CHAPTER He-W 800 ELIGIBILITY FOR MEDICAL ASSISTANCE

PART He-W 801 - DEFINITIONS

He-W 801.01 Definitions A.

(a) “Adoptive parent” means, for the purposes of deprivation of support or care, an individual who has legally adopted a child and has therefore assumed the same parental rights and responsibilities for such child as a biological parent.

(b) “Adult” means any individual age 18 or older, except as modified by various program policies.

(c) “Adult category” means the medical assistance program under old age assistance (OAA), medical assistance for employed adults with disabilities (MEAD), medical assistance for employed older adults with disabilities (MOAD), aid to the needy blind (ANB), and aid to the permanently and totally disabled (APTD).

(d) “Advance notice” means a written decision which is generated by the department and provided to a casehead prior to a negative change in benefits.

(e) “Advance notice period (ANP)” means the period of time from the date a notice of decision denying, decreasing, or terminating benefits is generated to a casehead to the date the change takes effect.

(f) “Aid and attendance” means a veterans affairs allowance.

(g) “Aid to the needy blind (ANB)” means the medical assistance program as described in RSA 167:6, IV.

(h) “Aid to the permanently and totally disabled (APTD)” means the medical assistance program as described in RSA 167:6, VI.

(i) “Alimony” means payments for maintenance and care made to and on behalf of a former or estranged spouse.

(j) “Allowable deduction” means an amount subtracted from case income which represents an expense that is or was paid by an assistance group (AG) member or other person whose income is counted in the determination of eligibility.

(k) “Annuity” means any monetary source of fixed or periodic payments, either for life or for a term of years.

(l) “Applicant” means a person on whose behalf an application for assistance is being made for any of the NH department of health and human services (department) programs.

(m) “Applicant spouse” means the spouse of an OAA, ANB, MEAD, MOAD, or APTD individual who lives with the OAA, ANB, MEAD, MOAD, or APTD individual in an independent living arrangement and is also applying for or receiving OAA, ANB, MEAD, MOAD, or APTD medical assistance.

(n) “Application” means a formal request for assistance or services pursuant to RSA 167:8, which is signed and dated by an individual or authorized representative (AR).

(o) “Assets” means all income and resources of a medical assistance applicant or recipient and the applicant or recipient’s spouse.

(p) “Assistance group (AG)” means the individuals living together with or without benefit of a dwelling pursuant to He-W 830.01(a), whose needs, income, and resources are considered and combined together when determining eligibility or the level of benefits for medical assistance.

(q) “Asylee” means a non-citizen that has been granted political asylum by the U.S. Attorney General.

(r) “Authorized representative (AR)” means an individual acting on behalf of the casehead in some or all of the aspects of initial and continuing eligibility.

(s) “Available income” means all income which is regular and recurring and income which is treated as available for use regardless of actual receipt.

Source. #13836, eff 12-28-23

He-W 801.02 Definitions B–C.

(a) “Beneficiary” means any individual or individuals, designated in a trust instrument as benefiting in some way from the trust.

(b) “Budgetary unit” means a group of individuals:

(1) Who reside in the same housing unit; and

(2) Whose needs are taken into account in identifying the income and resource levels against which countable income and resources are measured to determine eligibility for medical assistance.

(c) “Burial plot” means a conventional gravesite, crypt, mausoleum, urn, or other repository which is customarily and traditionally used for the remains of a deceased person.

(d) “Cap” means the gross income eligibility ceiling for the categorically needy level of eligibility for adult categories of assistance.

(e) “Caretaker relative” means an individual who is not the biological parent, but is legally related to, and providing care for, a child in an AG.

(f) “Case” means the group of programs associated with a particular casehead, including financial assistance, medical assistance, child care, or the supplemental nutrition assistance program (SNAP) or any combination of the above.

(g) “Casehead” means the individual under whose name the case is listed.

(h) “Case income” means the combined countable income of all AG members.

