to ESI either directly, as an employee, or indirectly, through another individual who is eligible for it, and NH HIPP determines it is cost-effective for the applicant or recipient and his or her spouse and dependents to enroll in ESI, the NHHPP/NHHPP-M applicant and recipient, and his or her spouse and dependents, are required to enroll in the ESI. These households are then automatically enrolled in NH HIPP, which pays for the employee's share of any costs associated with the enrollment in ESI. Termination of NHHPP/NHHPP-M for the individual results when the NHHPP/NHHPP-M applicant or recipient:

-     fails or refuses without good cause to provide within 30 days of NH HIPP's request:

1.    the information necessary to determine the availability and cost-effectiveness of enrolling in ESI, if the individual has access to it either directly as an employee or indirectly through another individual who is eligible for it; or

2.    the good cause reason for not providing the information;

-     fails or refuses to:

1.    enroll in ESI within 15 days of NH HIPP's notification to the client that ESI is cost-effective; or

2.    provide verification of enrollment in ESI;

-     disenrolls from ESI after NH HIPP has determined that ESI is cost-effective; or

-   fails or refuses to enroll in the Premium Assistance Program (PAP), once it becomes available in 2016 following the sunset of the Bridge Program on December 31, 2015. Under PAP, individuals will still receive NHHPP/NHHPP-M, and DHHS will continue to cover the costs of NHHPP/NHHPP-M coverage, but NHHPP/NHHPP-M coverage will be provided by the health insurance plans that qualify to be on the Health Insurance Marketplace (formally known as the Federally Facilitated Marketplace or FFM). See DFA SR 14-04 or visit www.healthcare.gov for more information about the Health Insurance Marketplace.

Exception: Medical assistance will not be terminated for a child or a spouse who cannot enroll in ESI due to the household member with access to ESI failing to cooperate with NH HIPP program requirements.

�      NH HIPP determines if enrollment in ESI is more cost-effective for NH when compared to enrollment in NH Medicaid Care Management (MCM). Although District Office workers will not be involved in the ESI process, the following information has been provided for reference:

-     The NHHPP/NHHPP-M recipient is required to tell DHHS if he or she has access to ESI at the time of application and at any other such time as coverage becomes available. Questions about access to other health insurance is already a part of the application and redetermination process and the federal application for medical assistance, via DFA Form 800MA or DFA Form 800 Insert as well as in NH EASY. However, NH HIPP will be sending a separate NH HIPP application to referred individuals.

-     Cost-effectiveness will be evaluated at application, redetermination, whenever a change in employment status occurs in which the individual's or the household member's access to ESI is impacted, and whenever an employer changes the ESI or ESI components to which the individual or household member has access. Collection of information needed about ESI and cost-effectiveness of ESI is the responsibility of NH HIPP, whereas reporting changes in employment or ESI status is the responsibility of the NHHPP/NHHPP-M recipient. Any information needed by the District Office workers regarding eligibility for NHHPP/NHHPP-M because of the recipient's failure or refusal to comply with NH HIPP requirements without good cause will be passed to the worker from NH HIPP via New HEIGHTS.

-     It is expected that the majority of NHHPP/NHHPP-M recipients will not have access to ESI. Of the expected small group of people who do have access to ESI, it is also assumed that ESI will not be determined to be cost-effective compared to enrollment in NH Medicaid. As such, it is expected that most people determined eligible for NHHPP/NHHPP-M will be enrolled in NH Medicaid.

�      As is current policy with every category of assistance, NHHPP/NHHPP-M recipients must report all changes in circumstances which affect eligibility, or, if enrolled in NH HIPP, any changes that impact NH HIPP eligibility such as, but not limited to, changes in health insurance coverage, within 10 days of the date the change occurs.

�      Unemployed NHHPP/NHHPP-M applicants and recipients are referred to NH Employment Security (NHES) to receive help in obtaining employment and to file for unemployment benefits, if eligible. In addition to text being added to the Statements of Understanding page of the paper application and the eligibility interview summary (EIS) in New HEIGHTS, the following special text message will be populated on the "open" notice of determination (NOD) generated to each individual determined eligible for NHHPP:

Are you unemployed? If so, you have been referred to NH Employment Security (NHES). You must contact them to file for unemployment benefits, if eligible, and to get help in finding a job. Go to http://www.nhes.nh.gov/locations/index.htm for information about NHES office locations. RSA 126-A:5,XXVI

�      Individuals are eligible for NHHPP/NHHPP-M for up to 12 months, at which point the individual must participate in a redetermination of eligibility either online or by completing a paper reapplication. As with all MAGI categories of MA, no interviews are required at application or redetermination.

