Financial Eligibility for Nursing Facilities

(a) The department shall provide medical assistance for all the dates for which payment is requested when the following criteria have been met:

(1) The individual has been determined eligible for categorically or medically needy medical assistance;

(2) The individual has been determined eligible for a medical service for all dates for which medical payment is requested;

(3) The individual has satisfied all procedural requirements; and

(4) The individual has been physically placed at the proper level of care.

(b) Each individual applying for or in nursing facility care shall be treated as an assistance group of one.

(c) If the individual's net income, as defined in He-W 801.05, is greater than the rate of the nursing facility, the individual shall be eligible for in and out medically needy medical assistance, as defined in He-W 801.05, and the cost of the nursing facility care shall be an allowable expense for spending down to the protected income level, as defined in He-W 801.06.

(d) Nursing care payments shall be made only on behalf of individuals in licensed, certified nursing facilities.

(e) Individuals in licensed but uncertified nursing facilities shall be considered to be residing in an independent living arrangement.

(f) The nursing facility rate used in determining eligibility shall remain in effect until the next eligibility determination.

(g) The veteran’s affairs aid and attendance allowance shall be used in full to offset the cost of nursing facility care.

(h) A deduction for the cost of health insurance shall be allowed regardless of whether the expense is mandatory or voluntary .

( i ) Whenever health insurance premiums are due more frequently than monthly, the cost shall be converted to a monthly amount in accordance with He-W 852.05.

(j) Whenever health insurance premiums are due less frequently than monthly, the cost shall be averaged over the period it is intended to cover in order to obtain a monthly amount.

Source. (See Revision Note #1 at Chapter heading for He-W 600) #5171, eff 6-26-91; ss by #5565, eff 2-8-93; ss by #6955, eff 3-3-99; ss by #8783, INTERIM, eff 12-30-06, EXPIRES: 6-28-07; ss by #8903, eff 6-28-07; ss by #10895, eff 7-22-15 (See Revision Note at Part heading for He-W 876); ss by #14359, eff 8-28-25, EXPIRES: 8-28-35

PART He-W 877 RESERVED

PART He-W 878 IN AND OUT MEDICALLY NEEDY MEDICAL ASSISTANCE

Revision Note:

Document #10743, effective 12-12-14, readopted with amendments He-W 678.01 titled “In and Out Medically Needy Medical Assistance”, the only rule in Part He-W 678 similarly titled “In and Out Medically Needy Medical Assistance”, and renumbered the rule as He-W 878.01 in a new Part He-W 878, both titled “In and Out Medically Needy Medical Assistance”. The source note information for He-W 878.01 prior to Document #10743 includes the documents filed under He-W 678.01.

Although He-W 678.01 had last been filed under Document #8684, effective 7-21-06, this rule did not expire on 7-21-14 since it was extended pursuant to RSA 541-A:14-a until replaced by He-W 878.01 in Document #10743, effective 12-12-14.