SR 21-01 Dated 01/21

 BFA SR 21-01

STATE OF NEW HAMPSHIRE

INTER-DEPARTMENT COMMUNICATION

SUMMARY

This SR releases a 1.3% cost-of-living adjustment (COLA) for January 2021 to Social Security Administration (SSA), Supplemental Security Income (SSI) and Veterans Affairs (VA) Annual Review benefits, and its associated increase to the SSI maximum benefit levels. This COLA increase is:

·         “passed along” in NH via formula-based updates to the adult Standards of Need (SON) which are used in Old Age Assistance (OAA), Aid to the Permanently and Totally Disabled (APTD), and Aid to the Needy Blind (ANB) eligibility and benefit determination process for applicants and recipients residing in independent living arrangements, residential care facilities, and community residences. [See 42 USC 1382g, 20 CFR 416.2095-2099, RSA 167:3-c,II-b, RSA 167:7,I & I-a, RSA 167:27-c, He-W 648.04, and He-W 658.03];

·         used to determine the Nursing Facility (NF) CAP which is then used to determine eligibility for NF and Home and Community-Based Services (HCBS), including HCBS Choices For Independence (HCBS-CFI) categorically-needy services, as well as the income disregard for HCBS or HCBS-CFI medically-needy recipients who were receiving services as of 10/1/08. [See 20 CFR 416.405, 20 CFR 416.414, He-W 858.05 and He-W 858.06]; and

·         used to determine the ineligible child disregard and parental living allowance used in ANB parental deeming for ANB applicants and recipients under the age of 18. [See 20 CFR 416.1165(d)(3)(i) and He-W 652.03(f)].

Additionally this SR releases updates to:

·         Medicare Part B and Part D premium amounts. [See 42 USC 1395r(a)(1) and 42 USC 1395w-102(b)(6) respectively];

·         Presumed Maximum Value (PMV) used for disbursements from Special Needs Trusts that can be treated as unearned income;

·         Spousal impoverishment figures, pursuant to 42 USC 1396r-5(g);

·         Substantial Gainful Activity (SGA) income ceiling used in the initial eligibility determination for APTD cash and medical assistance only. [See 20 CFR 404.1574(b), 20 CFR 404.1575(c), 20 CFR 404.1584(d), 20 CFR 416.974(b), and 20 CFR 416.975(c)];

·         the home equity limit used in the NF, HCBS, and HCBS-CFI eligibility determination process. [See 42 USC 1396p(f)(1)(C)];

·         the Protected Income Level (PIL). [See He-W 601.06(s) and He-W 858.04];and

·         Child Allocation deduction and the Parental Living Allowance related to parental deeming for ANB applicants and recipients under the age of 18, pursuant to 20 CFR 416.1165(d)(3)(i) and He-W 652.03(f).

The following forms and their associated instructions were revised to reflect the increased spousal impoverishment figures:

·         BFA Form 798A, Resource Assessment for Institutionalized Individuals with Community Spouses and its associated New HEIGHTS-generated Form AE0020;

·         BFA Form 799, Spousal Income Protection, and its associated New HEIGHTS-generated Form AE0017; and

·         BFA Form 799A, Income Computation Worksheet for Allocation of Income for Institutionalized Individuals, and its associated New HEIGHTS-generated Form AE0017.

This SR releases the 2021:

·         Withholding rates for FICA (Social Security) and FIT (Federal Income Tax); and

·         FICA income ceiling.

FICA and FIT withholding rates are allowed in determining self-employment income for most programs and nursing facility and HCBC employment expense disregards. Employment expense disregards are based on allowable FIT and FICA withholding deductions.

POLICY

Based upon the 1.3% cost-of-living adjustment (COLA) increase to SSA/SSI and VA Annual Review benefits, the SSI maximum monthly benefit levels for independent living arrangements increased as follows:

·     $794 for an individual (from $783);

·        $1,191 for an individual and either a spouse or needy essential person (from $1,175); and

·        $1,588 for a couple and needy essential person (from $$1,567).