�      NHHPP/NHHPP-M applicants are entitled to retroactive medical assistance, if eligible, but only back to August 15, 2014, the start date of the programs. Retroactive medical assistance is not available for NHHPP/NHHPP-M prior to August 15, 2014. For example, if a NHHPP/NHHPP-M applicant applies on August 31, 2014, retroactive medical assistance is available back to August 15, 2014 only, if eligible.

�      In and Out medical assistance is not provided for NHHPP/NHHPP-M. If an individual is determined ineligible for NHHPP/NHHPP-M due to being over income, he or she will be referred to the Health Insurance Marketplace (formally known as the Federally Facilitated Marketplace or FFM) for a determination of eligibility for the cost-affordability plans offered there. If, however, the individual is categorically eligible as medically-needy for any other In and Out medical assistance offered in NH, the individual may choose to be covered under that other In and Out medical assistance category.

�      Qualified Hospitals (QHs) and Qualified Entities (QEs) who have been trained by DHHS may make presumptive eligibility (PE) decisions for NHHPP/NHHPP-M on or after August 15, 2014. QHs/QEs can help people apply for NHHPP/NHHPP-M during the open enrollment period, but cannot make PE determinations before the start date of the program.

�      All NHHPP/NHHPP-M recipients will be automatically placed in the Alternative Benefit Plan (ABP).

�      applicants who answer yes to the following question on his or her application for medical assistance are considered medically frail, as defined in 42 CFR 440.315(f): Do you have a physical, mental, or emotional health condition that causes limitations in activities (like bathing, dressing, daily chores, etc) or live in a medical facility or nursing home?

-     Recipients designated as medically frail may choose between two benefit plans: the ABP or NH's standard Medicaid plan.

-     Both benefit plans offer very similar coverage with the following differences:

1.    the ABP does not offer access to long-term care (LTC) services unless the individual is receiving non-Medicare skilled nursing facility (SNF) services, whereas NH's standard Medicaid plan does offer these LTC services. This means that if non-SNF LTC services are required, he or she can only get these services by choosing the standard Medicaid benefit plan, as long as he or she meets LTC level of care; and

2.    NH's standard Medicaid Plan does not offer a substance use disorder benefit or chiropractic services, whereas the ABP does offer a substance use disorder benefit and chiropractic services. The ABP does not limit the number of visits for some services. This means that if the recipient requires help to stop using drugs or alcohol or needs chiropractic services, he or she can only get these services under the ABP.

-     A "medically frail" determination will occur at application, redetermination, or whenever a change in medical health occurs and the individual requests a new determination because of the change.

-     Individuals designated as "medically frail" have the right to switch back and forth from the ABP to the standard Medicaid plan at any time. Medically Frail NHHPP recipients are never "locked in" to their benefit plan. The effective date of any change in plan made during District Office business hours is the next calendar day. Any change in plan made during non-business hours is effective the next business day following the date the information is entered or uploaded into New HEIGHTS. If, for example, an NHHPP-M recipient changes plans on Friday at 11 PM, the information will be uploaded into New HEIGHTS on Monday, and the change in plan will be effective Tuesday.

�      All NHHPP/NHHPP-M recipients who are referred to NH HIPP will receive Fee for Service Medicaid until such time as the NH HIPP cost-effectiveness is determined. If determined not cost-effective, recipients will receive the NH Medicaid Care Management (MCM) Health Plan Selection package. Those NHHPP/NHHPP-M recipients who provide ESI information after being enrolled in an MCM Health Plan, will remain enrolled in the MCM Health Plan until such time as the NH HIPP assessment and enrollment process is complete.

