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(109-01-filing-an-application-aam)New Hampshire Adult Assistance Manual: 109.01 Filing an Application#

(109-01-filing-an-application-aam)(block-1)109.01 Filing an Application (AAM)#

109.01 Filing an Application (AAM)

SR 11-40 Dated 10/11 Previous Policy

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The official Filing Date for applications is the date when the application is completed and received by the District Office (DO), if the completed application is received by the DO during business hours on a day that the DO is open for business. If received after hours or on a day when the DO is closed for business, the official fling date of the application is the next day the DO is open for business.

Applications can be submitted:

. online via the NH EASY website;

. in-person at the District Office; or

. via mail.

Personal eligibility interviews are in person at the District Office or, if approved by the District Office Supervisor, by telephone.

Exceptions:

. Applications made using DFA Form 800Q, Assisted Application For Help With Medicare Costs Through the Medicare Savings Program , or applications made using DFA Form 800, Application for Assistance , in which the only program of assistance requested is QMB, SLMB, or SLMB135, may be submitted by mail, and no face-to-face interview is required.

. A Qualified Medicare Beneficiary (QMB), Specified Low Income Medicare Beneficiary (SLMB/SLMB135), or Qualified Disabled and Working Individual (QDWI) application received by New HEIGHTS as an electronic Low Income Subsidy ( LIS) data transmittal from the Social Security Administration ( SSA), is considered to be the same as if the applicant had submitted a DFA Form 800, Application for Assistance. No face-to-face interview is required.

A completed application for the adult categories of assistance must, at minimum, contain the applicant ' s:

. name;

. address;

. signature, or the signature of an authorized representative acting on behalf of the applicant; and

. request for program(s) of assistance.

Individuals have the right to file an application on the same day they contact the District Office.

Exceptions :

. When a resident of an institution applies for assistance prior to leaving the institution, the filing date of the application is the date the applicant is released from the institution.

. For individuals applying for medical assistance at New Hampshire Hospital or any federally qualified health clinic or other agency or outreach site authorized to assist individuals with filing an application, the time frames begin from the date the application is filed at the facility.

. When individuals file applications for LIS at the SSA and consent to have their LIS data transmitted to the Department for determination of eligibility for the QMB, SLMB/SLMB135, or QDWI programs, the date the LIS application is filed at the SSA is the date of application for QMB, SLMB/SLMB135 or QDWI. The date the transmitted data is received at New HEIGHTS is the begin date for processing the application.

Support Staff Process

Direct individuals to the NH EASY website or the DHHS website to apply for assistance, or provide the individual with DFA Form 800, Application for Assistance , upon request . If the paper DFA Form 800 is provided:

. Assist the applicant in completing the form, if requested.

. When the individual returns the application, review to ensure the application is complete as described above, and then date stamp the application.

. Complete the "Agency Use Only" section on the back of the first page (the Coversheet) of DFA Form 800, indicating the date the application was received.

. Review the application for eligibility for expedited Food Stamp benefits (see the Food Stamp Manual , PART 125 , EXPEDITED SERVICE ). All individuals potentially eligible for expedited Food Stamp benefits are interviewed on the same day that the application is filed. If the applicant cannot be interviewed on the date of application, schedule a personal or phone interview for the next business day or when it is otherwise convenient for the applicant.

. For all other individuals, schedule the individual for an eligibility interview by completing Client Registration (CR) in New HEIGHTS and using the "Schedule Individuals" screen. Do not initiate or print Form 800H, also known as the HAF , at the conclusion of CR. Write a note on DFA Form 797, Eligibility Narrative , to notify the FSS that CR has been completed.

. Give the DFA Form 800 Coversheet plus New HEIGHTS-generated letter CS0002, Schedule Initial Interview , DFA Form 800A, DFA Program and Services Guide , and all other applicable forms to the individual.

. Create an electronic case file for the individual.

Filing of an Application Received in the Wrong DO

If an application is mailed to the wrong District Office (DO), date stamp it and forward it to the appropriate DO on the same day that it was received, unless it meets the criteria for expedited Food Stamp benefits. If information on the application indicates the household is eligible for expedited benefits, process the Food Stamp portion of the application immediately.

If an individual contacts the wrong DO, give the individual the address and telephone number of the correct DO and offer the individual the opportunity to complete an application that same day.

If the individual hand-delivers an application to the wrong DO, schedule an appointment for the correct DO and forward the application to that office. Give the individual the address and telephone number of the correct DO, with the CS0002 indicating the time of the individual ' s appointment in the correct office.

Special Procedures for Applications Filed by Mail

Once a mailed DFA Form 800 is received in the DO, support staff review all the information on the application and complete the "agency staff only" boxes on the application. Most applicants will then be scheduled for the next available interview appointment. However, the following applications are not immediately scheduled for an interview:

. applications containing information indicating potential eligibility for Expedited Food Stamp benefits . These applications are given to the Supervisor for review once the support staff determines potential eligibility. If the Supervisor confirms the potential eligibility, support staff calls the applicant to schedule an interview for the next business day, or another day convenient to the applicant. If the applicant cannot be reached by phone, an interview is scheduled no sooner than 5 business days from the date of application; and

. applications containing information indicating no potential eligibility for any DFA assistance program or service requested . These applications are given to the Supervisor for review as well. If the Supervisor confirms that there is no potential eligibility for all assistance requested on DFA Form 800, the DFA worker may deny all assistance requested without an interview, per PART 121 , INTERVIEWS .

(109-03-when-the-application-is-filed-aam)New Hampshire Adult Assistance Manual: 109.03 Processing a Filed Application#

(109-03-when-the-application-is-filed-aam)(block-1)109.03 Processing a Filed Application (AAM)#

109.03 Processing a Filed Application (AAM)

SR 15-10 Dated 02/15 Previous Policy

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The time frames for processing the application begins on the date the completed DFA Form 800, Application for Assistance , is received, or “filed,” in the District Office. Once DFA Form 800 is filed, schedule all applicants potentially eligible for DFA programs and services for an initial eligibility interview.

Exceptions:

• Applicants using DFA Form 800Q, Assisted Application For Help With Medicare Costs Through the Medicare Savings Program , or applicants using DFA Form 800, Application for Assistance , in which the only program of assistance requested is QMB, SLMB, or SLMB135, do not require an interview.

• The date New HEIGHTS actually receives the LIS application data from the SSA is considered to be the begin date for processing the QMB, SLMB/SLMB135, or QDWI application.

Prior to the initial interview, review DFA Form 800 to determine if potential eligibility exists for the requested programs.

If the Applicant Is Ineligible for All Programs of Assistance Requested

If the applicant is ineligible for all programs of assistance requested, discuss the reason(s) why the individual is ineligible for assistance prior to the initiation of Application Entry (AE) in New HEIGHTS . Explain to the individual that they have a right to a full eligibility interview if they request one. If the individual does not want a full interactive interview:

• refer the individual to a community, state, or federal agency that may be able to assist them;

• deny the application by choosing the status “Denied” and the most appropriate denial code on the “Conclude Interview” screen in Client Registration (CR). Only choose “Withdrawn” as a status if both of the following criteria are met:

- no reason for the client’s withdrawal is known by the FSS or the reason the individual wants to withdraw their application is known, but no denial code adequately represents the person’s withdrawal reason; and

- if the individual chooses to withdraw their application after being notified that all rights to an administrative appeal are forfeited in the withdrawal process. In the rare instance when both these criteria exist, the client must sign the withdrawal section of DFA Form 800 and indicate the specific programs that are being withdrawn, and it must be explained to the individual that the individual can reapply at any time;

• add case comments to indicate why the applicant is not eligible; and

• add a row to the “DO Traffic” screen in CR and select the value “Apply – CR Denial.”

Potential Eligibility Exists

If potential eligibility exits, begin the eligibility interview by initiating Application Entry (AE) in New HEIGHTS.

While in the interview, complete the necessary New HEIGHTS screens to determine eligibility for the programs requested by the applicant on DFA Form 800. *

At the completion of the interview:

• generate the Form 811H, Eligibility Interview Summary (EIS), which summarizes the information provided during the application process;

• review the Your Rights and Responsibilities pages of the EIS;

• review EACH statement on the EIS Statements of Understanding page;

• have the client initial and sign in appropriate spaces on the EIS Statements of Understanding page;

• sign and date in the spaces provided once the client has signed;

• scan the EIS;

• provide the applicant with a copy of the signed EIS; and

• if the applicant:

- has internet access, provide the applicant with DFA Form 800W, Website Forms , which directs the applicant to the DHHS website to review the information associated with the programs of assistance for which the household is applying ; or

- does not have internet access or refuses to sign DFA Form 800W, provide the required program-specific paper forms listed on Form 800W to the client for review.

Prior to ending the interview, review the following with the applicant:

• providing verifications. Review all of the verifications that need to be provided to the District Office. Emphasize that the verifications need to be provided as soon as possible so that a decision about eligibility can be made;

• reporting changes. Discuss DFA Form 215, Reporting Requirements Handout . Explain the types of changes the client needs to report and when, as well as the importance of reporting these changes to the District Office in a timely manner;

• who determines eligibility. If the client is applying for APTD, ANB, MEAD, CFI, HCBC, HC-CSD or Nursing Home Care, explain that DFA determines eligibility based on financial and non-financial criteria, but another division will determine eligibility based on an independent medical decision; and

• the client ’ s right to appeal a decision. Explain to the client that if the client does not agree with DFA ’ s decision, then he or she has the option to file an appeal with the Administrative Appeals Unit or through the District Office. Notify them that clients have a right to bring someone with them to the appeal, like a friend, relative, or lawyer, or they can come alone. DHHS will not pay for any legal services the individual wants, but there is free and reduced cost legal services available in NH.

References : He-W 601.01(n) & (p), He-W 601.03(a), He-W 602.03, RSA 167:8,I

(109-09-reuse-of-an-application-after-denial-or-closing-aam)New Hampshire Adult Assistance Manual: 109.09 Reuse of an Application After Denial or Closing (AAM)#

(109-09-reuse-of-an-application-after-denial-or-closing-aam)(block-1)109.09 Reuse of an Application After Denial or Closing (AAM)#

109.09 Reuse of an Application After Denial or Closing (AAM)

SR 23-17 Dated 04/23 Previous Policy

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If an Application was Denied in Error

Reuse BFA Form 800, BFA Form 800Q, or an eApplication to open a denied application if the denial was an agency error.

The application date is the date the application was first filed. If the information on the application has changed, the individual must provide verification if required, and the worker must document all changes. Conduct another interview if necessary.

If a Case was Closed in Error

Reopen case if the closure was an agency error.

The application date on POA is the date of closure. If any information has changed, the individual must provide verification if required, and the worker must document all changes. Conduct another interview if necessary.

If an Application was Denied or Case Closed for Failure to Provide Verifications

Reuse the information from the original application and follow the Simplified Reapplication process if an application for assistance was denied or a case was closed due to failure to provide verification. The Simplified Reapplication process can be used when:

· an applicant provides required verification within 30 days of the denial notice; or

· a former recipient provides required verification within 10 days of the end of the advance notice period.

The applicant/former recipient must fill out the following information on a new BFA Form 800, Application for Assistance :

· Name

· Address

· Program of Assistance requested

· Signature

The FSS must briefly meet with the individual (in person or over the phone) to ensure:

· The household still meets all program eligibility requirements;

· All missing verifications have been received;

· No additional programs have been requested; and

· No additional changes in the case have occurred.

The date the simplified BFA Form 800 is filed is the new application date.

Example: Original Application Date: 11/6

Interview Date: 11/9

Verification Due Date: 11/19

Application Denied: 11/20, no verifications provided

The applicant has until 12/20, 30 days from the date of the denial notice, to use the Simplified Application process.

Important: If any changes are reported from the original application or if any new programs are being requested, the Simplified Reapplication process cannot be used. A new complete application must be provided and the individual must participate in another interview.

References : He-W 601.01; He-W 601.03; 45 CFR 206.10; RSA 167:8, I; He-W 606.01

(109-11-application-for-retroactive-medical-assistance-qdwi-slmb-slmb135-or-slmb175-aam)New Hampshire Adult Assistance Manual: 109.11 Application for Retroactive Medical Assistance, QDWI, SLMB, or SLMB135#

(109-11-application-for-retroactive-medical-assistance-qdwi-slmb-slmb135-or-slmb175-aam)(block-1)109.11 Application for Retroactive Medical Assistance, QDWI, SLMB, or SLMB135 (AAM)#

109.11 Application for Retroactive Medical Assistance, QDWI, SLMB, or SLMB135 (AAM)

SR 03-04 Dated 01/03 Previous Policy

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Advise individuals applying for financial or medical assistance that they are entitled to apply for retroactive medical assistance and/or SLMB, QDWI, or SLMB135 * for a 3 month period prior to the application date. Retroactive eligibility may be established for 1, 2, or all 3 periods directly preceding the date of application. Application for retroactive assistance can be requested and provided without qualifying for or requesting ongoing assistance.

The individual applies for retroactive assistance coverage on Form 779, Application for Retroactive Medical Assistance . The request must be made no later than a 9 month period from the first date of the retroactive period for which coverage is requested.

Example

If the date of application was May 12, then the retroactive months and the deadlines for requesting retroactive medical assistance coverage would be as follows:

Retroactive Month Deadline February 12 - March 11 October 12 March 12 - April 11 November 12 April 12 - May 11 December 12

Exceptions:

• Determine retroactive coverage for QDWI, SLMB, SLMB135, or * 1619 certified individuals and recipients of Refugee Medical Assistance in whole months from the first of the application month.

• Determine eligibility for retroactive months one month at a time. For each retroactive month, determine whether the individual would have been eligible for assistance if an application had been filed for that month.

• QDWI or SLMB135 * recipients cannot be eligible for Medicaid benefits and QDWI or SLMB135 * coverage in the same month.

• An authorized representative may apply for retroactive assistance on behalf of a deceased individual. Determine eligibility only for the retroactive period prior to and including the month of death.

• When the individual has not been a New Hampshire resident for the entire retroactive period, determine eligibility only for months in which New Hampshire residency is verified.

If the individual is eligible for a retroactive month, explain the retroactive billing and payment process.

(109-application-process-aam)New Hampshire Adult Assistance Manual: 109 APPLICATION PROCESS#

(109-application-process-aam)(block-1)109 APPLICATION PROCESS (AAM)#

109 APPLICATION PROCESS (AAM)

SR 23-04 Dated 02/23 Previous Policy

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Advise individuals that they may file the application before an interview is conducted.

To complete the application process, the applicant must do all of the following:

• complete an application;

• participate in an eligibility interview, if required by the program of assistance requested; and

• provide all required verification within timeframes.

Individuals have the right to:

• apply for assistance;

• file an application on the same day the District Office has been contacted; and

• have an eligibility decision made on their application for assistance.

Individuals can apply for assistance in 5 ways:

• Individuals can apply for assistance by visiting the following website and completing an application online: https://nheasy.nh.gov ;

• Individuals can print out an application from www.dhhs.nh.gov/apply-assistance and mail the completed application to the District Office;

• Individuals can apply over the phone by calling 1-800-852-3345, extension 9700;

• Individuals can contact a District Office and request an application be mailed; or

• Individuals may also apply for assistance at hospitals by completing and submitting BFA Form 800, Application for Assistance .