The 2021 adult Standards of Need for OAA, ANB, and APTD individuals increased as follows:

The Nursing Facility CAP used to determine NF, HCBS, and HCBS-CFI categorically-needy services has increased to $2,382 (from $2,349).

The Income Disregard for HCBS or HCBS-CFI medically-needy recipients who were receiving services as of 10/1/08 is:

·         $69 for HCBS-CFI (formerly $102); and

·         the difference between the cost of services on 9/26/08 and the NF CAP of $2,382 for all other HCBS categories.

Parental Deeming for ANB applicants and recipients under the age of 18:

·         The Child Allocation deduction is the difference between the SSI maximum benefit for a couple and an individual. The 2020 Child Allocation deduction amount is $397 per child, (i.e. $1,191 - $794 = $397), as follows:

·         The Parental Living Allowance is the SSI maximum benefit for a couple (if there are 2 parents) or an individual (if there is one parent). The 2021 Parental Living Allowance:

-          Couple (2-parent): $1,191 (from $1,175)

-          Individual (1-parent): $794 (from $783).

The Spousal Impoverishment limits for 2021 are:

·         Maximum monthly maintenance needs allowance increased from $3,217 to $3,260;

·         Minimum community spouse resource allowance increased from  $25,728 to $26,076; and

·         Maximum community spouse resource allowance increased from $128,640 to $130,380.

The Medicare Part B standard monthly premium cost:

·         Increases to $148.50 from $144.60 for:

-        new enrollees in Part B in 2021;

-        people who don’t have their Part B premiums deducted from Social Security benefits, which includes recipients currently eligible for State “buy-in” of their Part B premium;

-        those individuals who are not collecting Social Security benefits;

-        individuals with annual income above $87,000; and

-        dual-eligibles, which are people eligible for both Medicaid and Medicare.

NOTE: Family Services Specialists (FSS) should not make any changes to the Part B premium amounts or SSI/SSA benefits displayed in New HEIGHTS unless one of the following occurs:

·         the casehead provides verification that their Part B premium or benefit amount is a different amount than displayed; or

·         the individual’s case is placed on the discrepancy report after the mass change, at which point the individual will need to present verification of income or premium amount.

New recipients for any assistance other than the MAGI categories of medical assistance will need to verify, per current policy, their premium and benefit amount so that the FSS can enter the correct amount. However, electronic verification will occur at the time of application and based upon the information provided by the individual for applicants of the MAGI categories of medical assistance. Paper verification for applicants of MAGI categories of medical assistance will only be required if there is a discrepancy between what the applicant provided about their premium and benefit amount and what is retrieved during the electronic crossmatch with Medicare.

The Medicare Part D Low-Income Premium Subsidy and the Maximum Co-Pays for Full Benefit Dual Eligible Individual for 2021 are:

Medicare Part D NH Low-Income Premium Subsidy Amount is now $29.08

Maximum Co-Pays for Full Benefit Dual Eligible (FBDE) individuals:

·  Institutionalized Individuals                         $0.00

·         Non-Institutionalized Beneficiaries

-        Up to or at 100% FPL

§  Generic/Preferred                        $1.30

§  Other                                            $4.00

§  Above Out-of-Pocket Threshold  $0.00

-        Over 100% FPL

§  Generic/Preferred                         $3.70

§  Other                                             $9.20

§  Above Out-of-Pocket Threshold   $0.00

The Substantial Gainful Activity (SGA) income ceiling increased from $1,260 to $1,310. The SGA is used only during initial APTD eligibility determinations for cash and medical assistance; working APTD applicants must have an adjusted earned income of less than the SGA.

The Home Equity Limit used in the financial eligibility determination process for NF, HCBS, and HCBS-CFI services is $603,000 (from $595,000). NF/HCBS services need to be denied or terminated if the applicant or recipient for NF/HCBS services has equity in the home that exceeds this figure.

The Protected Income Level (PIL) for all group sizes remains unchanged.

The Presumed Maximum Value (PMV) for disbursements from Special Needs Trusts to third parties for food or shelter that can be counted as unearned income is $284.66 for an individual, $417 for an individual with a needy essential person, and $417 for an individual with a spouse.