UNRELATED POLICY CHANGE

Due to feedback from the Centers for Medicare and Medicaid Services (CMS), this SR also releases unrelated policy changes to the following:

�      the eligibility determination process for Children's Medicaid (CM), including Children with Severe Disabilities (CSD). Formerly children had to be under the age of 20 to be eligible for this program. Now, per feedback from CMS, children must be under the age of 19 to meet the age requirement for these categories of medical assistance;

�      the eligibility determination process for Parent/Caretaker Relative medical assistance (MA). Formerly one of the eligibility requirements for this program was that an individual had to be a parent or caretaker relative of a dependent child which was defined as a child under the age or 18 or under age 21 and a full time student in secondary school (or equivalent vocational or technical training). Now, per feedback from CMS, a dependent child for Parent/Caretaker Relative MA is defined as a child under the age of 18 or under age 19 and a full time student in secondary school (or equivalent vocational or technical training); and

�      how tax dependent exceptions are applied when determining MAGI household composition for tax dependents. Formerly, if the individual was a child under the age of 20, living with both parents, and expected to be claimed as a tax dependent by one parent but the parents did not expect to file a joint tax return, or the individual was a child under the age of 20 who expected to be claimed by a non-custodial parent, a tax dependent exception existed and the tax dependent's household composition was determined using the non-filer rules. These exceptions still exist, but the age of the child for both exceptions has changed. Now if the individual is a child under the age of 19 or under age 21 and a full time student in secondary school (or equivalent vocational or technical training), the age requirements for the tax dependent exceptions have been met.

NEW HEIGHTS & NH EASY SYSTEMS PROCEDURES AND IMPLEMENTATION

Effective June 28, 2014, the NHHPP/NHHPP-M eligibility determination process will be available in NH EASY and the system has been programmed to obtain all information needed to determine NHHPP/NHHPP-M eligibility for the open enrollment period:

�      applicants and recipients of the new programs will be identified as follows:

-     NH Health Protection Program: NHHPP, coded as MGIA

-     Medically Frail NH Health Protection Program: NHHPP-M, coded as MGIM

-     Emergency Non-citizen NH Health Protection Program: A-NHHPP, coded as MGI5.

�      The first paragraph of the following text will display on every NHHPP/NHHPP-M "open" Notice of Decision (NOD). The subsequent two paragraphs will display depending upon the circumstances for the individuals in the household:

Important Information: NH Health Protection Program

Per RSA 126-A:5,XXIII(c)(3), and RSA 126-A:5,XXIV(c)(3), the Health Insurance Premium Payment Program and the Voluntary Bridge to Marketplace program are subject to cancellation upon notice.

This next paragraph will only display on the NOD if an NHHPP/NHHPP-M individual has self-attested that they have third party medical insurance coverage or employer sponsored insurance:

Important Information: NH Health Insurance Premium Payment Program

You have told us that [variable name 1, name 2] has access to insurance coverage through an employer. You are being referred to the NH Health Insurance Premium Payment (HIPP) program. This means that you must cooperate with the HIPP program. The HIPP program will figure out if it is cost-effective for you to get employer sponsored insurance (ESI). HIPP will contact you for certain information to make this determination. You must respond to those letters when you get them. If approved for the HIPP program, and you are not already enrolled in ESI, you must enroll in ESI by the deadlines HIPP gives you. HIPP will then help pay for your ESI. If you don't cooperate and enroll in ESI by the deadlines, your NHHPP coverage will end. If HIPP tells you that ESI is not cost-effective, you will get a Medicaid Care Management enrollment letter in the mail.

This next paragraph will display on the NOD for any NHHPP/NHHPP-M individual in the case for which the previous paragraph does not apply:

Important Information: NH Health Insurance Premium Payment Program

To be eligible for NHHPP, [variable name 1, name 2] must get insurance coverage through an employer if they have access to it and if the employer sponsored insurance (ESI) is determined to be cost-effective. The above is being referred to the NH Health Insurance Premium Payment (HIPP) program. This means that they must cooperate with the HIPP program. The HIPP program will contact the above if HIPP finds any of the above may have access to ESI. HIPP will contact them for more information to figure out if ESI is cost-effective. You must respond to HIPP if they contact you so that your NHHPP coverage does not end.

�      The following statement was added to the NH EASY Statements of Understanding page, and to the Eligibility Interview Summary (EIS) in New HEIGHTS: I understand that my receipt of medical assistance under the NH Health Protection Program requires me to contact NH Employment Security for the purpose of finding employment if I am unemployed. Note: this information will be added to the DFA Form 811S, Statements of Understanding, at the next printing of the form.

�      The following has been implemented related to the medically frail policy:

-     the following question was added to NH EASY to identify medically frail NHHPP applicants: Does this person have a physical, mental, or emotional health condition that causes limitations in activities (like bathing, dressing, daily chores, etc.) or live in a medical facility or nursing home?

-     the following question was added to the Non-Financial Case Characteristic Screen and to NH EASY: "Is anyone in the household medically Frail?"