Requesting an Application from a District Office

An individual may request an application by contacting any District Office. BFA Form 800, Application for Assistance , is provided to any individual requesting an application. Provide BFA Form 800 Insert, Medical Assistance for Children, Pregnant Women, and Parent/Caretaker Relative, along with BFA Form 800, to individuals interested in applying for Medical Assistance.

Completing an Application

A completed application for the adult categories of assistance must, at minimum, contain the applicant’s name, address, signature and type of assistance requested.

Application Filing Date

The official Filing Date for applications is the date when the application is completed as described above and received by the District Office. If a paper application is received, this date is stamped onto the official application, and entered onto the “coversheet” of BFA Form 800 before the coversheet is returned to the applicant for reference. Also see Section 109.01 , Filing an Application .

Eligibility Interview

Most applicants, including applicants for nursing facility care, are required to also participate in an interactive interview with a Family Services Specialist (FSS). See PART 121 , INTERVIEWS .

Required Verification

All applicants must provide verification of:

• eligibility factors and circumstances;

• information related to benefit allotment amount; and

• information the individual provided on the application or to the FSS during the interview. See PART 123 , PENDING INFORMATION .

References: He-W 601.01; He-W 601.03; RSA 167:8; 45 CFR 206.10

(115-vendor-payees-aam)New Hampshire Adult Assistance Manual: 115 VENDOR PAYEES#

(115-vendor-payees-aam)(block-1)115 VENDOR PAYEES (AAM)#

115 VENDOR PAYEES (AAM)

SR 12-19 Dated 11/12 Previous Policy

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Authorize payment to a vendor payee for a portion or all of the individual ’ s assistance payment when:

• The individual voluntarily requests in writing a vendor payment; and

• DHHS determines that a vendor payment is in the individual ’ s best interest.

All vendor payments are made directly to a bank account, selected by the vendor, through Electronic Funds Transfer (EFT).

To initiate a vendor payment, the individual must do all of the following:

• Request vendor payments in writing;

• Specify the vendor ’ s name, address, and amount of payment; and

• Notify the Department in writing to change or terminate a vendor payment.

When an individual ’ s request for vendor payment is received by the Department and is complete:

• Process the request to initiate, terminate, or change the vendor payment;

• provide the individual with adequate notification regarding action taken on vendor payments; and

• Advise the individual that any vendor due to receive rent payments directly from the Department will not receive any rent payments until the first available payroll after a completed New HEIGHTS-generated Form AE0006, Vendor EFT Information Request Form, is received and processed by the Department. Form AE0006 is automatically sent to the vendor when the vendor information is entered into New HEIGHTS. If New HEIGHTS is unavailable or the AE0006 cannot be accessed:

- Send the vendor DFA Form 706, Information Needed to Process Electronic Funds Transfer (EFT) .

- If it is a new vendor who is not enrolled with the Department, send Form AW-9, Alternate W-9 Form-CIS , to the vendor along with DFA Form 706.

Exceptions: Do not authorize payments to a vendor payee when any of the following circumstances apply:

· The individual has a protective payee due to mismanagement of funds;

• The individual has a foster parent, guardian, or conservator;

• The individual is involved in a dispute with the vendor payee regarding financial obligations;

• The vendor payee is coercing the individual;

• The worker has knowledge that the vendor payee will not provide the individual with the same quality and quantity of goods as the vendor payee would provide to the general public;

· Two-party payments are requested; or

• There is already a vendor payment being made .

References : He-W 686.01; RSA 167:5; RSA 167:26; 45 CFR 234.70

(119-benefit-delivery-time-frames-aam)New Hampshire Adult Assistance Manual: 119 BENEFIT DELIVERY TIME FRAMES#

(119-benefit-delivery-time-frames-aam)(block-1)119 BENEFIT DELIVERY TIME FRAMES (AAM)#

119 BENEFIT DELIVERY TIME FRAMES (AAM)

SR 15-26 Dated 07/15 Previous Policy

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As long as all State Supplement Program (SSP) eligibility requirements are met at the time the first SSP benefit allotment is issued, SSP financial assistance, which includes the Aid to the Permanently and Totally Disabled (APTD), Old Age Assistance (OAA), and Aid to the Needy Blind (ANB) programs, begins the first day of the *semimonthly payment period in which SSP eligibility is determined. See Section 617.01 , Assistance Payments: Determination, Frequency, and Issuance , for more information.

Exceptions:

. When an ANB or APTD application is denied solely due to a *Disability Determination Unit (DDU) decision that an individual is not considered blind or disabled, and the DDU decision is subsequently reversed by DDU or an administrative appeal, financial assistance begins on the first day of the month of that denial decision, provided that:

- all general, technical, and categorical eligibility requirements were met during the entire month in which the original DDU denial decision was made, and

- the individual is currently eligible.

. When eligibility is based on a life insurance offset (see Life Insurance Offset in Part 411, Life Insurance Offset) , begin financial assistance on the same day as medical assistance.

. When an eligibility determination is made after the 45-day or 90-day application processing periods (see PART 116 , APPLICATION PROCESSING TIME FRAMES ), financial assistance begins effective with the payment period of the month in which:

- the 45 th day fell, for OAA and ANB applicants; or

- the 90 th day fell, for APTD applicants.

Exception : When an eligibility decision is made after the 45 or 90 days application processing period because a decision could not be reached because the applicant or an examining physician delayed or failed to take a required action, or because there was an administrative or other emergency beyond DHHS' control, cash begins the first day of the semimonthly payment period in which SSP eligibility is determined after that 45 th or 90 th day, as long as SSP eligibility requirements are met at the time the first SSP benefit allotment is issued.

References : He-W 672.02, RSA 167:10, 42 CFR 435.912(a), (c), & (e)

(135-01-fair-hearing-requests-and-the-anp-aam)New Hampshire Adult Assistance Manual: 135.01 Fair Hearing Requests and the ANP#

(135-01-fair-hearing-requests-and-the-anp-aam)(block-1)135.01 Administrative Appeal Requests and the ANP (AAM)#

135.01 Administrative Appeal Requests and the ANP (AAM)

SR 13-12 Dated 9/13 Previous Policy

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If an individual requests an administrative appeal within *15 days from the date on the notice of the termination of APTD cash assistance , continue assistance at the pre-change level pending the appeal decision. If an individual requests an administrative appeal after the *15 days expire, or if there is no advance notice period (ANP), the termination or decrease takes effect on schedule.

Any benefits received during pending appeals is subject to recoupment if the Administrative Appeals Unit (AAU) does not find in favor of the individual.

Exception: Individuals whose APTD cash assistance was denied or terminated because the individual was denied Social Security Administration (SSA)-related benefits because the individual did not meet SSA medical criteria, can only continue to receive cash assistance at the pre-change level pending the AAU decision when the following criteria are met:

• The request for continued receipt of APTD cash assistance pending the appeal is received within 15 days from the date on the notice of the termination of APTD cash assistance; and

• Within that same 15-day period, the individual provides documentation signed and dated by a physician, physician’s assistant (PA), advanced practice registered nurse (APRN), or psychologist which in cludes the printed name of the health professional, the specialty of the health professional, and the address and phone number of the health professional, and states:

- that the individual’s medical condition has increased in severity during the 12 months prior to the date the individual requested the administrative appeal; or

- that the medical condition for which the SSA based the decision to deny the individual SSA benefits is unrelated to the medical information upon which the Disability Determination Unit (DDU) based the decision to approve the individual for APTD benefits.

Note : The statement from the physician, PA, APRN, or psychologist regarding a medical condition increasing in severity must specify the increase happened at some point within the last 12 months prior to the date the individual requested an administrative appeal. If the increasing severity of the medical condition happened over a period of time longer than 12 months, or at some point prior to 12 months, the individual cannot receive continued benefits while pending the appeal.

EXAMPLES : A physician, PA, APRN, or psychologist’s statement indicates that an individual’s medical condition has increased in severity:

• due to an incident which happened 13 months prior to the date the individual filed the administrative appeal. This individual would not be eligible for continued receipt of APTD cash benefits while the individual is waiting for the AAU decision because the incident happened more than 12 months prior to the date the individual filed the administrative appeal.

• over the course of the individual’s illness, which they have been suffering from over the past 5 years. This individual would not be eligible for continued receipt of APTD cash benefits while the individual is waiting for the AAU decision because the increase in severity happened over a period of time longer than 12 months prior to the date the individual filed the administrative appeal.

• 2 days prior to the individual’s submission of the request for an administrative appeal. This individual would be eligible for continued receipt of APTD cash benefits while the individual is waiting for the AAU decision because the incident happened less than 12 months prior to the date the individual filed the administrative appeal.

If the individual fails to provide the documentation above, or the documentation provided does not demonstrate that the requirements have been met, the individual is not eligibility for continued receipt of APTD cash assistance pending the appeal.

If the termination of APTD cash assistance is ultimately overturned at the appeals hearing:

• due to the individual’s medical condition having increased in severity during the 12 months prior to the date the individual requested the administrative appeal, provide the individual 30 days from the date the District Office receives the AAU decision to verify that the individual:

- has appealed the SSA denial; and

- has sent SSA the documentation regarding the increased severity of their medical condition.

• because the medical condition for which the SSA denied SSA benefits is not the medical condition for which the individual was approved APTD cash assistance, provide the individual 30 days from the date the District Office receives the AAU decision to verify that the individual:

- has reapplied for SSA benefits; and

- that the medical condition for which the individual has reapplied for SSA benefits is the same medical condition for which DDU approved the individual for APTD cash assistance.

If the individual fails to provide verification within 30 days, and APTD is then terminated, do not continue APTD cash assistance pending the appeal decision.

Any benefits received during pending appeals is subject to recoupment if the AAU does not find in favor of the individual.

(141-actions-on-changes-aam)New Hampshire Adult Assistance Manual: 141 ACTIONS ON CHANGES#

(141-actions-on-changes-aam)(block-1)141 ACTIONS ON CHANGES (AAM)#

141 ACTIONS ON CHANGES (AAM)

SR 14-17 Dated 09/14 Previous Policy

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When an individual reports a change in earned income:

· first attempt collateral contact. If collateral contact is successful, consider the reported information as verified and no further action is necessary.

· if collateral contact is unsuccessful, verify the reported change by using:

- information provided by the client, if the change is expected to decrease benefits. See PART 145 , CHANGES THAT DECREASE BENEFITS ; or

- standard verification procedures, if the change is expected to increase benefits. See PART 143 , CHANGES THAT INCREASE BENEFITS .

For other reported changes that have occurred , take all of the following actions:

· Record the reported change and the date;

· Redetermine eligibility by either:

- a desk review (see PART 153 , DESK REVIEWS ); or

- a full redetermination (see PART 155 , REDETERMINATION );

· Take action on the change within 10 working days;

· Notify the individual of any needed verifications because of the reported change, using New HEIGHTS-generated AE0055, Proof Needed to Determine Your Assistance . If New HEIGHTS is unavailable, use paper backup BFA Form 808, Proof Needed to Determine Your Assistance ;

· Allow the individual 10 calendar days from the date the change occurs to provide verification of the change; and

· Determine the effect of the change on the individual’s eligibility and benefits.

For other reported changes that are expected to occur , take all of the following actions:

· Record the reported change and the date the change is expected to occur; and

· Within 10 working days of the date the change was expected to occur, contact the individual to request verification of the change.

References : He-W 601.03; He-W 603.03; He-W 606.01; He-W 606.100; He-W 644.01; He-W 684.01;RSA 167:4-a; RSA 167:17; 45 CFR 206.10(a)(9)

(145-changes-that-decrease-benefits-aam)New Hampshire Adult Assistance Manual: 145 CHANGES THAT DECREASE BENEFITS#

(145-changes-that-decrease-benefits-aam)(block-1)145 CHANGES THAT DECREASE BENEFITS (AAM)#

145 CHANGES THAT DECREASE BENEFITS (AAM)

SR 03-33 Dated 09/03 Previous Policy

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When an individual reports a change in earned income that will reduce or terminate benefits:

. first attempt collateral contact. If collateral contact is successful, consider the reported information as verified and no further action is necessary; or

. if collateral contact is unsuccessful, verify the change using the information that the client provided. No additional paper verification is needed.

Exception : Standard verification procedures must be used for:

. changes in earned income discovered through the New Hire Match. Attempt collateral contact first but if it is unsuccessful, send DFA Form 756, Employment Verification , to the employer, and allow 10 days for the required verification; or

. insufficient or questionable client information which does not allow the FSS to verify the change based upon the client's statement.

For all other changes that will reduce or terminate benefits, take action as follows:

. Determine if the change will decrease or terminate benefits within 10 working days after the individual reports the change.

- Financial Assistance - Terminating cases receive only payments due prior to the expiration of the ANP. Decreasing cases receive the lower payment for the payroll in which the ANP expires.

- Medical Assistance - Terminations are effective the last day of the ANP. For Exceptions see P ART 161 , Termination of Medical Assistance, QMB, and SLMB . Decreases in level of eligibility are effective the day after the ANP expires.

If verification is not provided when the individual reports the change and you cannot determine if the result will be a decrease or termination, allow the individual 10 calendar days to provide verification of the change.

If verifications are not provided within the time frames, terminate the case.

Process a claim if an overpayment or overissuance occurs. See Parts 629 , Corrective Payments, and 631 , Recoupment of Financial Assistance .

(155-01-timely-notice-aam)New Hampshire Adult Assistance Manual: 155.01 Timely Notice#

(155-01-timely-notice-aam)(block-1)155.01 Timely Notice (AAM)#

155.01 Timely Notice (AAM)

SR 23-04 Dated 02/23 Previous Policy

_____________________________________________________________

Inform each individual of the need to review eligibility before benefits can be continued.

Notify individuals based on their household circumstances, that they are required to participate in a regularly scheduled redetermination via mail in, face-to-face/phone or online.

Face-To-Face/Phone Redetermination

A rede Interview letter , is sent to individuals who are required to participate in a face-to-face/phone redetermination and is generated by the 15 th of the month prior to the month the redetermination is due .

The letter advises the individual:

• of the date and time of the eligibility interview;

• that the individual must call to reschedule the interview if unable to attend the appointment and the individual wishes to continue receiving benefits; and

• of the effect on benefits for failure to attend;

The letter to the individual includes:

• BFA Form 775, Rental Verification Request ; and

• BFA Form 756, Employment Verification .

For a face-to-face/phone redetermination the individual must complete the BFA Form 800, Application for Assistance , or indicate any changes on the Eligibility Interview Summary (EIS) ; and participate in a face-to-face/phone interview.

Online or Mail-In Redetermination

Mail-In Redetermination

A mail-in redetermination package is sent to cases that are eligible for this type of redetermination by the 15th of the month prior to the month the redetermination is due.

The package includes:

• New HEIGHTS-generated CS0005, Mail-In Rede Letter ;

• a postage-paid business reply envelope;

• BFA Form 811R, Application: Your Rights and Responsibilities ; and

• BFA Form 800R, Application for Continued Eligibility for Financial, Medical, Child Care, and SNAP Benefits .

The letter advises the individual :

• of verifications needed to process the case;

• of the due date of the verification - 15th day of the last month of the redetermination period; and

• to contact the District Office if they have any questions.

Online Redetermination

Recipients with NH EASY accounts who are scheduled for what would usually be considered a mail-in redetermination are also eligible to complete their redetermination online.

If the NH EASY account holder ’ s redetermination method is "online", the online redetermination letter is generated by the 15th of the month prior to the month the redetermination is due.