The QMB/SLMB/SLMB135 resource limits for 2021 are:

·         $7,970 for an individual; and

·         $11,960 for a couple.

These limits are determined by subtracting the $1,500 allotment for burial expenses from the 2021 resource limits of $9,470 (or $3,000 from $14,960, if married) for low-income subsidy (LIS), as authorized under 42 USC 1396d(p)(1)(C).

FICA (Social Security)

·         The 2021 FICA withholding rate for both employees and employers has not changed and will remain at 7.65%. This subdivides into 6.20% for the Social Security (OASDI) share and 1.45% for Medicare’s (HI) portion.

·         Self-employed individuals pay a FICA withholding rate of 15.3%. These individuals may deduct from income tax one half of the 15.3% paid for the year as a business expense. The actual rate becomes 7.65% after the deduction.

·         For employees and employers, the Medicare portion of the FICA rate is 1.45% on 100% of earned income; for a self-employed individual, the rate is 2.9% on 100% of earned income. 

FICA Income Ceiling

·         The income ceiling subject to the full FICA withholding rate has increased from $137,700 to $142,800.

·         There is no ceiling to the amount of gross earned income from which Medicare may be withheld.

FIT (Federal Income Tax)

District Offices use the IRS Circular E to determine the applicable federal income tax (FIT) withholding rate. As of January 1, 2021, the 2020 Circular E will be obsolete. Electronic copies of the January 2021 IRS Circular E will be sent to each District Office under separate cover when they are released by the IRS. 

Federal Minimum Wage

The 2021 Federal minimum wage, effective since 7/24/09, remains at $7.25 per hour.

NEW HEIGHTS SYSTEMS PROCEDURES AND IMPLEMENTATION

SSA/SSI COLA Increase

Using the individual’s Social Security Number (SSN), SSA/SSI benefits are updated during the January Mass Change by crossmatching open:

·         SSA cases against BENDEX and SVES; and

·         SSI cases against SDX.

For those cases that match, the SSA/SSI amount will be replaced with the actual check amount listed in the BENDEX/SVES/SDX files, and benefits will be recomputed. For those SSA individuals that do not match, New HEIGHTS will apply the 1.3% increase and round up to the nearest dollar. For, SSI, New HEIGHTS will automatically update anyone whose current SSI amount is $783 to $794. For all others, HEIGHTS will apply the 1.3% increase and round up to the nearest dollar.

VA Increase

New HEIGHTS will apply a 1.3% COLA, dropping all cents, to all VA benefits with an annual review indicator and certain VA beneficiaries, widows and children of veterans, who do not have an annual review indicator. If a case with an annual review indicator also has Aid and Attendance (A&A) benefits, the 1.3% COLA will also be applied to the A&A benefits, dropping all cents.

Individuals who are coded as “VA Nursing Facility Pension” or “VA Frozen Pension” are not entitled to the January COLA and will not see the COLA applied to their benefits.

Parental Deeming

Recipients who are still currently eligible for an ANB cash grant despite having parental income and resources deemed to their case, will be automatically run thru the mass change with all the other adult categories and will have their ANB grants redetermined.

ANB cash recipients who do not get a cash grant due to parental deeming, but are still eligible for MA, will not have their eligibility for a cash grant automatically redetermined. These individuals will have to formally apply for cash and ask to have their eligibility redetermined. Parental income and resource information must be reverified at that time.

Three-Month Retroactive Medical Assistance Cases

New HEIGHTS will automatically use pre-mass change SON amounts for Three-Month Retroactive Categorically-Needy Medical Assistance eligibility determinations for months prior to January 1, 2021.

Pickle Amendment Cases

The Pickle Amendment prevents SSA cases receiving an adult category of state supplement (ANB, APTD, OAA) from closing due to the COLA increase New HEIGHTS Pickle Amendment cases are processed automatically. The calculations and COLA deduction for cases that would lose cash payment are invisible to DO staff. Questions about the calculations or COLA deduction on New HEIGHTS Pickle cases should be directed to the New HEIGHTS Help Desk.

