SR 24-12 Dated 03/24

 

STATE OF NEW HAMPSHIRE

DEPARTMENT OF HEALTH & HUMAN SERVICES - Bureau of family assistance (bfa)

INTER-DEPARTMENT COMMUNICATION

 

FROM THE OFFICE OF:

Director of Division of Economic Stability (DES), Karen E. Hebert    

BFA SIGNATURE DATE:

March 19, 2024

FROM THE OFFICE OF:

Director of Division of Medicaid Services (DMS) Henry D. Lipman   

DMS SIGNATURE DATE:

March 15, 2024

AT (OFFICE):

Bureau of Family Assistance

Division of Medicaid Services

TO:

All BFA Staff

All DMS Staff

SUBJECT:

Continuous Eligibility for Children’s Medical Assistance

RETROACTIVE EFFECTIVE DATE:

January 1, 2024    

 

SUMMARY

This Supervisory Release (SR) explains a change in the eligibility period for all Children’s Medical assistance categories. All children enrolled in Medicaid are continuously eligible for 12 months of assistance from their date of eligibility, without regards to any change in circumstance. This policy only applies to the Children’s Medical assistance program.

 

FORMER POLICY

NEW POLICY

If a child is determined eligible for Medicaid during initial eligibility or during redetermination, their eligibility could be terminated due to changes in circumstances.

 

If a child is determined eligible for Medicaid during initial eligibility or during redetermination, their eligibility shall not be terminated during their 12 month continuous eligibility period regardless of any changes in circumstances, with the exception of:

·   the child attains age 19;

·   the child ceases to be a resident of NH;

·   the child or the child’s representative requests to close the Medicaid;

·   DHHS determines that eligibility was erroneously granted at the most recent determination, because of agency error, fraud, abuse, or perjury attributed to the child or the child’s representative; or

·   the child is deceased.

 

 

BACKGROUND

Section 5112 of the Consolidated Appropriations Act, 2023 (CAA, 2023) amended titles XIX and XXI of the Social Security Act, to require that states provide 12 months of continuous eligibility for children under the age of 19 in Medicaid and the Children's Health Insurance Program (CHIP) effective January 1, 2024.

 

POLICY

Eligibility:

The continuous eligibility period begins on the day the child is initially determined eligible. A new 12-month period will start again if the child is also determined eligible during their redetermination of eligibility (passive or non-passive).

 

Continuous eligibility applies to all categories of children’s medical including Title IV-E Foster Care Medical and Adoption Subsidy, as DHHS must prevent the improper disenrollment of children leaving the Foster Care or Adoption Subsidy programs during the 12-month period of continuous eligibility.

 

Continuous eligibility does not apply to children who have a spenddown (in and out medical) or who were determined eligible based on the presumptive eligibility process.

 

IMPLEMENTATION

Process for Closures:

The only acceptable process for closing medical coverage for a child is when:

·         The child or child’s representative requests the medical assistance to close:

o   Close the individual on the ‘Program of Assistance’ screen by selecting the reason, ‘Closed at Recipient’s Request.’

o   Close with a 10 day Advanced Notice Period (ANP), unless the recipient has requested a 0 ANP.

o   Enter a clear and concise case comment.

 

·         The child moves out of New Hampshire:

o   Close the individual on the ‘Program of Assistance’ screen by selecting the reason, ‘Moved out of New Hampshire.’ 

o   Close with a 10 day ANP, unless the recipient has requested a 0 ANP.

o   Enter a clear and concise case comment.

 

·         The child passes away:

o   Close on the individual on ‘Additional Demographics-Details’ screen, by completing the ‘Date of Death’ field and send the Condolence  Letter. 

o   Close with 0 ANP.

o   Enter a clear and concise case comment.

 

o   Close the individual on the ‘Program of Assistance’ screen, by selecting the reason ‘Error in determining eligibility.’

o   Close with a 10 day ANP.

o   Enter a clear and concise case comment.

Note: The system will only allow a supervisor role to close the AG, for this reason. 

 

·         The case head passes away.

o   See DM titled ‘Procedure for Cases when the Case head is no Longer in the Home’ released 12/20/2023.

 

Children who become incarcerated:

Children who become incarcerated must be put into a ‘Suspended’ status. If the child is released while still within their continuous eligibility period, they will be removed from the ‘Suspended’ status and remain eligible until the end of their 12 month continuous eligibility period.

 

NEW HEIGHTS & NH EASY SYSTEMS PROCEDURES

The following updates have been made:

New HEIGHTS has been updated to allow 12 months of continuous Medicaid coverage for children after eligibility has been determined, regardless of reported changes, with the exceptions listed above. 

·  New HEIGHTS will determine any child currently open Medicaid on January 1, 2024 and not allow termination until the end of their 12 month certification period, with the exceptions listed above.

· Since children are protected from termination and adults over 19 are not, New HEIGHTS has been updated so that when both children and adults are enrolled in Medicaid, any change in circumstance(s) only impacts the adult(s) age 19 or older. The eligibility of the child during a continuous eligibility period is not impacted unless the change relates to one of the exceptions above.

· Due to allowing self-attestation during the initial eligibility determination, New HEIGHTS will not allow post-enrollment verifications to terminate any covered child after they have been determined eligible, as this is a change in circumstance and the child is still entitled to their 12 months of continued eligibility.

·   As a reminder to staff and to prevent confirmation of closure, New HEIGHTS has added a pop-up when running eligibility that reads ‘Children or Pregnant Women AG Can’t be Closed Due to Continuous Eligibility’.

·  For all other AGs in the case, New HEIGHTS will continue to allow confirmation as per the existing process.

· When eligibility for another program or household member is determined and remains open, the child’s redetermination date and continuous eligibility period will be extended for another 12 months from the new determination date. If determined no longer eligible, the system will retain the child’s existing redetermination date and there will be no change to the continuous eligibility period.

 

POLICY MANUAL REVISIONS

Revised Medical Assistance Manual Topics

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

Section 223.01      Verification: CM and Expanded CM

 

New Medical Assistance Manual Topics

Section 223.02      Verification: Continuous Eligibility for Children’s Medical

 

CLIENT NOTIFICATION

No client notification is planned or needed.

 

TRAINING

No special training is planned or needed.

 

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 Online Manuals.

 

DISTRIBUTION

This SR will be distributed according to the electronic distribution list for BFA policy releases. This SR, and revised Online Manuals, will be available for agency staff in the Online Manual Library, and for public access on the Internet at https://www.dhhs.nh.gov/sr_htm/sr.htm, effective April 1, 2024.

 

BFA/DMS:sl