The letter advises the individual:

• that household must complete the online Redetermination Application and send in all needed verifications by the 15th day of the following month;

• if the household does not complete the online redetermination process and/or provide all needed verifications by the due date, it will result in a termination of benefits;

• that the household may opt out of the online redetermination process and return to a mail-in redetermination process; and

• the household should contact the District Office if they have any questions.

The letter to the individual will also include:

• a postage-paid business reply Central Scanning Unit (CSU) envelope for the recipient to provide their verifications.

Individuals eligible to participate in the online or mail-in redetermination process are not required to participate in a face-to-face/phone interview. However, an interview must be granted if one is requested.

Exception: Require a face-to-face/phone interview for individuals who do not fully complete BFA Form 800R or do not complete the online Redetermination Application.

When verification is not sufficient or not provided in the online or mail-in redetermination process, send New HEIGHTS-generated AE0055, Proof Needed to Determine Your Assistance . If New HEIGHTS is unavailable, use paper backup BFA Form 808, Proof Needed to Determine Your Assistance .

References: He-W 606.01, He-W 606.100, He-W 644.01, He-W 684.01-.02, 45 CFR 206.10

(155-05-required-verification-for-redetermination-aam)New Hampshire Adult Assistance Manual: 155.05 Required Verification for Redetermination#

(155-05-required-verification-for-redetermination-aam)(block-1)155.05 Required Verification for Redetermination (AAM)#

155.05 Required Verification for Redetermination (AAM)

SR 23-04 Dated 02/23 Previous Policy

_____________________________________________________________

Notify the individual in writing with a verification checklist of any required information or verification needed to complete the redetermination and the due date for returning the verifications.

New HEIGHTS will generate a verification checklist anytime something is entered into the Application Entry screen, and is marked "Not Yet Verified", and eligibility is run.

If New HEIGHTS is unavailable, use the paper backup BFA Form 808, Proof Needed to Determine Your Assistance .

The individual must provide the required verification of all eligibility factors and circumstances requested, no later than 10 working days after the interview.

I f a personal interview is not required, no later than 10 working days after the required return date for DFA Form 771A, Nursing Facility Care Renewal, or BFA Form 800R, Application for Continued Eligibility for Financial, Medical, Child Care, and SNAP Benefits .

Terminate assistance if the individual refuses or fails to provide the required verifications within the time frame.

Exceptions :

• When a third party has not responded to a request for verification within the timeframe, send a follow-up request to the third party and to the individual. Allow an additional 10 working days for a response. If the verification is not provided within the second waiting period, terminate assistance unless the individual provides other acceptable verification.

• If assistance is being terminated due to lack of required verification and the individual provides the required verification within the advance notice period, stop the termination action and reinstate assistance.

Completion of Verification Requirements After the ANP Has Expired

If the assistance was terminated due to lack of verification and the individual provides all the required verification within the 10 days following the end of the advance notice period:

• have the individual fill out BFA Form 800, Application for Assistance , with their name, address, program of assistance, and signature;

• ensure that no other changes have occurred in the case that would affect eligibility and that no new program services have been requested on BFA Form 800 other than those which were originally terminated;

• if the individual meets all program eligibility requirements, reinstate assistance based on the new application date, with no new interview required; and

• generate financial benefits in accordance with PART 119 , BENEFIT DELIVERY TIME FRAMES .

References: He-W 837.01(s), He-W 606.01, He-W 606.100, RSA 167:83,II(c)-(d)

(222-home-and-community-based-care-for-in-home-supports-hcbc-ihs-aam)New Hampshire Adult Assistance Manual: 222 Home and Community Based Care for in-Home Supports (HCBC-IHS)#

(222-home-and-community-based-care-for-in-home-supports-hcbc-ihs-aam)(block-1)222 HOME AND COMMUNITY BASED CARE FOR IN-HOME SUPPORTS (HCBC-IHS) (AAM)#

222 HOME AND COMMUNITY BASED CARE FOR IN-HOME SUPPORTS (HCBC-IHS) (AAM)

SR 03-28 Dated 05/03 Previous Policy

_____________________________________________________________

Home and Community-Based Care for In-Home Supports (HCBC-IHS) offers a variety of community-based services that a developmentally disabled child who is under age 21 may need in order to prevent institutionalization. The Division of Developmental Services (DDS) determines if the individual has a developmental disability.

Developmentally disabled children who meet the categorical requirements of any Division of Human Services financial or medical assistance program may be eligible to receive community-based services if all of the following are met:

• the individual is under age 21;

• the individual ’ s income and resources are within the categorically or medically needy limits. See Chapter 601 , Income Limits ;

• DDS determines that the individual is eligible for area agency services;

• the DDS area agency establishes that the individual is appropriate for community-based services;

• the individual resides at home with their family, as determined by DDS;

• DDS determines that the individual has certain individual and/or caregiver factors which impede the caregiver ’ s ability to care for the child;

• DDS approves the individual service agreement and individualized budget which determine the costs of the needed HCBC-IHS services;

• DDS determines that in the absence of HCBC-IHS services, the individual would require placement in an intermediate care facility for the mentally retarded (ICF-MR); and

• the individual or their representative has chosen appropriate community-based care as an alternative to institutional care.

Exception: QMB, SLMB, and SLMB135 MA-only cases are not eligible for HCBC services.

(224-home-and-community-based-care-for-individuals-with-an-acquired-brain-disorder-aam)New Hampshire Adult Assistance Manual: 224 HOME AND COMMUNITY-BASED CARE (HCBC-ABD)#

(224-home-and-community-based-care-for-individuals-with-an-acquired-brain-disorder-aam)(block-1)224 HOME AND COMMUNITY-BASED CARE FOR INDIVIDUALS WITH AN ACQUIRED BRAIN DISORDER (HCBC-ABD) (AAM)#

224 HOME AND COMMUNITY-BASED CARE FOR INDIVIDUALS WITH AN ACQUIRED BRAIN DISORDER (HCBC-ABD) (AAM)

SR 03-04 Dated 01/03 Previous Policy

_____________________________________________________________

Home and Community-Based Care for Individuals with an Acquired Brain Disorder (HCBC-ABD) offers a variety of community-based services that an individual with an acquired brain disorder may need in order to prevent institutionalization. The Division of Developmental Services (DDS) determines if the individual has an acquired brain disorder. The criteria are provided below only for informational purposes.

An acquired brain disorder is a non-congenital condition affecting the brain or nervous system and presents a severe lifelong disabling condition that impairs a person's ability to function in society. To be considered an acquired brain disorder, the disorder or insult must have happened before age 60 and be due to one or more of the following:

• physical trauma due to a car, motorcycle, bicycle, or other related physical trauma or occurrence;

• an infectious disorder such as encephalitis or meningitis;

• anoxia (lack of oxygen to the brain);

• demyelinating (causing destruction of the myelin, the fatty substance which shields the nerves) and other inflammatory diseases such as multiple sclerosis; or

• other related disorders such as Huntington ’ s disease.

Individuals who meet the program categorical requirements of any DFA financial or medical assistance program may be eligible to receive community-based services if all of the following are met:

• individual is age 22 or older;

• individual ’ s income and resources are within the categorically or medically needy limits. See Part 601 , Income Limits;

• DDS area agency establishes that the individual is appropriate for services;

• DDS determines the individual has a medical necessity to receive skilled nursing or a rehabilitative level of care. See the Medical Assistance Manual , Item 955 ; and

• individual or their representative has chosen appropriate community-based care as an alternative to institutional care.

Exception: QMB, SLMB, and SLMB135 * MA only cases are not eligible for HCBC services.

(301-01-absence-from-new-hampshire-aam)New Hampshire Adult Assistance Manual: 301.01 Absence from New Hampshire#

(301-01-absence-from-new-hampshire-aam)(block-1)301.01 Absence from New Hampshire Temporary (AAM)#

301.01 Absence from New Hampshire Temporary (AAM)

SR 16-06 Dated 01/16 Previous Policy

__________________________________________________________________

Benefits are not affected by a temporary absence from New Hampshire. A temporary absence is when an individual or assistance group is out of the state but intends to keep New Hampshire as their residency and return to the state as soon as the reason for the absence is complete.

Examples of temporary absence include visiting: vacationing, temporary hospitalization, rehabilitation services, and school attendance.

Evaluate residency status in questionable cases or when an individual has been absent from New Hampshire longer than 30 days without notifying the department.

Examples of questionable residency situations include: recurring out-of-state EBT card transactions, out-of-state home ownership or rental, or use of a PO Box, rural route address, or general delivery address to receive mail.

If residency is questionable, evaluate information in the individual’s case and from outside information received about the household circumstances or call the individual. Things to consider are:

• reason for the absence;

• duration and frequency of absence(s);

• where personal and household possessions are kept;

• where the individual votes or pays resident taxes;

• place of employment;

• future plans; and

• in general, all factors which would establish a place of residency.

NOTE : Any one of above examples by itself is not proof that the individual is not a New Hampshire resident.

A written statement that is dated and signed from the individual is sufficient to document their residency unless there is conflicting evidence. If after evaluation residency remains doubtful, mail New HEIGHTS-generated AE0055, Proof Needed to Determine Your Assistance, (or paper backup BFA Form 808, Proof Needed to Determine Your Assistance, if New HEIGHTS is unavailable) to the client to request verification of residency. Enter an expected change in New HEIGHTS to check for verification in 10 days. If the individual does not respond within 10 days or provides insufficient information, deny or close the case.

Example : An FSS receives information that Stuart, who is receiving APTD financial assistance, owns a house in Florida despite his claiming New Hampshire residency. This prompts the FSS to assess other factors. The FSS calls Stuart, but Stuart does not answer. The FSS immediately mails Stuart the New HEIGHTS-generated AE0055, Proof Needed to Determine Your Assistance, to request verification of residency. Stuart submits proof that he does own a house in Florida, and this house is an excluded resource. He also submits proof from his landlord in New Hampshire verifying that he lives in his rental apartment for 10 months out of the year and returns to New Hampshire after his out-of-state visits. The FSS determines that, based on this information, Stuart’s New Hampshire residency is not questionable. The FSS reminds Stuart to notify DHHS anytime he plans to leave New Hampshire for more than 30 days.

For individuals who move out of New Hampshire permanently, financial assistance is to be closed immediately with no ANP.

References: He-W 601.06; He-W 601.07; He-W 601.08; He-W 606.10; He-W 606.11; He-W 618.02; He-W 699.02; RSA 21:6; RSA 167:6, I; RSA 167:6, V; RSA 167:78, XXIV; 42 CFR 435.403

(305-05-verification-of-citizenship-aam)New Hampshire Adult Assistance Manual: 305.05 Verification of Citizenship and Identity#

(305-05-verification-of-citizenship-aam)(block-1)305.05 Verification of Citizenship and Identity (AAM)#

305.05 Verification of Citizenship and Identity (AAM)

SR 15-07 Dated 01/14 Previous Policy

__________________________________________________________________

Verify citizenship and identity of each assistance group (AG) member at the initial determination of eligibility. For noncitizens, also verify citizenship status at each redetermination.

For most individuals, citizenship and identity are verified via an electronic data crossmatch process through the Social Security Administration (SSA), which uses the individual’s SSN, name, and date of birth to verify citizenship and identity information.

• If the SSA crossmatch fails to verify citizenship and identity, or the individual is unable or is not required to provide a SSN, other acceptable documentary proof of citizenship and identity must be provided.

The documents detailed in the chart below are considered the only acceptable forms of proof for citizenship and identity when applying for most categories of financial assistance.

NOTE: Also see the list of individuals who are exempt from these requirements below.

Citizenship and identity documents that are photocopied, faxed, scanned or copied in another manner (photograph) are considered valid proofs, unless the information on the copied document is inconsistent with other available information or the validity of the copy is questionable. The copied document does not have to be notarized.

PROOFS THAT VERIFY BOTH CITIZENSHIP and IDENTITY NO OTHER PROOF IS NEEDED TO VERIFY CITIZENSHIP AND/OR IDENTITY IF ONE OF THE DOCUMENTS IN THIS TOP SECTION IS SUBMITTED US Passport or US Passport Card (valid or expired if it was issued without limitation) Certificate of Naturalization Certificate of US Citizenship “Enhanced” State Driver’s License (From a state that verifies US Citizenship before issuing the license. License must say “Enhanced Driver License”) Documents issued by a federally recognized Indian Tribe Verification of Citizenship via a Federal or Another State Agency (If done after 7/1/06)

To verify CITIZENSHIP , an individual can submit: 1 Citizenship Document from Column A along with 1 Identity Document from Column B .

COLUMN A CITIZENSHIP DOCUMENTS COLUMN B IDENTITY DOCUMENTS • US Birth Certificate from one of the 50 states and DC; or PR, Guam, USVI, American Samoa, Swain’s Island, or CNMI (some date restrictions apply) • Certification of Report of Birth of US Citizen • Report of Birth Abroad of US Citizen • Certification of Birth • Birth Record Documented by Cross-Match with State Vital Statistics • US Citizen ID Card • Picture Driver’s License (issued only by US state or territory) • Picture School ID • US Military or Draft Card • State, Federal, or local government ID Card • Certificate of Degree of Indian Blood or Tribal Document with Picture • Military Dependent ID Card • US Coast Guard Merchant Marine Card • Northern Marianas ID Card (birth prior to 11/4/86) • Evidence of US Civil Service Employment (if employed prior to 6/1/76) • Final Adoption Decree (With child’s name and US birthplace, if the adoption is not final, a statement from a state approved adoption agency showing the child’s name and US birthplace.) • US Military Record (showing US birthplace) • Data Verification with SAVE Program (or other Dept. of Homeland Security verification process) • Proof of a child meeting the requirements in Section 101 of the Child Citizenship Act of 2000 • Hospital, clinic, doctor, nursing facility, skilled care facility or other medical institution records showing US birthplace. • Life, health, or other insurance records indicating a US place of birth. • Voter’s Registration Card • Proof of Identity Verified by a Federal or State Gov’t. Agency, such as: A Public Assistance, Law Enforcement, Internal Revenue, Tax Bureau, or Corrections Agency • 2 or more documents together , having the individual’s name, and consistent identifying information, such as: - Employer ID Cards - High School/HS Equivalency or College diplomas - Marriage Certificates - Divorce Decrees - Property Deeds/Titles • Official religious documents, recorded in the US, showing a US birthplace • Pre-school, school, Head Start or daycare records with child’s name and US birthplace • Federal or state census record showing US citizenship or US birthplace Special Identity Rules for Children Aged 19 and Younger: Clinic, doctor, hospital or school records, including nursery/daycare records or report cards. If citizenship documents listed above are not available, the individual can submit an affidavit to prove citizenship. It must be signed, under penalty of perjury, by another person who can attest to the individual’s citizenship. The affidavit must contain the individual’s name, date of birth, and US place of birth. It does not have to be notarized. If the above identity documents are unavailable, an individual can submit an affidavit, signed under penalty of perjury, by another person who can attest to the individual’s identity. The affidavit must contain the individual’s name and other identifying information, such as age, sex, race, height, weight, eye color or address. It does not have to be notarized. Individuals must be assisted in obtaining acceptable documentary evidence of citizenship, if assistance is needed.