-     a new Medically Frail Screen under Non-Financial and in NH EASY has been created to indicate if the individual is Medically Frail.

-     a new Benefit Plan Screen under Non-Financial and in NH EASY has been created to indicate the Medically Frail's choice of Plan and to view the history of plan choices.

-     two new medically frail notices have been developed to be generated out of New HEIGHTS. The first, the AE0125, will be generated upon an answer of "yes" to the medically frail question above and is attached to this SR for reference. The second, still in development, will be generated each time an NHHPP-M recipient switches plans. Final versions of both letters will be released under separate cover at a later date by New HEIGHTS.

�      If an individual has an APTD approval, New HEIGHTS will automatically consider that person to be medically frail (NHHPP-M), provided the individual is over income or over resources for APTD.

�      The cascade in New HEIGHTS has been revised so that if an individual is currently APTD In and Out, New HEIGHTS will cascade first to the NHHPP-M, NHHPP medically frail category, to determine whether the individual is income eligible for NHHPP. If the person is not eligible for NHHPP because the individual is over income, New HEIGHTS will cascade back to APTD In and Out medical assistance, otherwise the individual will open for NHHPP-M.

�      All the regular notices generated upon opening or closing for a Medicaid program have been updated to include NHHPP/NHHPP-M.

For further information, see the New HEIGHTS System Alert dated 6/27/14.

DESCRIPTION OF REVISIONS MADE TO FORMS

Any changes to DFA Forms will be released under separate cover at a later date.

POLICY MANUAL REVISIONS

Revised Medical Assistance Manual Topics

Introduction

PART 219  PARENTS CARETAKER RELATIVE MEDICAL ASSISTANCE

PART 223  CHILDREN'S MEDICAID AND EXPANDED CHILDREN'S MEDICAID

PART 229  CHILDREN WITH SEVERE DISABILITIES (CSD)

Section 229.05  CSD Children Turning 18 Years Old

PART 230  NEW HAMPSHIRE HEALTH PROTECTION PROGRAM (NHHPP/NHHPP-M)

Section 230.01  NHHPP/NHHPP-M Eligibility Criteria

Section 230.03  NHHPP - Medically Frail (NHHPP-M)

Section 230.05  NHHPP/NHHPP-M: Referral to NH Employment Security (NHES)

Section 230.07 NHHPP/NHHPP-M: Employer Sponsored Insurance (ESI) and the NH Health Insurance Premium Payment (NH HIPP) Program

Section 230.09 NHHPP/NHHPP-M: Marketplace Premium Assistance Program (PAP) and the Bridge Program

Section 230.11  NHHPP/NHHPP-M: Coverage Under the Alternative Benefit Plan (ABP)

Section 230.13  Verification: NHHPP/NHHPP-M

Section 230.15  Termination of NHHPP/NHHPP-M

Section 259.05  Tax Dependent Exceptions for MAGI

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

IMPLEMENTATION

The new categories of medical assistance described in this SR are effective August 15, 2014. However, from July 1, 2014 to August 14, 2014, an open enrollment period is being provided for NH citizens to apply for NHHPP/NHHPP-M with coverage to begin August 15, 2014 and enrollment in NH Medicaid Care Management, as appropriate, effective September 1, 2014.

CLIENT NOTIFICATION

Beginning June 28, 2014 in NH EASY, DHHS will begin accepting applications for NHHPP with coverage to begin August 15, 2014. Prior to the open enrollment period, the following outreach about the program occurred:

On April 17, 2014, the following new slider was added to the DHHS home page:

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

New Hampshire Health Protection Program

The New Hampshire Health Protection Program (NHHPP) is a new program that provides health care coverage to low-income people in New Hampshire. The NHHPP will be offered to people ages 19 to 65 whose income level is between 0 and 133% of Federal Poverty Level - equivalent to one person's monthly income of $1,294. Please refer to the chart below to see if you and your family may be eligible.

This year the following plans will be offered under the NHHPP, the NH Health Insurance Premium Payment (NH HIPP) Program, and the Voluntary Bridge to the Marketplace Program:

�      If you or someone in your family has access to health insurance through an employer, the NH HIPP Program will check to see if you are eligible for the NHHPP where the program will pay the employee's share of the insurance costs.

�      For people who are not eligible for the NH HIPP Program the Voluntary Bridge to the Marketplace Program will provide coverage through the State's Alternative Benefit Plan, now through New Hampshire's Medicaid Care Management (MCM) Program.