(i) “Category of assistance” means the types of medical assistance offered by the department, such as children’s medicaid, parent or other caretaker relative, pregnant women medical, OAA, ANB, MEAD, MOAD, or APTD.

(j) “Certified” as it relates to nursing facilities, means approval by the division of public health services as meeting federal financial participation requirements for medicare and medicaid.

(k) “Child” means a biological, adoptive, or step-dependent.

(l) “Citizen” means an individual born in the U.S. or born overseas to a parent born in the U.S., or someone who becomes a citizen through the naturalization process.

(m) “Community residence” means a:

(1) Residential facility which:

a. Provides housing on a 24-hour basis to individuals with a mental illness or developmental impairment; and

b. Receives funds or applies to receive funds from the department, community mental health programs, or area agencies; or

(2) Residential facility which houses individuals with a mental illness or developmental impairment who receive or might be eligible to receive the monthly allowance for shared homes and community living home residents, established pursuant to RSA 126.

(n) “Continuing care retirement communities (CCRC)” means, for the purpose of medical assistance eligibility, a community that offers a lifetime contract to its residents allowing a resident to age in place, guaranteeing services such as meals, housekeeping, maintenance, medical care, and nursing care, if needed, for the payment of specified fees. CCRC’s offer multiple levels of care, such as independent living, assisted living, and nursing home care, allowing a resident to age in place.

(o) “Countable income” means available income less excluded income and adjustments for determining the gross amount.

(p) “Countable resources” means real or personal property that is considered in determining eligibility.

Source. #13836, eff 12-28-23

He-W 801.03 Definitions D–E.

(a) “Date of application” means the date on which a signed application for assistance is received by the department.

(b) “Deemed income” means income which is considered available for use regardless of actual receipt.

(c) “Deemed resources” means that real and personal property that is considered to be available to the AG whether or not the property is owned by a member of the AG.

(d) “Department” means New Hampshire department of health and human services (DHHS).

(e) “Dependent child” means a child as described in RSA 167:6, V.

(f) “Deprivation” means the interruption or termination of one or both parent's function as a provider of maintenance, physical care, and guidance for the child due to death, continued absence, unemployment, or physical or mental incapacity.

(g) “Desk review” means verification of a reported or discovered change in an eligibility factor or case circumstance and the resultant adjustments to case eligibility or benefits, if any.

(h) “Disregard” means an amount subtracted from an individual or total combined AG income and is not counted in the determination of eligibility or the amount of assistance.

(i) “Documentary evidence” means written supportive information which authenticates and confirms that certain conditions or circumstances upon which good cause is predicated do, in fact, exist.

(j) “Earned income” means a monetary source or in-kind benefits received as payment for work performed either as an employee, through the receipt of wages, salaries, tips, or commissions, or as a self-employed individual.

(k) “Earned income disregard (EID)” means an amount which is computed and subtracted from earned income.

(l) “Earned income-in-kind” means compensation received for work performed in place of or as a supplement to wages, salary, commissions, profit or payment in cash, or otherwise received as the result of work performed, either employed by another or self-employed.

(m) “Effective income level” means effective income level as defined in 42 CFR 435.4.

(n) “Electronic account” means electronic account as defined in 42 CFR 435.4.

(o) “Eligibility determination” means an eligibility determination as defined in 42 CFR 435.4.

(p) “Employment expense disregard (EED)” means an amount subtracted from earned income, which represents a flat monthly amount or actual expenses, which are reasonably attributable to the earning of income.

(q) “Employment-related disregards” means the EED, the child or dependent care disregard, and the EID.

(r) “Equity value” means the current redemption rate or fair market value of a resource, less any financial claims against the resource.

(s) “Excluded income” means specific types of income which are not counted in the determination of eligibility or the level of eligibility.

(t) “Excluded resources” means real or personal property which is not counted in determining eligibility.

Source. #13836, eff 12-28-23

He-W 801.04 Definitions: F–H.

(a) “Face value” means the death benefit of a life insurance policy exclusive of dividend additions or additional amounts payable because of accidental death or under other special provisions.