Exceptions to the Above Citizenship & Identity Requirements:

The following individuals are exempt from the more restrictive identity and citizenship requirements described above:

· individuals who are entitled to or enrolled in Medicare (Part A, Part B, or Part D, for example);

· individuals who receive SSI, verified via the SDX;

· individuals who receive SSDI;

· newborn infants born to women who are current Medicaid recipients. Consider newborns who meet this criteria to have met citizenship and identity requirements at birth. No further proof is needed at subsequent redeterminations. This group includes children whose births were covered by Emergency Medicaid for Non-Citizens; and

· children receiving either Title IV-B services or Title IV-E adoption or foster care payments.

These exempted individuals can verify:

· citizenship with acceptable forms of proof such as birth or hospital records, voter registration cards, U.S. passport, and INS documentation which certifies citizenship or naturalization; and

· identity using any document that reasonably establishes the individual’s identity. If no document is available, use a collateral contact.

If an individual refuses or fails to verify citizenship and/or identity, deny or terminate financial assistance for the entire AG.

Exception: If applicants for financial assistance meet all other program eligibility requirements and the inability to verify citizenship and/or identity is the only reason that prevents a determination of eligibility for the applicant household because:

· the SSA data crossmatch failed to verify the applicant’s citizenship and/or identity; or

· the applicant is unable to provide citizenship and/or identity documentation; or

· the applicant is unable or not required to provide a SSN …

… do not automatically deny assistance. Instead, allow the applicant 95 days from the date on the notice of decision (NOD) to provide the required citizenship and/or identity documentation.

· For applicants who are able to use the SSA data crossmatch, the NOD is the New HEIGHTS-generated DX0011, Citizenship Verification Request .

· For applicants who are not able to use the SSA data crossmatch, the NOD is the generic open notice for financial or medical assistance.

If the required documentation is not provided within 95 days from the date on the NOD, terminate financial assistance for the entire AG.

References : He-W 601.02; He-W 606.02, He-W 606.28, 42 CFR 435.406-407, 45 CFR 233.50, 8 USC 1611-1613

Editorial Revisions Made: 11/2023

(305-07-determining-qualified-alien-status-aam)New Hampshire Adult Assistance Manual: 305.07 Determining Qualified Alien Status#

(305-07-determining-qualified-alien-status-aam)(block-1)305.07 Determining Qualified Alien Status (AAM)#

305.07 Determining Qualified Alien Status (AAM)

SR 24-29 Dated 10/24 Previous Policy

__________________________________________________________________

To be eligible, noncitizens must first be qualified aliens.

Exception: Certain Native Americans and victims of trafficking are eligible for financial assistance regardless of whether they are qualified aliens. See Part 305.09 , Eligibility for Certain Qualified Aliens.

A qualified alien is an individual who, at the time the individual applies for, receives, or attempts to receive assistance, is a(n):

• lawfully admitted permanent resident under the Immigration and Nationality Act (INA);

• asylee granted such status under section 208 of the INA;

• refugee admitted to the U.S. under section 207 of the INA;

• noncitizen whose deportation is being withheld under section 243(h) of the INA ( Note : after April 1, 1997, withholding of deportation is under section 241(b)(3));

• parolee paroled into the U.S. under section 212(d)(5) of the INA for a period of at least 1 year;

• conditional entrant into the U.S. under section 203(a)(7) of the INA as in effect prior to April 1, 1980;

• Cuban or Haitian entrant under section 501(e) of the Refugee Education Assistance Act;

• Amerasian immigrant under section 584 of the Foreign Operations, Export Financing, and Related Programs Appropriations Act of 1988 (usually the children of Vietnamese women and Americans present in Vietnam during the Vietnam War era);

• noncitizen who is or has been battered or subjected to extreme cruelty while residing in the U.S. by that person’s spouse, or by another member of the spouse’s family residing in the same household as the parent and the spouse acquiesced or consented to such battery or cruelty; or the noncitizen child of a battered parent;

• veteran or active in military service , including noncitizens on active military duty in the Armed Forces of the U.S., honorably discharged veterans who have met the minimum active duty commitment (24 months or the time period for which they were called to active duty), and their spouses or unremarried surviving spouses (if the individual is deceased), unmarried dependent children under 18 years of age, and Philippine nationals who served in the Philippine Commonwealth Army during WWII or as Philippine Scouts following WWII; or

• COFA Migrant: an individual who lawfully resides in the United States who has citizenship from the Federated States of Micronesia, the Republic of the Marshall Islands, or the Republic of Palau in accordance with the Compact of the Free Association (COFA).

All other non-citizens are ineligible for State Supplemental financial assistance benefits regardless of entry into the US or U.S. Citizenship and Immigration Services (USCIS) Bureau of Citizenship and Immigration Services (BCIS) status.

References : He-W 606.02, He-W 616.02, 42 CFR 435.406-407, 42 CFR 435.1008, 45 CFR 233.50, 8 USC 1611-1613, 8 USC 1641

(305-09-eligibility-for-certain-qualified-aliens-aam)New Hampshire Adult Assistance Manual: 305.09 Eligibility for Certain Qualified Aliens#

(305-09-eligibility-for-certain-qualified-aliens-aam)(block-1)305.09 Eligibility for Certain Qualified Aliens (AAM)#

305.09 Eligibility for Certain Qualified Aliens (AAM)

SR 01-24 Dated 08/01 Previous Policy

__________________________________________________________________

Qualified aliens may be eligible for benefits on either an unrestricted or a time-limited basis, depending on type of qualified alien status, or date of entry into the U.S.

Unless specifically mentioned in Section 305.11 , Qualified Aliens Eligible Without Restriction , or 305.13 , Qualified Aliens with Restricted Eligibility Based on Date of Entry into the U.S. , consider the alien to be ineligible.

Exceptions:

· Victims of Trafficking : Non-citizens who have been certified as a victim of trafficking by the Office of Refugee Resettlement (ORR), and who do not meet the definition of qualified alien, may still be eligible if the individuals were admitted to the U.S. as refugees . See Section 305.11 , Qualified Aliens Eligible Without Restriction , for a description of the eligibility status of refugees. Certified victims of trafficking must meet all other eligibility criteria for a program of assistance in order to receive benefits.

· Native Americans : Native Americans who are members of an Indian tribe as defined in section 4(e) of the Indian Self-determination and Education Assistance Act [25 USC 450(e)], or were born in Canada and are covered under the provisions of section 289 of the Immigration and Nationality Act (8 USC 1359) are eligible for financial and/or medical assistance, regardless of qualified alien status. Canadian-born Indians must have at least 50% American Indian blood.

References : He-W 601.01; He-W 601.05; He-W 606.02; He-W 616.02; 8 CFR 1.2; 8 CFR 101.1; 8 CFR 215.1(a); 45 CFR 233.50; 42 USC 1320b-7(d); 8 USC 1158; 8 USC 1255; 8 USC 1611-1613; 8 USC 1641

Editorial Revisions Made: 11/2023

(305-15-documentation-of-bcis-status-aam)New Hampshire Adult Assistance Manual: 305.15 Documentation of USCIS Status#

(305-15-documentation-of-bcis-status-aam)(block-1)305.15 Documentation of USCIS Status (AAM)#

305.15 Documentation of USCIS Status (AAM)

SR 04-30 Dated 05/04 Previous Policy

__________________________________________________________________

Require non-citizens to provide United States Citizenship and Immigration Services (USCIS) documentation of qualified alien status.

Types of USCIS non-citizen documentation include:

· Notifications on USCIS letterhead;

· U.S. stamps on passports; or

· USCIS computer-printed fee receipts.

Non-citizens may also present documentation not issued by USCIS. Verify all non-citizen documentation following the Verification Information System (VIS) verification procedures outlined in Section 305.17 , Verification of Qualified Alien Status .

Exception: If an individual currently receives Social Security, Supplemental Security Income (SSI) or Medicare benefits, and was approved for the same on or after August 22, 1996, this will be accepted as proof of citizenship or qualified alien status.

Non-citizens claiming qualified alien status due to battering or extreme cruelty must provide verification that:

· violence occurred while the individual was residing in the United States;

· the batterer was the spouse or parent of the battered non-citizen, or the non-citizen child’s parent was the subject of the battering;

· the battered spouse or child was residing with the batterer at the time of the incident(s); and

· the battered individual no longer resides with the batterer.

Accept any reasonable evidence of physical violence against the individual, such as:

· police reports;

· information from medical or school personnel;

· photographs; or

· signed statements from individuals familiar with the situation.

References : He-W 601.01; He-W 601.05; He-W 606.02; He-W 616.02; 8 CFR 1.2; 8 CFR 101.1; 8 CFR 215.1(a); 45 CFR 233.50; 42 USC 1320b-7(d); 8 USC 1158; 8 USC 1255; 8 USC 1611-1613; 8 USC 1641

Editorial Revisions Made: 11/2023

(305-17-verification-of-qualified-alien-status-aam)New Hampshire Adult Assistance Manual: 305.17 Verification of Qualified Alien Status#

(305-17-verification-of-qualified-alien-status-aam)(block-1)305.17 Verification of Qualified Alien Status (AAM)#

305.17 Verification of Qualified Alien Status (AAM)

SR 04-30 Dated 5/04 Previous Policy

__________________________________________________________________

The United States Citizenship and Immigration Services (USCIS) maintains various databases on non-citizens in the U.S. Verify the accuracy of documents provided by the non-citizen against USCIS data using the Verification Information System (VIS) primary and secondary verification process.

Primary verification: To initiate primary verification, access VIS through the Internet and follow the instructions on each screen.

Secondary verification: Perform secondary verification procedures when:

· the initial System Response in VIS indicates "Institute Additional Verification"; or

· the information in the VIS Initial Results section does not match the information on the documents provided by the non-citizen.

If requested, provide USCIS with copies of the needed documents and USCIS Form G-845, Verification Request. Attach photocopies of the front and back of all pages of the non-citizen's original documents.

The following chart lists common USCIS documents.

COMMON USCIS DOCUMENTS DOCUMENT DESCRIPTION AND NON-CITIZEN STATUS I-94 - Arrival-Departure Record Issued to most non-citizens upon entry into the U.S. It is attached to an unexpired foreign passport. Often it includes neither an A-number nor a photograph. It also may contain entries such as the following: • Section 203(a)(7)- Conditional Entry • Section 207- Refugee • Section 208- Asylee • Section 212(d)(5)- Parolee • Cuban/Haitian Entrant • Amerasian Immigrant (may have codes AM1, 2, 3 or AM 6, 7, or 8) I-151 (Obsolete) - Alien Registration Receipt Card (Also called "Green Card") Issued to lawful permanent residents prior to June 1978. This form is no longer issued. Although no longer acceptable as verification of lawful permanent resident status, an expired I-151 does not indicate lack of permanent resident status. Encourage the individual to contact BCIS, 1-800-375-5283, for instructions on how to replace the I-151 card with the current I-551 card. I-327 - Reentry Permit Issued to lawful permanent residents (lawful immigrants) before they leave the U.S. for a one- to two-year period. The document bears an expiration date. I-551 - Permanent Resident Card (also called "Green Card" although it is no longer green) Issued to lawful permanent residents after June 1978. Valid indefinitely. Replaced previous Form I-151, which is no longer valid as of 3/20/96. Also known as the "Alien Registration Receipt Card." • Also issued to conditional residents, such as non-citizen spouses of U.S. citizens or lawful residents. When this is the case, the form is only valid until the expiration date on the back. Annotated "CR." I-571 - Refugee Travel Document Issued to non-citizens who have been granted refugee status. This document contains an expiration date. N-560A - Certificate of naturalization Issued for babies verified by USCIS as born to U.S. citizens overseas.

References: He-W 601.01; He-W 601.05; He-W 606.02; He-W 616.02; 8 CFR 1.2; 8 CFR 101.1; 8 CFR 215.1(a); 45 CFR 233.50; 42 USC 1320b-7(d); 8 USC 1158; 8 USC 1255; 8 USC 1611-1613; 8 USC 1641

Editorial Revisions Made: 11/2023

(307-institutions-aam)New Hampshire Adult Assistance Manual: 307 INSTITUTIONS#

(307-institutions-aam)(block-1)307 INSTITUTIONS (AAM)#

307 INSTITUTIONS (AAM)

SR 08-03 Dated 01/08 Previous Policy

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An institution is an establishment furnishing food, shelter, and some treatment or services to two or more persons unrelated to the proprietor. Residential care facilities, community residences, shelters for the homeless and battered women, and drug or alcohol treatment centers are not institutions.

Individuals who are inmates of public institutions or patients in institutions for tuberculosis or mental diseases, are not eligible for benefits.

Exceptions : All of the following institutionalized individuals may be eligible for adult category financial assistance, if all other eligibility requirements are met:

· individuals at public institutions who physically reside outside the institution, even if they are under the general supervision of the institution. This includes residents of the three NH Department of Corrections (DOC) Transitional Housing Units (THU) [Calumet THU, North End THU, and Shea Farm THU], and individuals who are on work release or home confinement;

· individuals who are admitted to the New Hampshire Hospital, including the Anna Philbrook Center, for purposes of evaluation only, for a period not to exceed 3 months;

· inmates of NH Correctional Facilities who become inpatients of a medical facility while they are still incarcerated;

· adults in residential care facilities and community residences;

· individuals under age 22 or age 65 or older, and hospitalized at a Designated Receiving Facility. Eligibility is determined differently depending on the actual or anticipated length of stay. See Section 307.01 , Individuals in Designated Receiving Facilities;

· patients at the psychiatric unit of the Dartmouth - Hitchcock Medical Center;

· children in licensed foster homes, group homes, nonprofit private child care institutions, or public child care institutions with less than 25 children; and

· children participating in the special education program at the Sununu Youth Services Center (DCYF/DJJS).

References : He-W 601.06; He-W 606.18; He-W 624.01; RSA 167:79,IV(b); 42 CFR 435.1009 - 435.1010

Editorial Revisions Made: 11/2023

(311-01-relatives-ability-to-contribute-aam)New Hampshire Adult Assistance Manual: 311.01 Relative's Ability to Contribute#

(311-01-relatives-ability-to-contribute-aam)(block-1)311.01 Relative's Ability to Contribute (AAM)#

311.01 Relative's Ability to Contribute (AAM)

SR 26-03 Dated 03/26 Previous Policy

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To evaluate whether a liable relative is able to contribute to the support of an applicant or recipient of financial assistance, consider the following:

• Number of Legal Dependents

The number of legal dependents claimed by the liable relative for IRS purposes

Note: the applicant or recipient is not included as a legal dependent, even if residing with the relative.

• Gross Annual Income

If self-employed, deduct cost of doing business.

• Allowable Deductions

Certain expenses may be deducted from gross annual income before assessing liability or contribution amount. These may include:

o Unreimbursed or unreimbursable medical costs

o Educational expenses

o Court-ordered support or alimony payments

o Repayments, including garnishments, or prior indebtedness

o Business related costs for self-employed individuals

o Exceptional expenses that affect health, safety, or prevent homelessness

Examples include : home repairs, back taxes, transportation for medical services; expenses related to natural disasters such as floods, fires, earthquakes and hurricanes; and expenses resulting from manmade events such as theft of clothing, food or money, eviction, or loss of an owned residence.

Note: All exceptional expenses require written approval from a supervisor.

• Income Threshold Table

The table below is used to assess whether a liable relative has enough income, after allowable deductions, to contribute to the individual.

