Reimbursement
(a)The department shall request applicants for medical…#
(a) The department shall request applicants for medical assistance, including medical assistance provided under medicaid expansion, and their spouses, if any, to provide their signatures indicating that the department has advised them of the requirements of RSA 167:16-a, but a signature on the form shall not be an eligibility requirement.
(b)The form requested in (a) above shall include:#
(b) The form requested in (a) above shall include:
(1) The printed name of the applicant;
(2) The printed name of the applicant’s spouse, if applicable;
(3) The applicant’s street address;
(4) The county where the applicant resides;
(5) The dated signature of the applicant, and spouse if applicable; and
(6) Acknowledgement that the department has advised the applicant of the requirements of RSA 167:16-a.
Source. #13769, eff 9-28-23
PARTS He-W 891 through He-W 894 RESERVED
PART He-W 895 UNDUE HARDSHIP
Revision Note :
Document #11170, effective 8-22-16, readopted with amendments Part He-W 695 titled “Undue Hardship”, which contained He-W 695.01 through He-W 695.08, and renumbered He-W 695 as He-W 895, containing He-W 895.01 through He-W 895.08. The source note information for He-W 895.01 through He-W 895.08 prior to Document #11170 includes the documents filed under He-W 695.01 through He-W 695.08, respectively.
Although He-W 695 had last been filed under Document #9225, effective 8-1-08, the rules in He-W 695 did not expire on 8-1-16 since they were extended pursuant to RSA 541-A:14-a until replaced by the rules in He-W 895 in Document #11170, effective 8-26-16.