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(a) Beneficiaries meeting at least one of the following conditions shall be exempted from the community engagement requirement:
(1) Beneficiaries who are unable to participate due to illness, incapacity, or treatment, as certified by a licensed medical professional. This exemption shall include the beneficiary’s participation in inpatient and residential outpatient SUD treatment or intensive outpatient SUD services that is consistent with Levels 2.1 and above as found in the American Society of Addiction Medicine (ASAM) Criteria: Treatment Criteria for Substance-Related, Addictive, and Co-Occurring Conditions, Third Edition (2013), henceforth referred to as “ASAM Criteria 2013”, available as noted in Appendix A;
(2) Beneficiaries who are participating in a state-certified drug court program;
(3) A custodial parent or caretaker as defined in RSA 167:82, II(g) where the required care is considered necessary by a licensed medical professional;
(4) A custodial parent or caretaker of a dependent child under 6 years of age provided that the exemption shall only apply to one parent or caretaker of a common child or children in the case of a 2-parent household;
(5) A custodial parent or caretaker of a child with developmental disabilities who is residing with the parent or caretaker;
(6) Pregnant women as defined in 42 CFR 435.4;
(7) Beneficiaries with a disability who are unable to comply with the community engagement requirement due to disability-related reasons;
(8) Beneficiaries residing with an immediate family member who has a disability and is unable to meet the community engagement requirement for reasons related to the family member’s disability;
(9) Beneficiaries who experience a hospitalization or serious illness;
(10) Beneficiaries residing with an immediate family member who experiences a hospitalization or serious illness; or
(11) Beneficiaries who are medically frail, as certified by a licensed medical professional.
(b) Beneficiaries meeting at least one of the conditions in (a)(1) – (11) above shall complete the required form for the condition as specified for the condition in accordance with He-W 837.04 below.
(c) Beneficiaries who fall in at least one of the following categories, based on the information available in the department’s eligibility system(s), shall be exempted from the community engagement requirement and shall not have to supply additional information to the department:
(1) Beneficiaries who are approved by the department for aid to the permanently and totally disabled (APTD), aid to the needy blind (ANB), medicaid for employed adults with disabilities (MEAD), nursing facility, home and community based services (HCBS), or home care for children with severe disabilities through age 20 (HC-CSD);
(2) Beneficiaries who are receiving supplemental security income (SSI), social security disability income (SSDI), railroad disability, or veteran disability benefits;
(3) Beneficiaries who are pregnant as defined in 42 CFR 435.4, and whose pregnancy status is indicated in the department’s eligibility system(s);
(4) A beneficiary who is a custodial parent or caretaker for a dependent child under 6 provided that the exemption shall only apply to one parent or caretaker of a common child or children in the case of a 2-parent household;
(5) A beneficiary who is a custodial parent or caretaker of a child with developmental disabilities who is residing with the parent or caretaker and who is currently approved by the department for services under the home and community based services developmental disability waiver (HCBS-DD);
(6) Beneficiaries who are receiving supplemental nutritional assistance program (SNAP) benefits and who are exempt from the program’s employment requirements;
(7) Beneficiaries who are receiving temporary assistance for needy families (TANF) benefits and who are exempt from the program’s employment requirements; and
(8) Beneficiaries who are enrolled in health insurance premium program (HIPP).
(d) The exemptions in (c) above shall continue for as long as the particular circumstance continues to exist.
(e) A beneficiary who is exempted in (c) above may request to participate voluntarily in the community engagement requirement and shall have access to the granite workforce program pursuant to He-W 639.
(f) Beneficiaries voluntarily participating in the community engagement requirement in (e) above shall not be subject to suspension or termination for noncompliance with the community engagement requirement.
Source. #12733, INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W 837.04)