Legally Liable Relative plus Number of Legal Dependents (excluding the applicant or recipient) Adjusted Gross Annual Income (200% of FPG) (Gross income minus allowable deductions) 1 $31,920 2 $43,280 3 $54,640 4 $66,000 5 $77,360 6 $88,720 7 $100,080 8 $111,440 For each additional dependent add: $11,360

The liable relative’s required contribution is calculated by comparing their gross annual income minus any approved expenses to the amounts listed in the table:

· If their adjusted gross income is less than or equal to the table amount, no contribution is required .

· If their adjusted gross income is greater than the table amount, they must contribute at least 10% of the amount exceeding the table value .

References : He-W 601.05; He-W 622.01(c); RSA 167:3; 42 USC 9902(2)

(315-09-aptd-verification-requirements-for-ssa-denial-aam)New Hampshire Adult Assistance Manual: 315.09 APTD Verification Requirements for SSA Denial#

(315-09-aptd-verification-requirements-for-ssa-denial-aam)(block-1)315.09 APTD Verification Requirements for SSA Denial (AAM)#

315.09 APTD Verification Requirements for SSA Denial (AAM)

SR 13-12 Dated 07/13 Previous Policy

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Aid to the Permanently and Totally Disabled (APTD) applicants and recipients who are denied Social Security Administration (SSA)-related benefits due to not meeting SSA medical disability criteria are not eligible for an APTD cash grant if the SSA denial

. occurred within the 12 months prior to the individual's application date for APTD cash; or

� occurs any time after the individual's application date for APTD cash.

Eligibility for APTD medical assistance remains unchanged.

This policy is applied differently based on the individual's APTD cash recipient status as of June 30, 2011.

For individuals who were not recipients of APTD cash assistance on June 30, 2011, - which means individuals who were pending APTD cash assistance before July 1, 2011, individuals who applied on or after July 1, 2011, or individuals who began to receive APTD cash assistance on or after July 1, 2011 - APTD cash assistance is denied or terminated:

. upon the first denial of SSA-related benefits due to not meeting the SSA medical criteria, if that denial occurred within 12 months prior to the individual's application for APTD cash assistance, or any time after the individual's application date for APTD cash; or

. if the individual fails to provide the required proof of the SSA denial, as described below, within timeframes.

For individuals who were open and receiving APTD cash assistance as of June 30, 2011 , APTD cash assistance is terminated:

. upon the second denial of SSA-related benefits due to the APTD recipient not meeting SSA medical criteria, when the following criteria are met:

- only one denial from prior to July 1, 2011 may be used, as long as that denial occurred between the 12 months prior to the individual's application date and June 30, 2011; and

- at least one denial must be made any time after July 1, 2011. Note: If no denials occurred between the 12 months prior to the individual's application date and June 30, 2011, then both denials must come on or after the July 1, 2011 date before APTD cash may be terminated; or

. if the individual fails to provide the required proof, as described below, within timeframes.

Verification Requirements for Individuals Who Apply for APTD Cash Assistance On or After July 1, 2011 or Begin to Receive APTD Cash Assistance On or After July 1, 2011

All individuals who are pending APTD cash assistance before July 1, 2011, apply for APTD cash assistance on or after July 1, 2011 or begin to receive APTD cash assistance on or after July 1, 2011 must provide a copy of the SSA letter which describes why the individual was denied SSA-related benefits by SSA, if their application for those benefits is subsequently denied. If the SSA-related benefits are approved, the individual must provide proof of the benefit amount that they will be receiving, per current policy.

Verification Requirements for Individuals Who Were Open and Receiving APTD Cash Assistance on June 30, 2011

Individuals who were open and receiving APTD cash assistance on June 30, 2011 must provide the following proof:

. the reason SSA denied their application for SSA-related benefits;

. how many times the individual has appealed SSA ' s decision to deny the SSA-related benefits; and

. the reason SSA has denied each of the appeals, if there has been more than one appeal.

Terminate APTD cash assistance if verification is not received within timeframes.

Verification requirements applicable to all APTD-eligible individuals whose APTD cash grant is denied or terminated because SSA denied SSA-related benefits due to the individual not meeting SSA medical criteria, or because the individual failed to provide required proof within timeframes.

If the Department has denied or terminated an individual ' s APTD cash grant due to the individual not meeting the SSA medical criteria, or because the individual did not give the Department the required verification timely, the individual may reapply for APTD cash, BUT they are to be denied for APTD cash assistance each time they apply until the individual provides the proof described below.

. APTD applicants or recipients whose APTD cash benefits have been denied or terminated because SSA denied SSA-related benefits due to the individual not meeting SSA medical criteria, may have their eligibility for APTD cash benefits reconsidered only if the APTD cash applicant or recipient provides proof that their appeal of the SSA decision denying the SSA-related benefits due to not meeting the SSA medical criteria, has been successful. This proof should be apparent in that the individual has been determined by SSA to have met their medical criteria and the individual will now be receiving an SSA-related benefit. Individuals are ineligible for APTD cash assistance until proof that a SSA-related benefit has been approved is provided .

. For those individuals who were denied APTD cash for failing to provide the required proof within timeframes, eligibility for APTD cash benefits may be reconsidered only if the APTD cash applicant or recipient provides proof that they were denied SSA-related benefits for another reason other than not meeting the SSA medical criteria. In this case, the individual must still provide all required proof described above and in PART 315 in total (as the regular Developing Potential Sources of Income policy still applies), including why the individual was denied SSA-related benefits, proof they have appealed the SSA decision, and that they are complying with all SSA application requirements (including the SSA application or process requirement that resulted in their denial), before eligibility for APTD cash assistance can be reconsidered. Individuals are ineligible for APTD cash assistance until this proof is provided .

If the individual provides all required proof after being terminated or denied APTD cash, and is then determined eligible for APTD cash based on the proof provided, the APTD cash grant is issued:

- according to the policy in Section 109.09 , Reuse of Forms 800, 800HR, and 800Q After Denial or Closing ; or

- the next semi-monthly payment period in which APTD cash eligibility was determined from the submitted proof.

315.09 APTD Verification Requirements for SSA Denial (AAM)

(315-11-denial-or-termination-of-assistance-aam)New Hampshire Adult Assistance Manual: 315.11 Denial or Termination of Assistance#

(315-11-denial-or-termination-of-assistance-aam)(block-1)315.11 Denial or Termination of Assistance (AAM)#

315.11 Denial or Termination of Assistance (AAM)

SR 13-12 Dated 07/13 Previous Policy

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Deny or terminate financial assistance for the entire assistance group (AG) and deny or terminate medical assistance for all adults in the AG if any individual in the AG who is potentially eligible for other income or benefits refuses or fails to:

. apply or complete the application process for the other income or benefit(s);

. provide information or verification to obtain the other income or benefit(s);

. cooperate with the eligibility-determining agencies or individuals responsible for the other income or benefit(s);

. meet the application timeframes described Section 315.03 , Application Requirements for Developing Potential Sources of Income , or set by the eligibility-determining agencies or individuals responsible for the other income or benefit(s);

. pursue all appeal options, up to, but not including, court action, if found ineligible for the other income or benefit due to medical reasons; or

. accept the other income or benefit(s) for which they may be eligible.

Deny or terminate Aid to the Permanently and Totally Disabled (APTD) financial assistance when:

. an individual applies for an APTD cash grant on or after July 1, 2011 and has been denied Social Security Administration (SSA)-related benefits due to not meeting SSA medical disability criteria within 12 months prior to the individual's application date, or any time after the individual's application date. Eligibility for APTD medical assistance remains unchanged;

. an individual's application for an APTD cash grant is pending on or after July 1, 2011 and the individual has been denied SSA-related benefits due to not meeting SSA medical disability criteria within 12 months prior to the individual's application date, or any time after the individual's application date. Eligibility for APTD medical assistance remains unchanged;

. an individual was receiving an APTD cash grant as of June 30, 2011 and has been denied Social Security Administration (SSA)-related benefits for a second time due to not meeting SSA medical disability criteria, as long as the following criteria were met:

- only one denial from prior to July 1, 2011 may be used, as long as that denial occurred between the 12 months prior to the individual's application date and June 30, 2011, and

- at least one denial must have occurred any time after July 1, 2011. Note : If no denials occurred between the 12 months prior to the individual's application date and June 30, 2011, then both denials must come on or after the July 1, 2011 date before APTD cash may be terminated.

Eligibility for APTD medical assistance remains unchanged; or

. any APTD financial assistance applicant or recipient does not provide the required proof from SSA within timeframes

If the Department has denied or terminated an individual ' s APTD cash grant due to the individual not meeting the SSA medical criteria, or because the individual did not give the Department the required verification timely, the individual may reapply for APTD cash, BUT they are to be denied until the individual provides the proof described in Section 315.09 , APTD Verification Requirements for SSA Denial .

(317-03-reimbursement-medical-assistance-for-non-institutionalized-individuals-aam)New Hampshire Adult Assistance Manual: 317.03 Reimbursement - Medical Assistance for Non-Institutionalized Individuals#

(317-03-reimbursement-medical-assistance-for-non-institutionalized-individuals-aam)(block-1)317.03 Reimbursement - Medical Assistance for Non-Institutionalized Individuals (AAM)#

317.03 Reimbursement - Medical Assistance for Non-Institutionalized Individuals (AAM)

SR 11-43 Dated 11/11 Previous Policy

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Inform all non-institutionalized applicants for medical assistance under the OAA, ANB, MEAD, BCCP, and APTD programs:

. of DHHS ' s obligation to recover from their estate for medical assistance received by recipients age 55 and older;

. that for the purposes of recovery of medical assistance, a recipient ' s "estate" includes:

- all property, real or personal, in which the recipient holds an interest on the date of the recipient ' s death. Such interests include joint tenancy with rights of survivorship, tenancy in common, life estates, and living trusts, without regard to the date that such title or interest was established; and

- both assets that pass through probate and assets that pass outside the probate process, such as certain trust assets, assets held jointly, and unpaid annuity balances that benefit the recipient;

. that DHHS will only pursue recovery from the recipient ' s assets;

. that DHHS will only pursue recovery after the recipient ' s death, unless the property is voluntarily sold or refinanced while a lien is in place;

. that if DHHS ' s pursuit of recovery would cause undue hardship to the recipient ' s heirs, a waiver is available when recovery action begins;

. that DHHS will pursue recovery from the recipient ' s estate, but only if the recipient has no surviving spouse, child who is under age 21 years, or child who is blind or permanently and totally disabled; and

. that recovery is limited to the actual amount paid on behalf of the recipient from age 55 and older.

Exception : If benefits were incorrectly paid, recoupment of the erroneous payment can be required while the recipient is alive or regardless of the above criteria for recovery. See PART 633 , RECOUPMENT OF MEDICAL ASSISTANCE .

Inform the individual or the ANB child ' s parents of DHHS ' s recovery obligations and the recipient ' s rights and responsibilities with DFA Form 770, Reimbursement Agreement and Acknowledgment . Failure or refusal to complete the medical assistance portion of DFA Form 770 does not result in denial or termination from assistance.

*Scan the original signed DFA Form 770 *into the individual ' s electronic case record.

(317-04-reimbursement-medical-assistance-provided-to-permanent-residents-of-medical-institutions-aam)New Hampshire Adult Assistance Manual: 317.04 Reimbursement - MA for Residents of Medical Institutions#

(317-04-reimbursement-medical-assistance-provided-to-permanent-residents-of-medical-institutions-aam)(block-1)317.04 Reimbursement - Medical Assistance Provided to Permanent Residents of Medical Institutions (AAM)#

317.04 Reimbursement - Medical Assistance Provided to Permanent Residents of Medical Institutions (AAM)

SR 11-43 Dated 11/11 Previous Policy

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Inform applicants for medical assistance as a permanent resident of a nursing facility, intermediate care facility for the mentally retarded (ICF-MR), or other medical institution, of the following:

. that DHHS has an obligation to recover from their estate when the estate is probated and from any assets that pass outside of probate after the death of the recipient;

. that recovery is limited to the actual amount paid on behalf of the recipient for medical assistance; and

. that for the purpose of recovery of medical assistance, a recipient ' s "estate" includes:

- both assets that pass through probate and assets that pass outside the probate process, such as certain trust assets, assets held jointly, and unpaid annuity balances that benefit the recipient.

Recovery Prior to the Death of the Recipient

DHHS may file a lien at the county registry of deeds on real property owned by the recipient, including the home, prior to the death of the recipient only under the following conditions:

1. the individual ' s home is not currently lawfully occupied by the individual ' s:

- spouse (to be a spouse , a couple must not be divorced or legally separated);

- child who is under age 21;

- child who is blind or permanently and totally disabled as defined in Section 1619 of the Social Security Act, or

- sibling who has an equity interest in the home and who has continuously resided in the individual ' s home for a period beginning at least 1 year immediately before the date of the individual ' s admission to the medical institution.

2. DHHS has given the recipient advance notice of intent to file a lien and assurance that the recipient will have the opportunity to request an administrative appeal on the lien filing.

3. DHHS has determined that the individual cannot be reasonably expected to be discharged from the medical institution and return home.

Exceptions: Regardless of the criteria above, DHHS may pursue:

. recoupment of the erroneous payment if benefits were incorrectly paid. See PART 633 , RECOUPMENT OF MEDICAL ASSISTANCE ; and

. recovery of assistance provided, if the property on which a lien is filed is voluntarily sold or refinanced while a lien is in place.

Any lien must be released upon the individual ' s discharge from the medical institution.

Recovery After the Death of the Recipient

. DHHS will pursue recovery from the estate of a deceased institutionalized recipient ' s estate only if there is no surviving:

- spouse;

- child who is under age 21; or

- child who is blind or permanently and totally disabled as defined in Section 1619 of the Social Security Act, and

. in cases where DHHS placed a lien on the recipient ' s home prior to the recipient ' s death, only if there is no:

- son or daughter who has continuously resided in the individual ' s home for a period of at least two years immediately before the date of the individual ' s admission to the medical institution to the present, and the child establishes that he or she provided care to the individual, which permitted the individual to reside at home rather than in a medical facility, or

- sibling who has continuously resided in the individual ' s home for a period of at least 1 year immediately before the date of the individual ' s admission to the medical institution to the present, and the sibling has an equity interest in the home.

Exception: If benefits were incorrectly paid, reimbursement can be required regardless of the individual ' s survivors.

Inform the individual of DHHS ' s recovery obligations and the recipient ' s rights and responsibilities, with DFA Form 770, Reimbursement Agreement and Acknowledgment . Failure or refusal to complete the medical assistance portion of DFA Form 770 does not result in denial or termination of medical assistance.

*Scan the original signed DFA Form 770 into the individual ' s electronic case record*.

(411-jointly-owned-personal-property-aam)New Hampshire Adult Assistance Manual: JOINTLY OWNED PERSONAL PROPERTY#

(411-jointly-owned-personal-property-aam)(block-1)JOINTLY OWNED PERSONAL PROPERTY (AAM)#

JOINTLY OWNED PERSONAL PROPERTY (AAM)

SR 15-10 Dated 02/15 Previous Policy

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Personal property resources which an assistance group member owns together with a non-assistance group member. The treatment differs according to when joint ownership of the resource was established:

Before November 1, 1995

Consider jointly owned personal property as being shared equally among the owners. Give individuals the opportunity to establish that they own more or less than an equal share. If the individual can establish that one or more of the owners owns more or less than an equal share, only consider the share actually owned by the assistance group member as a countable resource.