Medicare Part B Premiums

FSS should not make any changes to the amounts displayed in New HEIGHTS unless the casehead provides verification that their Part B premium or benefit amount is different than displayed, or unless the individual’s case is placed on the discrepancy report after the mass change, at which point the individual will need to present verification of income or premium amount. New applicants, other than applicants for the MAGI categories of medical assistance, will need to verify their premium, per current policy, so the FSS can enter the correct amount.

Spousal Impoverishment Cases

Effective January 1, 2021, the maximum monthly maintenance allowance increases from $3,216 to $3,259.50 per month. When determining income allocated to the community spouse for months prior to January 2021, use the $3,216 amount. For example, if an individual applied for institutionalized care in January and requested retroactive medical assistance for December, the District Office would calculate the spousal allocation separately for December and January.

The minimum and maximum resource allowance for the community spouse is also increasing from $25,728 to $26,076 and from $128,640 to $130,380 respectively.

·         The new figures apply to requests for resource assessments that are currently in process or being processed after 12/31/20.

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

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

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

QMB, QDWI, SLMB, and SLMB135 Cases

Federal law mandates that COLA increases for the year 2021 cannot be used to determine QMB, QDWI, SLMB, and SLMB135 eligibility until after the annual update to the federal poverty levels is effective in the spring of 2021. Until the new figures are available, cases that would close due to the COLA will be kept open automatically by New HEIGHTS.

Reminder: New HEIGHTS adds a deduction called “QMB/QDWI/SLMB COLA Deduct” to the “Other Allowable Deduction” screen for these cases. Do not change the amount or end date the deduction; New HEIGHTS will automatically end date the deduction when the federal poverty levels become effective.

Adult Category Recoupment

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

Rollbacks

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

Patient Liability

Nursing facilities are automatically notified of the patient’s liability, the monthly amount the resident is expected to pay towards their care, through MMIS. Any time a new patient liability is created or a change is made to a current resident’s patient liability, New HEIGHTS will automatically generate the AE0009, Patient Liability Letter, to the nursing facility resident and/or authorized representative.

Categorically Eligible Food Stamp Households

Food Stamp policy in FSM PART 231, CATEGORICALLY ELIGIBLE HOUSEHOLDS, states that certain public assistance and SSI households are categorically eligible for Food Stamp benefits without regard to income or resources. To be considered categorically eligible, all members of the Food Stamp household must be included in an open public assistance and/or SSI case. New HEIGHTS will calculate Food Stamp categorical eligibility automatically.

Withholding Rates for FICA & FIT and Income Ceilings for FICA Taxes

There are no system changes associated with this information release.

SYSTEM CHANGES

Mass Change Schedule

The January Mass Change, impacting approximately 60,246 cases, will be included in the daily run over the course of 21 days, as follows:

Mass Change NOD

Notices of Decision (NOD) generated during the January Mass Change will contain special text messages that correlate to the change(s) that occurred in the case, as follows:

Group 1: In and Out Cases

The federal government increased Social Security, SSI, and some VA benefits to reflect increases in the cost of living. Your eligibility for medical assistance was refigured using the new benefit amount and income limit.

Group 2: Nursing Facility Cases

The federal government increased Social Security, SSI, and some VA benefits to reflect increases in the cost of living. The 2021 standard Medicare Part B premium is $148.50. Your cost of care liability was refigured using your new benefit amount and this year’s Medicare Part B premium.

Group 3: All Cash Cases

The federal government increased Social Security, SSI, and some VA benefits to reflect an increase in the cost of living. The income limits for OAA, ANB and APTD cash assistance were also increased. For individuals living in an independent living arrangement, the income limit increased to $808 for a group size of one, and $1,192 for a couple. For individuals living in a residential care facility or an enhanced family care residence, the income limit increased to $988. For individuals living in a subsidized community residence, the income limit increased to $870. For individuals living in a non-subsidized community residence, the income limit increased to $930.

