Institutional Residence

(c) A personal interview shall not be required of individuals described in (b) above when the individual:

(1) Is discharged within 60 days from the date of admission; and

(2) Provides to DHHS all of the following information in writing :

a. Individual’s name, case number, discharge address, and indication of whether the individual received medical assistance prior to admission to NHH;

b. Date of admission to and discharge from NHH;

c. Shelter costs for the non-adult categories of medical assistance;

d. Assistance group composition of all people that will reside at the discharge address with the individual , and their relationship to the individual;

e. Current income of the individual and all household members;

f. Current resources, pursuant to He-W 601.07(f), of the individual and all household members;

g. Amount and type of any third -party medical coverage held by the individual and all household members;

h. Any other changes in or information about case circumstances that would impact eligibility; and

i . Individual’s or representative’s dated signature acknowledging:

1. That the individual has reported all changes that have occurred since the individual’s last eligibility determination and that the information provided to DHHS is true and complete to the best of his or her knowledge;

2. That the individual must provide proof of all statements and information provided to DHHS, and that the individual’s or representative’s signature gives permission to DHHS to contact other persons or organizations to get additional proofs of the individual’s eligibility;

3. That any person who intentionally makes a false statement or misrepresents his or her circumstances or intentionally fails to disclose the receipt of property, wages, income, or resources, or any changes in circumstances that would affect his or her initial or continued eligibility for assistance may be found guilty of violating state law;

4. That the individual must report any changes in circumstances within 10 calendar days of when the change occurs, or as instructed by DHHS, pursuant to RSA 167:17; and

5. That if the individual is not satisfied with any decision made by DHHS, the individual may request an appeal within 30 calendar days from the date of the notice; and

(3) Provides to DHHS documentation of changes in address, shelter costs for the non-adult categories of medical assistance, assistance group composition, income, resources, and medical coverage that have occurred since the last eligibility determination, within 10 calendar days of the date of the request.

(d) A personal interview shall be required to redetermine medical assistance for individuals released from an institution when:

(1) An eligibility redetermination was due or overdue when the individual was admitted to New Hampshire Hospital;

(2 ) An eligibility redetermination is due during the month the individual is discharged from New Hampshire Hospital;

(3) DHHS determines that the individual failed or refused to cooperate without good cause pursuant to He-W 601.04( i ) with the medical review process pursuant to He-W 685.01; or

(4) The individual does not meet the criteria described in (c) above.

Source. #11042, eff 2-24-16