November 1, 1995 or Later

Consider personal property resources which an individual owns with someone who is not an applicant or recipient as belonging to the individual. *If more than one of the joint owners apply for or are receiving assistance, assume that each applicant/recipient owns an equal share. An individual wishing to rebut the presumption of ownership may submit a written statement with verification that includes:

• a corroborating statement from each other account holder

• if an account holder is incompetent or a minor, a corroborating statement from a competent adult aware of the circumstances surrounding establishment of the account

• account records showing deposits, withdrawals and interest in the months for which ownership is an issue

• if the individual does not own any of the funds, evidence showing that the individual can no longer withdraw funds from the account

• if the individual owns only a portion of the funds, evidence showing removal from the account of such funds, or removal of the funds owned by the other account holder(s), and redesignation of the account.

Treatment : Countable Resource

Exception : The addition of a joint owner to an asset must be evaluated as an asset transfer. See Transfer of Assets .

See Real Property for the treatment of jointly owned real property.

References : He-W 656.03, RSA 167:4-a, RSA 167:7,IV

(411-life-insurance-offset-aam)New Hampshire Adult Assistance Manual: LIFE INSURANCE OFFSET#

(411-life-insurance-offset-aam)(block-1)LIFE INSURANCE OFFSET (AAM)#

LIFE INSURANCE OFFSET (AAM)

SR 94-04 Dated 04/94 Previous Policy

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Applicants are allowed to offset medical expenses against the equity value of life insurance for a three-month period. The offset gives the individual access to the Division of Family Services ’ s financial or medical assistance programs while reducing the equity value of their life insurance policies.

Allow an applicant to offset life insurance if all of the following are met:

• the equity value of countable life insurance policies exceeds the resource limits, but other countable resources are within the limits,

• the applicant is unable to reduce the excess resources within the allowable application time frames, and

• the applicant or applicant ’ s spouse who is living with the applicant has incurred and is liable for unpaid medical expenses which offset the excess equity value.

Use the following steps to allow a life insurance offset.

1. Determine the excess value of life insurance policies.

2. Subtract in chronological order unpaid medical bills which:

- were incurred before the period eligibility is requested, or

- are incurred within the period eligibility is requested.

3. Continue subtracting unpaid medical bills until the remaining equity value of life insurance combined with other resources is less than or equal to the resource limit, provided the application time frames do not expire.

4. See Chapter 100, Part 119 , Benefit Delivery Time Frames , to determine the effective date of eligibility.

5. Allow applicants 3 months to reduce resources within the allowable resource limit. The three-month period begins the date they provide verification of all resources and incurred unpaid medical bills.

6. Follow up at the end of the three-month period. Count the equity value of any countable life insurance policies with other countable resources. Do not allow any further offset of medical expenses.

Example An individual applies for OAA-MA on July 10, and has a $1,000 savings account and a life insurance policy with a $5,000 face value and $4,500 equity value. The applicant has outstanding medical bills that include a $2,500 hospital bill incurred in March and a $500 pharmacy bill incurred on July 15. Both bills are unpaid. The applicant submits all verifications on August 4.

$1,000 savings +4,500 equity value of life insurance $5,500 countable resources (over $2,500 resource limit — allow Life Insurance Offset $4,500 equity value of life insurance -2,500 hospital bill from March - 500 pharmacy bill from July 15 $1,500 remaining equity value of life insurance +1,000 savings $2,500 countable resources (resource eligible)

Allow applicant 3 months starting on August 4 to reduce resources within the $2,500 limit.

(411-real-property-aam)New Hampshire Adult Assistance Manual: REAL PROPERTY#

(411-real-property-aam)(block-1)411 REAL PROPERTY (AAM)#

411 REAL PROPERTY (AAM)

SR 26-01 Dated 01/26 Previous Policy

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Real estate in the form of land or buildings. The treatment of real property varies depending on the type of property it is.

Determining Real Property Resource Value

TYPE OF PROPERTY STATUS Home (residence) Excluded Income-Producing Excluded Residence of Spouse or Child who is either a minor, blind, or disabled Excluded Jointly Owned and Inaccessible Excluded Temporarily Unoccupied Excluded Jointly Owned and Accessible Countable - Allow Disposal Period Permanently Unoccupied Countable - Allow Disposal Period Vacation Property Countable-Allow Disposal Period

The various types of real property are listed below with the appropriate treatment:

HOME

Real property consisting of the house or mobile home and any adjoining land or buildings necessary to its maintenance that are owned and occupied as the residence of the assistance group. A vehicle used as an assistance group’s home is treated as a home rather than a vehicle.

Treatment: Excluded Resource

Exceptions:

For individuals applying for or receiving HCBS services or nursing facility care, homes placed into trusts established after 8/10/93, including irrevocable trusts, in which the individual or the institutionalized individual's spouse:

- is a beneficiary of the trust , are a countable resource. See TRUSTS USING THE ASSETS OF THE INDIVIDUAL OR SPOUSE .

- is not a beneficiary of the trust , must be evaluated as an asset transfer. See PART 415 , TRANSFER OF ASSETS .

Although the home is an excluded resource, individuals whose equity interest in their home exceeds $752,000 are ineligible for NF/HCBS services unless their spouse, child under 21, or child who is blind or disabled is lawfully residing in the home.

- The equity interest of the home is the current market value of the home minus any encumbrance. An encumbrance is a legally binding debt against the resource. This can be a mortgage, reverse mortgage, home equity loan, or other debt that is secured by the home.

- For jointly owned property, the fractional interest held by the applicant or recipient of long-term care services minus any encumbrances cannot exceed $752,000.

- See Section 415.27 , Undue Hardship , for information on the hardship waiver process.

INCOME-PRODUCING PROPERTY

Real property that is not occupied by the assistance group but producing income at least sufficient to meet the expenses of its ownership and maintenance.

Treatment: Excluded Resource for the adult categories of assistance.

Countable Resource for the FANF and FANF-related categories of assistance. If the individual is over resources, allow the individual to dispose of the property in accordance with the disposal policy below.

JOINTLY OWNED REAL PROPERTY

Real property which is owned jointly with a non-assistance group member. If the terms of ownership prevent unilateral sale or disposition and the other owner(s) refuse(s) to sell the property, consider the property an inaccessible resource.

Treatment: Excluded Resource

Jointly owned real property that does not meet the above criteria is considered accessible.

Treatment: Countable resource. If the individual is over resources, allow the individual to dispose of the property in accordance with the disposal policy.

Exception: The addition of a joint owner to an asset must be evaluated as an asset transfer. See PART 415 , TRANSFER OF ASSETS .

REAL PROPERTY NECESSARY AS A RESIDENCE

For the individual's:

- spouse; or

- child who is either a minor, blind, or disabled.

Treatment: Excluded Resource

UNOCCUPIED REAL PROPERTY

The home temporarily unoccupied by the assistance group due to the individual's temporary absence, such as an illness requiring temporary hospitalization or institutionalization.

Treatment: Excluded Resource

The home permanently unoccupied by the assistance group due to permanent hospitalization or institutionalization or any other unoccupied real property that is not:

- income-producing;

- necessary as a residence for the individual's spouse or child who is either a minor, blind, or disabled; or

- considered an inaccessible resource due to the terms of joint ownership.

Treatment: Countable Resource. If the individual is over resources, allow the individual to dispose of the property in accordance with the disposal policy.

VACATION PROPERTY

A home used part of the year that does not produce income consistent with its fair market value.

Treatment: Count the equity value. If the individual is over resources, allow the individual to dispose of the property in accordance with the disposal policy.

PROVISIONAL ASSISTANCE DURING DISPOSAL OF REAL PROPERTY

Individuals over the resource limit because of countable real property may receive provisional assistance if he or she tries to dispose of the countable real property in excess of limits. Allow an individual to dispose of, or take action to dispose of, countable real property if the equity value of the property alone or in combination with other countable resources exceeds the resource limit. The property is not counted as a resource during the disposal period. The individual - not DHHS - is responsible for disposing of real property.

Individuals whose eligibility is denied or terminated because of excess resources must verify how the resources were spent before assistance can be granted.

Provisional assistance requires that the individual dispose of real property. Use the following steps.

1. Notify the individual to dispose of the property within 6 months of the date of notification. Good faith means the individual must genuinely attempt to sell the property and cannot refuse a reasonable offer.

2. Deny or terminate assistance if the individual refuses to dispose of, or take action to dispose of, the property within 6 months.

3. Exclude the equity value of the property during the disposal period.

4. Follow up after the six-month disposal period to determine if the property has been sold. Property counts as of the first day of the seventh month unless an extension has been granted.

- If the property has not been sold and the individual can demonstrate valid reasons for his or her inability to sell the property, the District Office Supervisor can extend the period for another 3 months.

- If the individual cannot demonstrate a good faith effort to sell the property, do not allow an extension period. Count the equity value of the property as a countable resource.

5. When the property is sold, count the net proceeds from the sale of the property as a lump sum resource.

References: He-W 601.03; He-W 601.04; He-W 601.06; He-W 601.07; He-W 606.78; He-W 620.01; He-W 656.03 - He-W 656.05; He-W 895.02; He-W 895.05; RSA 167:7,IV; RSA 167:81; 42 USC 1382b; 42 USC 1396p(f)

(411-special-needs-trusts-aam)New Hampshire Adult Assistance Manual: SPECIAL NEEDS TRUSTS#

(411-special-needs-trusts-aam)(block-1)SPECIAL NEEDS TRUSTS (AAM)#

SPECIAL NEEDS TRUSTS (AAM)

SR 22-27 Dated 09/22 Previous Policy

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Also known as Trusts for Disabled Individuals, there are two separate types of these trusts: (1) those established by the individual, a parent, grandparent, guardian, or court, and (2) those established and managed by a non-profit organization. They are not counted as a resource when they meet the following conditions.

1. A trust containing the assets of an individual under age 65 who has been determined disabled by DHHS or the Social Security Administration (SSA) is not counted in determining eligibility for medical assistance if : For Trusts Established Prior to December 13, 2016: ● A parent, grandparent, legal guardian of the individual, or a court established the trust for the benefit of the individual; and ● The trust contains a provision that upon the individual's death, DHHS will receive all amounts remaining in the trust, up to an amount equal to the total amount of medical assistance paid on behalf of the individual. For Trusts Established On or After December 13, 2016: ● The individual , a parent, grandparent, legal guardian of the individual, or a court established the trust for the benefit of the individual; and ● The trust contains a provision that upon the individual’s death, DHHS will receive all amounts remaining in the trust, up to an amount equal to the total amount of medical assistance paid on behalf of the individual. After the individual turns 65, the trust is still not counted as a resource. However, any addition or augmentation of the trust after that date is treated as a transfer of assets for less than fair market value. 2. A trust containing the assets of an individual of any age who has been determined disabled by DHHS or SSA and which meets all of the following conditions is not counted in determining eligibility for medical assistance : ● The trust is established and managed by a non-profit organization; ● A separate account is maintained for each beneficiary of the trust, even though the trust pools the funds in these accounts; ● Accounts in the trust are established by the individual, parent, grandparent, legal guardian of the individual, or by a court solely for the benefit of individuals who are disabled; and ● To the extent that any amount remaining in the beneficiary's account upon the death of the beneficiary are not retained by the trust, any remaining funds in the account are paid to DHHS up to the amount remaining in the fund or equal to the total amount of medical assistance paid on behalf of the beneficiary. Treatment : Excluded resource if the above conditions are met. If the trust does not meet the conditions above, see Trusts Using the Assets of the Individual or Spouse or Trusts Using the Assets of Other Parties , whichever is appropriate. All trusts must be forwarded to State Office for a trust review. State Office will determine whether the trust is countable as a resource, or any disbursements are countable as income.

References: He-W 656.04; 42 U.S.C. 1396p(d)(4)(A); RSA 167:4; 42 USC 1382c(a)(3)

(411-trusts-using-the-assets-of-the-individual-or-spouse-aam)New Hampshire Adult Assistance Manual: TRUSTS USING THE ASSETS OF THE INDIVIDUAL OR SPOUSE#

(411-trusts-using-the-assets-of-the-individual-or-spouse-aam)(block-1)411 TRUSTS USING THE ASSETS OF THE INDIVIDUAL OR SPOUSE (AAM)#

411 TRUSTS USING THE ASSETS OF THE INDIVIDUAL OR SPOUSE (AAM)

SR 22-27 Dated 09/22 Previous Policy

____________________________________________________________

Treatment of this type of trust differs based on the date the trust was established.

Trusts Established After August 10, 1993

Trusts or similar legal devices established:

• after August 10, 1993; or

• prior to August 10, 1993, but to which additional funds were added after that date.

The following requirements apply regardless of:

• the purpose for which the trust or similar legal device was established;

• any restrictions on distributions or their use; or

• whether the trustees or similar entities can exercise discretion under the trust.

No clause or requirement in the trust, no matter how specifically it applies to state or federal programs, will preclude a trust from being considered under this section. Where a trust includes assets of others as well as the individual, this policy applies only to the assets attributable to the individual.

Revocable Trusts

Revocable trusts can be revoked by the grantor and include trusts that are called irrevocable but which will terminate if some action is taken by the grantor.

Treatment: The entire principal of the trust is counted as an available resource to the individual.

• Trust payments made to, on behalf of, or for the benefit of the individual, are considered unearned income to the individual; and

• Any payments from the trust which are not made to, on behalf of, or for the benefit of the individual, are considered assets disposed of for less than fair market value.

Irrevocable Trusts

Irrevocable trusts cannot in any way be revoked by the grantor.

Treatment: Treat the principal of the trust as an inaccessible resource.

Exception: If terms of the trust permit payments to, for the benefit of, or on behalf of the individual, treat:

• payments of income or payments from the principal of the trust made to or benefiting the individual as unearned income;

• income from the principal of the trust which could be paid to or for the benefit of the individual, but is not, as a resource available to the individual;

• any portion of the principal of the trust that could be paid to or for the benefit of the individual, but is not, as a resource available to the individual; and

• any payments of income or principal of the trust which are not paid to or for the benefit of the individual as a transfer of assets for less than fair market value, effective with the date of transfer.

If some or none of the trust can be paid to the individual, treat:

• payments of income or payments from the principal that can be made to or for the benefit of the individual, as unearned income or as a resource available to the individual; and

• that portion of the principal or income on the principal which cannot be paid, as a transfer of assets for less than fair market value.

In treating portions of the principal or income which cannot be paid to the individual as a transfer of assets, the transfer date is the date the trust was established or, if later, the date payment to the individual was restricted or eliminated.

NOTE: All trusts must be forwarded to DHHS.trustdept@dhhs.nh.gov for review. The Trust Department will determine whether the trust is countable as a resource, or if any disbursements are countable as income.

References: He-W 601.07; He-W 656.04; RSA 167:4

(413-able-stable-accounts-aam)New Hampshire Adult Assistance Manual: ABLE/STABLE ACCOUNTS#

(413-able-stable-accounts-aam)(block-1)413 ABLE/STABLE ACCOUNTS (AAM)#

413 ABLE/STABLE ACCOUNTS (AAM)

SR 23-16 Dated 03/23 Previous Policy

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ABLE/STABLE-NH Accounts are a tax-advantaged savings account plan for individuals w ho are blind or disabled. Funds from ABLE/STABLE-NH accounts (distributions) can be used to pay for Qualified Disability Expenses (QDE). (See AAM Glossary Q-words for examples of QDEs)

Treatment: Excluded Resource

ABLE/STABLE-NH Account Contributions

Individuals can contribute their own resources, including resources that would otherwise be countable to their own ABLE/STABLE-NH account. Doing so would reduce their countable resources when determining eligibility.