Coming in 2016, the Premium Assistance Program (PAP) will begin. Participants who qualify will move from the Bridge Program to the Health Insurance Marketplace. The State will continue to cover the costs of the insurance however coverage will be provided by health insurance plans that qualify to be on the Marketplace.

Please continue to check this website in the coming weeks for updates about coverage and when enrollment will begin.

If you are interested in knowing if you qualify at this time for any other Department of Health and Human Service assistance program, you can go to an online calculator (Do I Qualify?) at nheasy.nh.gov.

Governor Maggie Hassan issued press releases on the program on the following dates:

�   April 28, 2014. Text of that press release can be found at http://www.governor.nh.gov/media/news/2014/pr-2014-04-28-health-protection.htm.

�   June 16, 2014. Text of that press release can be found at http://www.governor.nh.gov/media/news/2014/pr-2014-06-16-nh-health-protection.htm.

The first paragraph of the following text will display on every NHHPP/NHHPP-M "open" NOD. The subsequent two paragraphs will display depending upon the circumstances for the individuals in the household:

Important Information: NH Health Protection Program

Per RSA 126-A:5,XXIII(c)(3), and RSA 126-A:5,XXIV(c)(3), the Health Insurance Premium Payment Program and the Voluntary Bridge to Marketplace program are subject to cancellation upon notice.

This next paragraph will only display on the NOD if an NHHPP/NHHPP-M individual has self-attested that they have third party medical insurance coverage or employer sponsored insurance:

Important Information: NH Health Insurance Premium Payment Program

You have told us that [variable name 1, name 2] has access to insurance coverage through an employer. You are being referred to the NH Health Insurance Premium Payment (HIPP) program. This means that you must cooperate with the HIPP program. The HIPP program will figure out if it is cost-effective for you to get employer sponsored insurance (ESI). HIPP will contact you for certain information to make this determination. You must respond to those letters when you get them. If approved for the HIPP program, and you are not already enrolled in ESI, you must enroll in ESI by the deadlines HIPP gives you. HIPP will then help pay for your ESI. If you don't cooperate and enroll in ESI by the deadlines, your NHHPP coverage will end. If HIPP tells you that ESI is not cost-effective, you will get a Medicaid Care Management enrollment letter in the mail.

This next paragraph will display on the NOD for any NHHPP/NHHPP-M individual in the case for which the previous paragraph does not apply:

Important Information: NH Health Insurance Premium Payment Program

To be eligible for NHHPP, [variable name 1, name 2] must get insurance coverage through an employer if they have access to it and if the employer sponsored insurance (ESI) is determined to be cost-effective. The above is being referred to the NH Health Insurance Premium Payment (HIPP) program. This means that they must cooperate with the HIPP program. The HIPP program will contact the above if HIPP finds any of the above may have access to ESI. HIPP will contact them for more information to figure out if ESI is cost-effective. You must respond to HIPP if they contact you so that your NHHPP coverage does not end.

Twelve public outreach meetings were held around the state to provide education about NHHPP, as outlined in the table below. The meetings targeted nonprofit and civic organization staff members: Affordable Care Act (ACA) Navigators, Certified Application Counselors (CACs) and MPAs, providers and other stakeholders. Content, however, was also appropriate for potential program beneficiaries.

Administrative rules have been promulgated for He-W 841.08. At release, however, these rules have not yet been reviewed by the Joint Health Care Reform Oversight (JHRCO) Committee, as required by RSA 161:11, because there have been some delays in forming this committee. Once this committee has reviewed and commented upon the rules, the rules will then need to be reviewed by the Medical Care Advisory Committee (MCAC), to carry out the provisions at 42 CFR 431.12. As such, it is unclear when a public hearing on the proposed rules may be held, but at this point it will be scheduled no earlier than early autumn 2104.

No other client notification is planned.

TRAINING

All stakeholders were invited to an NHHPP eligibility an application training on Wednesday May 28, 2014 from 10 -12. The training was offered via webinar as well.

Staff informational sessions were held on Friday May 30th, 9-11 AM and 1-3 PM in the Brown Auditorium. Additional District Office staff trainings were provided on Wednesday, June 25 through Friday, June 27, 2014.

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 July 28, 2014. Additionally, this SR, and printed pages with posting instructions, will be distributed under separate cover to all internal hard copy holders of the Medical Assistance Manual.

DFA/JBV:s