Someone in your cash assistance case, which may include a foster child or an adoption subsidy child in your care, had a change in their Social Security, SSI, or VA benefit amount. Eligibility for cash assistance was refigured using the new benefit amount. If you receive OAA, ANB, or APTD cash assistance, the new income limits were also used. The change in your cash assistance benefit amount may have also changed your food stamp and/or medical assistance benefits.

Group 4: Remaining Selected Cases (Cases Experiencing a Change in VA/SSI/SSA, Part A/B, Food Stamp Only, Child Care Only, or MA Only)

The federal government increased Social Security, SSI, and some VA benefits to reflect increases in the cost of living. Because someone in your assistance group had a change in their Social Security, SSI, or VA benefit amount, eligibility for assistance was refigured using the new benefit amount.

QMB, SLMB, or QDWI cases, whose eligibility would end due solely to the cost of living increase, will remain open until the new federal poverty guidelines are available. In March we will refigure your case and notify you of any change.

Group 5 Clean Up Cases (Includes cases that exceptioned out during the mass change)

The federal government increased Social Security, SSI, and some VA benefits to reflect increases in the cost of living. The income limits for cash assistance for OAA, ANB, and APTD were also increased.

Because someone in your assistance group had a change in their Social Security, SSI, or VA benefit amount, eligibility for assistance was refigured using the new benefit amount. If someone in your assistance group receives OAA, ANB, or APTD cash assistance, the new income limits were used in the refiguring, too.

QMB, SLMB, or QDWI cases, whose eligibility would end due solely to the cost of living increase, will remain open until the new federal poverty guidelines are available. In March we will refigure your case and notify you of any change.

Medicare Part B

New HEIGHTS will automatically update the Medicare Part B premium amount with the figure specified on the BENDEX report. If the Bendex or SVES file has Medicare information and New HEIGHTS does not have information in the system for this individual, the Medicare information will be automatically entered into the pertinent fields in New HEIGHTS.

POST-MASS CHANGE REPORTS

The reports described below will be produced as a result of the Mass Change. These reports will be available in New HEIGHTS as indicated below.

NMC820RA: MC Skipped Cases RPT

The Unearned Income Type Unverified report lists cases that were not selected for computation during the Mass Change because there was an unverified SSA, SSI, or VA income type or claim number or an unverified Part B premium amount. These cases require further District Office action. The report contains the following information: DO, Worker ID, Client Name, and Case Number. This report will be available on the first business day after each run of the mass change.

NMC540RA: AG’s Affected by MC

This report lists all cases that the Mass Change ran successfully through confirmation. It contains the following information: DO, Worker Name, Client Name, and Case Number. This report will be available on the first business day after each run of the mass change.

NMC550RA: MC Exception

This report lists cases that were selected for computation during the Mass Change, but were not confirmed due to some discrepancy in data. These cases require further District Office action. It contains the following information: DO, Worker Name, Client Name, Case Number, Reason for Exception, and Mass Change Type. This report will be available on the first business day after each run of the mass change.

NMC810RA: MC PT Liab Override RPT

The Nursing Facility with Patient Liability Override report lists cases that contain a Patient Liability override and therefore the amount did not change. These cases require further District Office action. The report contains the following information: DO, Worker ID, Client Name, and Case Number. Nursing Facility cases will be run on December 30, 2020. The report will be available to the field the first business day following its running, on December 31, 2020. This report will be rerun after the clean-up run on January 19, 2021, so another report will be available the next day, on January 20, 2021.

NMC850RA: HCBS Liability Override RPT

The HCBS Liability Override report lists cases that contain a CFI or HCBS liability override and therefore the amount did not change. These cases require further District Office action. The report contains the following information: RID #, Client Name, Case Number, Casehead Name, Case Status, Client Phone #, and CFI or HCBS type. CFI/HCBS cases will be run on December 30, 2020. The report will be available to the field the first business day following its running, on December 31, 2020. This report will be rerun after the clean-up run on January 19, 2021, so another report will be available the next day, on January 20, 2021.