Example 1: John contributes $3,000 of his own personal resources into his ABLE/STABLE-NH account from his IRA account. After the transfer of resources to the ABLE/STABLE-NH account, John’s personal countable resources are now reduced when determining his eligibility.

If an individual is contributing their own income to their ABLE/STABLE-NH account that income is still used in determining eligibility, there is no reduction in countable income when determining eligibility.

Example 2: Jose receives SSDI of $2,500 a month; he puts $2,000 monthly from his SSDI benefit into his STABLE-NH Account. When determining his countable income for all BFA programs we would still count his SSDI of $2,500 a month, because there is no reduction in his countable income. However, we would not count the $2,000 added to his STABLE-NH account each month as a countable resource.

Third party contributions to an ABLE/STABLE-NH account as well as disbursements from an individual’s Special Needs Trust or Pooled Trust to an individual’s ABLE/STABLE-NH account are not counted as a resource or income for that individual.

Example 3: Martha receives a $10,000 contribution from her families Pooled Trust that was established for her in her youth. The transfer of funds from the Pooled Trust to her ABLE/STABLE-NH account are not counted as a resource or income for Martha.

Note: There is no special treatment for contributions made to another person’s ABLE/STABLE-NH account. Therefore, someone contributing to another individual’s ABLE/STABLE-NH account and then applying for Medicaid coverage for themselves may find that their contribution would constitute a transfer of assets.

ABLE/STABLE-NH ABLE Account Distributions

Distributions from ABLE/STABLE-NH accounts are not counted as a resource or as income as long as they are used for a QDE for the individual.

Estate Recovery

Funds remaining in an ABLE/STABLE-NH account upon the death of the account beneficiary are subject to existing estate recovery policy.

References : 26 CFR 529A; 74 USC 722.500; 42 USC 722.50

(415-01-what-is-an-asset-transfer-aam)New Hampshire Adult Assistance Manual: 415.01 What Is an Asset Transfer?#

(415-01-what-is-an-asset-transfer-aam)(block-1)415.01 What Is an Asset Transfer? (AAM)#

415.01 What Is an Asset Transfer? (AAM)

SR 96-02 Dated 01/96 Previous Policy

____________________________________________________________

A transfer of assets exists when

• title or ownership of assets passes from one individual to another individual,

• another person is given access to assets through joint ownership,

• a document to transfer assets at a future date is completed and delivered to the individual who will receive the asset,

• action is taken that reduces or eliminates an individual ’ s ownership or control of such assets,

• another person is given access to the asset through joint ownership and any action is taken either by the individual or by any other person, that reduces or eliminates the individual ’ s ownership,

• an instrument to transfer title at some future date has been completed by the individual who is applying for or receiving assistance and delivered to the individual who is to receive title,

• an individual who is applying for or receiving financial assistance or institutionalized care has transferred or transfers title or ownership of an otherwise excluded home to another individual or entity, including a home which has become income producing,

• an individual places assets into an irrevocable trust or similar legal device including an annuity,

• an individual applying for or receiving financial assistance or institutional care obtains a reverse mortgage, home equity conversion mortgage, or similar loan on an otherwise excluded home or other real property and transfers the proceeds to another individual,

• an individual applying for or receiving financial assistance or institutional care converts a countable asset, or

• an individual is entitled to an asset but does not receive the asset because of action

- by the individual or the individual ’ s spouse,

- by a person, including a court or administrative body, with legal authority to act in place of or on behalf of the individual or the individual ’ s spouse, or

- by any person, including any court or administrative body, acting at the direction or upon the request of the individual or the individual ’ s spouse.

Actions causing an asset not to be received include, but are not limited to,

• irrevocably waiving any pension income or any other form of income or waiving an inheritance,

• refusing to accept or access injury settlements, judgments or court awards,

• diverting of tort settlements by the defendant into a trust or similar device to be held for the benefit of the individual, or

• refusing to take legal action to obtain a court ordered payment that is not being paid, such as child support or alimony.

(415-11-evaluation-of-transfers-aam)New Hampshire Adult Assistance Manual: 415.11 Evaluation of Transfers#

(415-11-evaluation-of-transfers-aam)(block-1)415.11 Evaluation of Transfers (AAM)#

415.11 Evaluation of Transfers (AAM)

SR 96-02 Dated 01/96 Previous Policy

____________________________________________________________

1. Determine if the individual or institutionalized individual ’ s spouse received fair market value from a transfer when:

- The individual or institutionalized individual ’ s spouse transferred, assigned, or disposed of countable assets;

- The value of the assets alone or combined with other countable assets exceeded the allowable limit in effect at the time or the transfer, and

- The transfer has the effect of reducing assets within allowable limits or results in earlier eligibility; or

- An institutionalized individual or their spouse transferred the home to another individual.

If the individual or institutionalized individual ’ s spouse makes more than one asset transfer, evaluate each transfer separately.

Compensation for a transfer must be in a tangible or otherwise assessable form with intrinsic value. A transfer of assets for love and consideration, or similar reasons, is not considered to be a transfer for fair market value. Also, a transfer of assets to a relative in return for providing care in the past is not a transfer for fair market value unless written evidence documents that a compensation agreement was in effect at the time services were provided.

If fair market value is received, no further evaluation is required.

If fair market value is not received, determine whether assets may have been transferred for purposes of qualifying for assistance.

2. Use the following guidelines to help evaluate the asset transfer:

- time frames between the transfer and the date of application,

- the health of the individual at the time of the transfer, and

- the economic situation of the individual at the time of the transfer.

Consider a transfer questionable if the information suggests the individual may have transferred assets for purposes of qualifying for assistance. The burden of proof for substantiating that assets were not transferred for purposes of qualifying for assistance rests with the individual.

(415-19-transfer-of-assets-into-an-annuity-aam)New Hampshire Adult Assistance Manual: 415.19 Transfer of Assets into an Annuity#

(415-19-transfer-of-assets-into-an-annuity-aam)(block-1)415.19 Transfer of Assets into an Annuity (AAM)#

415.19 Transfer of Assets into an Annuity (AAM)

SR 08-17 Dated 02/06 Previous Policy

____________________________________________________________

An annuity is any instrument which gives the right to receive fixed, periodic payments, either for life or a term of years. Annuities that can be cashed in are considered revocable trusts. *

Disclosure of Annuities

Applicants and recipients must disclose any interests they have in an annuity or the device is considered an asset transferred for less than fair market value (FMV).

The community spouse must disclose any interests they have in an annuity purchased on or after 2/8/06 or the device is considered an asset transferred for less than FMV.

Determination of FMV

The purchase of an annuity by an institutionalized individual is automatically treated as an asset transferred for less than FMV unless the State is named as:

. the primary beneficiary for at least the total amount of medical assistance paid on behalf of the institutionalized individual; or

. the contingent beneficiary after the community spouse, minor, or disabled child. If a representative of such child or spouse disposes of any remaining benefit for less than FMV, the State must then be named as the primary beneficiary.

Annuities purchased by or on behalf of an applicant or recipient of NF/HCBC services on or after 2/8/06 (including settlements of litigation) must meet the criteria of at least one of the three scenarios below to be considered to have received FMV for the transfer.

Scenario 1* Scenario 2 Scenario 3 The annuity is: . irrevocable and non-assignable; . provides payments in equal amounts during the term of the annuity, with no deferral or balloon payments made; and . is actuarially sound using the SSA Life Expectancy Tables in the back of this Chapter. Determine if the expected return on the annuity corresponds with a reasonable estimate of the individual ' s life expectancy. If the average number of years of expected life remaining for the individual: - coincides or exceeds the life of the annuity, the annuity is actuarially sound; or - is less than the life of the annuity, the individual did not receive fair market value for the annuity . The annuity meets the definition of: . an Individual Retirement Annuity; or . a Deemed Individual Retirement Account under a Qualified Employer Plan. See the Glossary for specific defintions. The annuity was purchased with proceeds from either a: . Traditional Individual Retirement Account; . Trust or account created by an employer for the exclusive benefit of his or her employees or their beneficiaries, if that trust: - meets the criteria of a Individual Retirement Account; and - has separate accounting for the interest of each employee or member; . Simplified Retirement Account; . Simplified Employee Pension; or . ROTH Individual Retirement Account. See the Glossary for specific defintions.

* Annuities must meet Scenario 1 or be considered a transfer of assets for less than FMV when the annuity was purchased by the:

. applicant or recipient prior to 2/8/06; or

. non-applicant spouse.

Purchase of an Annuity by the Non-Applicant Spouse

The purchase of an annuity on or after 2/8/06 by the non-applicant spouse is automatically treated as a disposal of an asset for less than FMV unless the State is named as:

. the primary beneficiary for at least the total amount of medical assistance paid on behalf of the institutionalized individual(s); or

. the contingent beneficiary after the minor or disabled child. If a representative of such child disposes of any remaining benefit for less than FMV, the State must then be named as the primary beneficiary.

Assets Transferred into an Annuity for Less Than FMV

Applicants and recipients of the adult categories of financial assistance, NF, and HCBC/CFI who transfer assets into an annuity for less than FMV must serve a penalty period. For more information on penalty periods, see Section 415.23 , Determining and Applying the Penalty Period .

(415-23-determining-and-applying-the-penalty-period-aam)New Hampshire Adult Assistance Manual: 415.23 Determining and Applying the Penalty Period#

(415-23-determining-and-applying-the-penalty-period-aam)(block-1)415.23 Determining and Applying the Penalty Period (AAM)#

415.23 Determining and Applying the Penalty Period (AAM)

SR 08-17 Dated 02/06 Previous Policy

____________________________________________________________

Consider the following factors when determining the penalty period(s) for transfers of assets for less than fair market value.

. When a countable transfer of assets takes place during an existing penalty period, a new penalty period does not begin until the existing penalty period expires.

. For assets transferred on or after 2/8/06, the total value of all transfers that occurred during the look-back period is used to calculate the penalty period.

. When a spouse of an individual transfers an asset that results in a penalty for the individual, the penalty period is apportioned between the spouses when:

- the spouse either is or becomes eligible for institutional medical assistance;

- a penalty could be assessed against the spouse; and

- some portion of the penalty against the individual remains at the time the above conditions are met.

. When the penalty period for an individual is interrupted due to the death of the individual or due to discharge from institutionalized care, the remaining penalty period applicable to both spouses is served by the remaining spouse, or shared by both spouses in the latter case.

. Any penalty period imposed for a transfer of assets runs continuously from the starting date, regardless whether the individual remains institutionalized.

Apply the penalty period as follows:

. The penalty period is based solely on the value of the assets transferred.

. For HCBC or institutionalized medical assistance applicants/recipients who have transferred assets to an irrevocable trust where the principal is not available to them, the penalty period is unlimited and is based on the amount transferred.

. For financial assistance applicants/recipients who have transferred assets, other than into an irrevocable trust, the penalty period is 36 months from the date of transfer.

. For financial assistance applicants/recipients who have transferred assets to an irrevocable trust where the principal is not available to them, the penalty period is 60 months from month of transfer.

. When the amount of uncompensated value is less than the average monthly nursing facility rate or includes full months and a partial month, a partial month penalty applies.

Use the following steps to determine the actual penalty period:

1. Determine the uncompensated value of the transfer. The uncompensated value is the difference between:

- fair market value; and

- the amount of compensation actually received by the individual in exchange for the asset.

Exception : The uncompensated value for annuities transferred for less than FMV is the original purchase price of the annuity.

2. The penalty period is the number of months plus any part of a month determined by:

- dividing the total uncompensated value by the statewide average monthly nursing facility private pay rate;

- dividing the statewide average monthly nursing facility private pay rate (found in Appendix A of the Medical Assistance Manual) by 30.42 to get a daily rate; and

- dividing any leftover uncompensated value by the daily rate to calculate any partial month penalty.

3. If more than one transfer has been made, combine the penalty into one period. (Apply a separate penalty period to each transfer that is made prior to 2/8/06).

4. *The start date of a penalty period for assets transferred for less than FMV on or after 2/8/06 is:

- for applicants, the date the individual would otherwise be eligible for NF/HCBC services but for the penalty period; or

- for recipients:

. the first day of the month after which assets were transferred for less than FMV; or

. the date in which the individual initially became eligible for HCBC/NF services, if later .

Asset transferred prior to 2/8/06:

. The total value of transfers for one month is used to calculate the penalty when a series of transfers have been made within one month.

. The start date of the penalty period is the first day of the month in which assets were transferred, unless that date occurs during an existing penalty period.

. If multiple transfers are made so that penalty periods do not overlap, the individual penalty periods must be calculated and applied sequentially.

(415-25-when-a-penalty-period-for-transferring-assets-is-not-assessed-aam)New Hampshire Adult Assistance Manual: 415.25 When a Penalty Period for Transferring Assets Is Not Assessed#

(415-25-when-a-penalty-period-for-transferring-assets-is-not-assessed-aam)(block-1)415.25 When a Penalty Period for Transferring Assets Is Not Assessed (AAM)#

415.25 When a Penalty Period for Transferring Assets Is Not Assessed (AAM)

SR 98-09 Dated 02/98 Previous Policy

____________________________________________________________

A penalty is not assessed for transferring assets for less than fair market value when:

. The individual verifies in writing to the Division of Family Assistance (DFA) their intention and attempt to dispose of the asset either at fair market value, or for other valuable consideration, and a description of the circumstances that caused the transfer for less than fair market value supported by written evidence for the value at which the asset was disposed.

. The individual provides satisfactory evidence to DFA that assets were transferred exclusively for a purpose other than to qualify for medical assistance. The individual also provides evidence for the purpose for which the asset was transferred as well as the reason it was necessary to transfer the asset in question for less than fair market value. Assurance that the individual was not considering medical assistance when the asset was disposed of is not sufficient.

. The assets transferred for less than fair market value have been returned to the individual. When a penalty has been assessed and payment for services denied, a return of all assets or the fair market equivalent requires a retroactive adjustment back to the beginning of the penalty period if the individual met all other eligibility criteria.

If only a part of the asset or its equivalent value has been returned, the penalty period is adjusted according to the value of the assets returned. That is, if only half of the assets are returned, reduce the penalty period by one half.

(415-27-undue-hardship-aam)New Hampshire Adult Assistance Manual: 415.27 Undue Hardship#

(415-27-undue-hardship-aam)(block-1)415.27 Undue Hardship (AAM)#

415.27 Undue Hardship (AAM)

SR 26-01 Dated 01/26 Previous Policy

____________________________________________________________

Applicants and recipients of NF/HCBS/CFI services may apply for a hardship waiver to waive:

• serving a penalty period for transferring assets for less than fair market value, by using DFA Form 791A, NF/HCBS Undue Hardship Application For Asset Transfers ; or

• the denial or termination of NF/HCBS services due to having equity in a home that exceeds $752,000, by using DFA Form 791E, NF/HCBS/CFI Undue Hardship Application Due to Home Equity Exceeding the Limit .

Applications for a hardship waiver, and all required documentation of the hardship, must be submitted within 30 calendar days of the date on DFA Form 791AN, Notice of Asset Transfer Penalty , or DFA Form 791EN, Notice of Excessive Equity Penalty .

All hardship waiver application packets received at the District Office are submitted to the BFA Asset Transfer Specialist at State Office. The State Office is responsible for:

• Making all hardship waiver application determinations;

• Notifying each applicant of the decision for their hardship waiver application using DFA Form 791HD, NF/HCBS Hardship Decision ; and

• Coordinating any subsequent Administrative Appeals.

Applicants and recipients of NF/HCBS/CFI services may be eligible for a waiver of the penalty period under the following conditions:

• The assets in question were transferred by someone other than the applicant or recipient and the applicant or recipient lacked the mental capacity to comprehend the disqualifying nature of the act;

• A penalty period would deprive the applicant or recipient of care such that the individual’s health or life would be endangered; or

• A penalty period would deprive the applicant or recipient of food, clothing, shelter, heat, hot water, electricity, gas service, cooking fuel, or transportation to medical appointments.

Applicants and recipients of NF/HCBS/CFI services may be eligible for a waiver of the denial or termination of NF/HCBS/CFI services due to having equity in a home that exceeds $752,000 , under the following conditions:

• the denial or termination of services would deprive the applicant or recipient of care such that the individual’s health or life would be endangered; or

• the denial or termination of services would deprive the applicant or recipient of food, clothing, shelter, heat, hot water, electricity, gas service, cooking fuel, or transportation to medical appointments.

References : He-W 620; RSA 167:4; RSA 167:13-16; 42 USC 1396p

(415-28-required-documentation-for-an-undue-hardship-waiver-application)New Hampshire Adult Assistance Manual: 415.28 Required Documentation for an Undue Hardship Waiver Application#

(415-28-required-documentation-for-an-undue-hardship-waiver-application)(block-1)415.28 Required Documentation for an Undue Hardship Waiver Application (AAM)#

415.28 Required Documentation for an Undue Hardship Waiver Application (AAM)

SR 26-01 Dated 01/26 Previous Policy

______________________________________________________________________________

Applicants and recipients who have applied for a hardship waiver are notified of the documentation required to verify the hardship and the timeframes for providing the documentation on the application for the hardship waiver.

Applicants and recipients must provide the following verifications when applying for a hardship waiver to waive serving a penalty period for transferring assets for less than fair market value:

• Lack of Mental Capacity

- a signed written statement from a licensed physician stating that the applicant or recipient was mentally incapacitated at the time of the transfer; or

- an order of findings from a probate court concerning the applicant’s or recipient’s competency.

• Health or Life Endangerment

- a signed statement from the nursing facility that indicates that the applicant or recipient is currently residing in the nursing facility and does not demonstrate the ability to pay for services; and

- a signed statement from a licensed physician or licensed nurse practitioner that indicates that he or she is the applicant’s or recipient’s primary care professional and that a penalty period would deprive the individual of medical care such that the individual’s health or life would be endangered. Applicants and recipients of HCBS/CFI services must additionally have the medical professional document that the individual does not demonstrate the ability to pay for services.

• Deprival of the Necessities of Life

- a signed statement by the applicant, recipient, or authorized representative documenting that a penalty period would deprive the individual of food, clothing, shelter, heat, hot water, electricity, gas service, cooking fuel, or transportation to medical appointments;

- a signed statement from every individual who directly received any asset transferred by the applicant or recipient of NF or HCBS/CFI services subject to a penalty period, documenting that the individual who received the transferred asset is unable or unwilling to provide the applicant or recipient of NF or HCBS/CFI services with food, clothing, shelter, heat, hot water, electricity, gas service, cooking fuel, or transportation to medical appointments; and

- individuals claiming to be deprived of heat, hot water, electricity, gas service, cooking fuel, or transportation to medical appointments must additionally provide documentation that the penalty period would result in a:

o discontinuation of the utility; or

o lack of transportation to obtain Medicaid-covered services from Medicaid-enrolled providers.

Applicants and recipients must provide the following verifications when applying for a hardship waiver to waive the denial or termination of NF/HCBS/CFI services due to having an equity interest in a home that exceeds $752,000 :

• Health or Life Endangerment

- a signed statement from the nursing facility that indicates that the applicant or recipient is a current resident of the nursing facility and does not demonstrate the ability to pay for services; and

- a signed statement from a licensed physician or licensed nurse practitioner that indicates that he or she is the applicant’s or recipient’s primary care professional and the denial or termination of services would deprive the individual of medical care such that the individual’s health or life would be endangered. Applicants and recipients of HCBS/CFI services must additionally have the medical professional document that the individual does not demonstrate the ability to pay for services.

• Deprival of the Necessities of Life

- a signed statement by the applicant, recipient, or authorized representative documenting that denial or termination of services would deprive the individual of food, clothing, shelter, heat, hot water, electricity, gas service, cooking fuel, or transportation to medical appointments;

- documentation that verifies that the denial or termination of services would deprive the individual of food, clothing, shelter, heat, hot water, electricity, gas service, cooking fuel, or transportation to medical appointments; and

- discontinuation of the utility; or

- lack of transportation to obtain Medicaid-covered services from Medicaid-enrolled providers.

References : He-W 620; RSA 167:4; RSA 167:13-16; 42 USC 1396p

(100-case-processing-aam)New Hampshire Adult Assistance Manual: 100 CASE PROCESSING#

(100-case-processing-aam)(block-1)100 CASE PROCESSING (AAM)#

(100-case-processing-aam)New Hampshire Adult Assistance Manual: 100 CASE PROCESSING#

(100-case-processing-aam)(block-1)100 CASE PROCESSING (AAM)#

(101-01-individual-rights-aam)New Hampshire Adult Assistance Manual: 101.01 Individual Rights#

(101-01-individual-rights-aam)(block-1)101.01 Individual Rights (AAM)#

(101-03-individual-responsibilities-aam)New Hampshire Adult Assistance Manual: 101.03 Individual Responsibilities#

(101-03-individual-responsibilities-aam)(block-1)101.03 Individual Responsibilities (AAM)#

(101-individual-rights-and-responsibilities-aam)New Hampshire Adult Assistance Manual: 101 INDIVIDUAL RIGHTS AND RESPONSIBILITIES#

(101-individual-rights-and-responsibilities-aam)(block-1)101 INDIVIDUAL RIGHTS AND RESPONSIBILITIES (AAM)#

(103-01-primary-language-data-collection-aam)New Hampshire Adult Assistance Manual: 103.01 Primary Language Data Collection#

(103-01-primary-language-data-collection-aam)(block-1)103.01 Primary Language Data Collection (AAM)#

(103-nondiscrimination-aam)New Hampshire Adult Assistance Manual: 103 NONDISCRIMINATION#

(103-nondiscrimination-aam)(block-1)103 NONDISCRIMINATION (AAM)#

(105-01-eligibility-determinations-aam)New Hampshire Adult Assistance Manual: 105.01 Eligibility Determinations#

(105-01-eligibility-determinations-aam)(block-1)105.01 Eligibility Determinations (AAM)#

(105-03-eligibility-reviews-aam)New Hampshire Adult Assistance Manual: 105.03 Eligibility Reviews#

(105-03-eligibility-reviews-aam)(block-1)105.03 Eligibility Reviews (AAM)#

(105-05-failure-to-comply-aam)New Hampshire Adult Assistance Manual: 105.05 Failure to Comply#

(105-05-failure-to-comply-aam)(block-1)105.05 Failure to Comply (AAM)#

(105-07-willful-withholding-of-information-aam)New Hampshire Adult Assistance Manual: 105.07 Willful Withholding of Information#

(105-07-willful-withholding-of-information-aam)(block-1)105.07 Willful Withholding of Information (AAM)#

(105-compliance-with-requirements-aam)New Hampshire Adult Assistance Manual: 105 COMPLIANCE WITH REQUIREMENTS#

(105-compliance-with-requirements-aam)(block-1)105 COMPLIANCE WITH REQUIREMENTS (AAM)#

(107-providing-verification-aam)New Hampshire Adult Assistance Manual: 107 PROVIDING VERIFICATION#

(107-providing-verification-aam)(block-1)107 PROVIDING VERIFICATION (AAM)#

(109-01-filing-an-application-aam)New Hampshire Adult Assistance Manual: 109.01 Filing an Application#

(109-01-filing-an-application-aam)(block-1)109.01 Filing an Application (AAM)#

(109-03-when-the-application-is-filed-aam)New Hampshire Adult Assistance Manual: 109.03 Processing a Filed Application#

(109-03-when-the-application-is-filed-aam)(block-1)109.03 Processing a Filed Application (AAM)#

(109-07-withdrawal-of-a-request-for-assistance-aam)New Hampshire Adult Assistance Manual: 109.07 Withdrawal of a Request for Assistance#

(109-07-withdrawal-of-a-request-for-assistance-aam)(block-1)109.07 Withdrawal of a Request for Assistance (AAM)#

(109-09-reuse-of-an-application-after-denial-or-closing-aam)New Hampshire Adult Assistance Manual: 109.09 Reuse of an Application After Denial or Closing (AAM)#

(109-09-reuse-of-an-application-after-denial-or-closing-aam)(block-1)109.09 Reuse of an Application After Denial or Closing (AAM)#

(109-11-application-for-retroactive-medical-assistance-or-slmb-aam)New Hampshire Adult Assistance Manual: 109.11 Application for Retroactive Medical Assistance or SLMB#

(109-11-application-for-retroactive-medical-assistance-or-slmb-aam)(block-1)109.11 Application for Retroactive Medical Assistance or SLMB (AAM)#

(109-11-application-for-retroactive-medical-assistance-qdwi-slmb-slmb135-or-slmb175-aam)New Hampshire Adult Assistance Manual: 109.11 Application for Retroactive Medical Assistance, QDWI, SLMB, or SLMB135#

(109-11-application-for-retroactive-medical-assistance-qdwi-slmb-slmb135-or-slmb175-aam)(block-1)109.11 Application for Retroactive Medical Assistance, QDWI, SLMB, or SLMB135 (AAM)#

(109-11-application-for-retroactive-medical-assistance-slmb-or-slmb135-aam)New Hampshire Adult Assistance Manual: 109.11 Application for Retroactive Medical Assistance, SLMB or SLMB135#

(109-11-application-for-retroactive-medical-assistance-slmb-or-slmb135-aam)(block-1)109.11 Application for Retroactive Medical Assistance, SLMB or SLMB135 (AAM)#

(109-13-choice-of-financial-assistance-aam)New Hampshire Adult Assistance Manual: 109.13 Choice of Assistance#

(109-13-choice-of-financial-assistance-aam)(block-1)109.13 Choice of Assistance (AAM)#

(109-15-concurrent-receipt-of-financial-assistance-aam)New Hampshire Adult Assistance Manual: 109.15 Concurrent Receipt of Financial Assistance#

(109-15-concurrent-receipt-of-financial-assistance-aam)(block-1)109.15 Concurrent Receipt of Financial Assistance (AAM)#

(109-application-process-aam)New Hampshire Adult Assistance Manual: 109 APPLICATION PROCESS#

(109-application-process-aam)(block-1)109 APPLICATION PROCESS (AAM)#

(111-01-ar-acting-in-place-of-the-individual-aam)New Hampshire Adult Assistance Manual: 111.01 AR Acting in Place of the Individual#

(111-01-ar-acting-in-place-of-the-individual-aam)(block-1)111.01 AR Acting in Place of the Individual (AAM)#

(111-03-ar-signature-required-aam)New Hampshire Adult Assistance Manual: 111.03 AR Signature Required#

(111-03-ar-signature-required-aam)(block-1)111.03 AR Signature Required (AAM)#

(111-authorized-representatives-ar-aam)New Hampshire Adult Assistance Manual: 111 AUTHORIZED REPRESENTATIVES (AR)#

(111-authorized-representatives-ar-aam)(block-1)111 AUTHORIZED REPRESENTATIVES (AR) (AAM)#

(113-01-mismanagement-of-funds-aam)New Hampshire Adult Assistance Manual: 113.01 Mismanagement of Funds#

(113-01-mismanagement-of-funds-aam)(block-1)113.01 Mismanagement of Funds (AAM)#

(113-03-protective-payee-criteria-aam)New Hampshire Adult Assistance Manual: 113.03 Protective Payee Criteria#

(113-03-protective-payee-criteria-aam)(block-1)113.03 Protective Payee Criteria (AAM)#

(113-05-protective-payee-responsibilities-aam)New Hampshire Adult Assistance Manual: 113.05 Protective Payee Responsibilities#

(113-05-protective-payee-responsibilities-aam)(block-1)113.05 Protective Payee Responsibilities (AAM)#

(113-protective-payees-aam)New Hampshire Adult Assistance Manual: 113 PROTECTIVE PAYEES#

(113-protective-payees-aam)(block-1)113 PROTECTIVE PAYEES (AAM)#

(115-vendor-payees-aam)New Hampshire Adult Assistance Manual: 115 VENDOR PAYEES#

(115-vendor-payees-aam)(block-1)115 VENDOR PAYEES (AAM)#

(116-application-processing-time-frames-aam)New Hampshire Adult Assistance Manual: 116 APPLICATION PROCESSING TIME FRAMES#

(116-application-processing-time-frames-aam)(block-1)116 APPLICATION PROCESSING TIME FRAMES (AAM)#

(117-01-when-eligibility-is-uncertain-aam)New Hampshire Adult Assistance Manual: 117.01 When Eligibility is Uncertain#

(117-01-when-eligibility-is-uncertain-aam)(block-1)117.01 When Eligibility is Uncertain (AAM)#

(117-joint-applications-aam)New Hampshire Adult Assistance Manual: 117 JOINT APPLICATIONS#

(117-joint-applications-aam)(block-1)117 JOINT APPLICATIONS (AAM)#

(119-01-initiation-of-medical-assistance-aam)New Hampshire Adult Assistance Manual: 119.01 Initiation of Medical Assistance#

(119-01-initiation-of-medical-assistance-aam)(block-1)119.01 Initiation of Medical Assistance (AAM)#

(119-03-initiation-of-qmb-and-slmb-aam)New Hampshire Adult Assistance Manual: 119.03 Initiation of QMB and SLMB#

(119-03-initiation-of-qmb-and-slmb-aam)(block-1)119.03 Initiation of QMB and SLMB (AAM)#

(119-03-initiation-of-qmb-qdwi-slmb-and-slmb135-aam)New Hampshire Adult Assistance Manual: 119.03 Initiation of QMB, QDWI, SLMB and SLMB135#

(119-03-initiation-of-qmb-qdwi-slmb-and-slmb135-aam)(block-1)119.03 Initiation of QMB, QDWI, SLMB and SLMB135 (AAM)#

(119-03-initiation-of-qmb-slmb-and-slmb135-aam)New Hampshire Adult Assistance Manual: 119.03 Initiation of QMB, SLMB and SLMB135#

(119-03-initiation-of-qmb-slmb-and-slmb135-aam)(block-1)119.03 Initiation of QMB, SLMB and SLMB135 (AAM)#

(119-benefit-delivery-time-frames-aam)New Hampshire Adult Assistance Manual: 119 BENEFIT DELIVERY TIME FRAMES#

(119-benefit-delivery-time-frames-aam)(block-1)119 BENEFIT DELIVERY TIME FRAMES (AAM)#

(121-01-interview-sites-aam)New Hampshire Adult Assistance Manual: 121.01 Interview Sites#

(121-01-interview-sites-aam)(block-1)121.01 Interview Sites (AAM)#