DESCRIPTION OF REVISIONS MADE TO FORMS

BFA Forms 798A,Resource Assessment for Institutionalized Individuals with Community Spouses, BFA Form 799, Spousal Income Protection, and BFA Form 799A, Income Computation Worksheet for Allocation of Income for Institutionalized Individuals, and their associated New HEIGHTS-generated Forms AE0017 and AE0020, were revised to include the increase in the spousal impoverishment limits.

With new spousal applications dated January 1, 2021 or later, use the updated forms. However, prior to detaching the new versions, rename and retain the January/July 2020 electronic versions of BFA Forms 798A, 799, and 799A, in case rollbacks are required.

The new versions of BFA Forms 798A, 799, and 799A will be electronically transmitted to each District Office with the electronic release of this SR. All forms identified in this SR are also available electronically, for DHHS staff only, on the N drive.

POLICY MANUAL REVISIONS

Revised Adult Assistance Manual Topics

Section 167.03                                COLA Adjustments Since 1977

PART 209                                       AID TO THE PERMANENTLY AND TOTALLY DISABLED

Section 209.03                                SGA Adjustments Since 2000

PART 411                                       COMMON TYPES OF RESOURCES: REAL PROPERTY

Section 415.27                                Undue Hardship

Section 415.28                                Required Documentation for an Undue Hardship Waiver Application

Section 419.03                                Determining the Protected Resource Amount

Section 419.05                                Procedures for Protection of Resources

PART 601, TABLE A                        INCOME LIMITS

PART 601, TABLE B                        SPECIAL INCOME LIMITS FOR CFI AND HCBS INDIVIDUALS

PART 601, TABLE H                        Federal Taxes, Income Ceilings, and Federal/State Minimum Wages

Section 603.03                                Employment Expense Disregard (EED)

Section 615.01                                ANB Parental Deeming Principles

Revised Family Assistance Manual Topics

PART 601, TABLE H                         Federal Taxes, Income Ceilings, and Federal/State Minimum Wages

Revised Food Stamp Manual Topics

PART 601, TABLE H                         Federal Taxes, Income Ceilings, and Federal/State Minimum Wages

Revised Medical Assistance Manual Topics

Section 161.03                                COLA Adjustments Since 1977

PART 209                                       AID TO THE PERMANENTLY AND TOTALLY DISABLED (APTD)

Section 209.03                                SGA Adjustments Since 2000

Section 407.07                                QMB, SLMB, and SLMB 135 Resource Limits

PART 411                                       COMMON TYPES OF RESOURCES: REAL PROPERTY

Section 415.29                                Undue Hardship

Section 415.31                                Required Documentation for an Undue Hardship Waiver Application

Section 419.03                                Determining the Protected Resource Amount

Section 419.05                                Procedures for Protection of Resources

PART 511                                       INCOME TYPES: TRUST DISBURSEMENTS

PART 601, TABLE A                        INCOME LIMITS

PART 601, TABLE B                        SPECIAL INCOME LIMITS FOR CFI AND HCBS INDIVIDUALS

PART 601, TABLE H                        Federal Taxes, Income Ceilings, and Federal/State Minimum Wages

Section 603.03                                Employment Expense Disregard (EED)

Section 627.03                                Allocation to a Community Spouse

IMPLEMENTATION

Changes identified in this SR are effective January 1, 2021 for current cases, and apply to any new cases processed on or after that date. Use the updated Forms 798A, 799, and 799A for any new spousal applications dated January 1, 2021 or later, However, prior to detaching the new versions, rename and retain the January/July 2020 electronic versions of BFA Forms 798A, 799, and 799A, in case rollbacks are required.

CLIENT NOTIFICATION

A one-time mailing, to notify all institutionalized individuals and their community spouses of the unchanged spousal impoverishment figures, is scheduled to be generated from State Office in January 2021. The 2021 Spousal Letter is attached to this SR for reference.

All individuals who experienced a change in their case due to the Jan MC updates will receive the NOD message as detailed in the Mass Change NOD section above.

No other client notification is planned.

TRAINING

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

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 Bureau of Family Assistance policy releases. 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 January 4, 2021. This SR 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 January 4, 2021. 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, Medical Assistance, and Forms Manuals.

BFA/KP:s