(b) “Fair market value” means, for purposes of this chapter:

(1) For all assets other than automobiles and trucks, the price at which a willing seller and a willing buyer will trade; or

(2) For automobiles and trucks, the trade-in value in the National Automobile Dealers Association’s (NADA) Official Used Car Guide, also known as the Kelley Blue Book, unless information is not available in the Kelley Blue Book, or unless the applicant or recipient proves the value of the vehicle is different.

(1) One or more adults and children, if any, related by blood, marriage, or adoption, who reside in the same home;

(2) Separate groups of related adults, other than spouses, or unrelated adults residing together;

(3) Minor siblings living with non-legally responsible relatives; or

(4) Minor siblings living under the care of unrelated persons.

(d) “Family member” means any individual who can be included in an AG, such as a parent or caretaker relative, child, or spouse.

(e) “Federal poverty level (FPL)” means the federal poverty level updated periodically in the federal register by the secretary of health and human services under the authority of 42 USC 9902(2), as in effect for the applicable budget period used to determine an individual’s eligibility.

(f) “Former foster care” means former foster care as described in 42 USC 1396a(a)(10)(A)(i)(IX).

(g) “Four month extended medical assistance” means medical assistance provided regardless of financial eligibility when certain specific factors are met by the AG.

(h) “Good cause” means a substantiated reason which justifies the parent or caretaker relative's refusal to cooperate and still retain eligibility for medical assistance.

(i) “Good faith effort to sell real property” means that the applicant or recipient is making a genuine attempt to sell the property and can provide evidence to the department that the property has been put up for sale, is currently for sale, and that no reasonable offer for the property has been refused.

(j) “Gross earned income for an individual employed by another” means the total amount, prior to payroll deductions.

(k) “Gross earned income for self-employed individuals” means the total monetary value or the dollar value of in-kind benefits received by a self-employed individual as compensation for work performed minus the cost of doing business.

(l) “Gross income” means the total amount of countable earned and unearned income or in-kind benefits received by AG members prior to any disregards or deductions.

(m) “Home and community-based services (HCBS)” means community services that individuals might need in order to prevent institutionalization.

Source. #13836, eff 12-28-23

He-W 801.05 Definitions: I–N.

(a) “Immigrant” means an individual lawfully admitted for permanent residence in the U.S. who entered the country with the express purpose of maintaining permanent residence.

(b) “In-and-out medical assistance” means medical assistance in any category to which is granted for a period of one to 6 months to eligible AGs.

(d) "Income-in-kind" means goods, commodities, or services which are provided as compensation or contribution in lieu of cash and is considered either earned or unearned.

(e) “Independent living arrangement” means the form of housing for OAA, ANB, and APTD individuals who do not reside in a residential care facility, a community residence, or a licensed and certified nursing facility.

(f) “Inmate” means an individual living in a public institution as described in RSA 167:78, XI, with the exception of those who are described in He-W 824.01.

(g) “Inpatient” means a patient who has been admitted to a medical institution as an inpatient on recommendation of a physician or dentist and who:

(1) Receives room, board, and professional services in the institution for a 24 hour period or longer; or

(2) Is expected by the institution to receive room, board, and professional services in the institution for a 24 hour period or longer even if it later develops that the patient dies, is discharged, or is transferred to another facility and does not actually stay in the institution for 24 hours.

(h) “Institutionalized individual” means, for purposes of asset transfers, an individual who is an inpatient in a medical institution, as described in 42 CFR 435.1009, and with respect to whom payment is based on a level of care provided in a nursing facility, or who is a home and community-based services applicant or recipient.

(i) “Insured” means an individual or organization whose life, health, or property is covered by an insurance policy.

(j) “Investigation” means an inquiry made by the department regarding the circumstances upon which a good cause claim is based when documentary evidence is not sufficient.

(k) “Interim disabled parent (IDP)” means the medically needy category of medical assistance for single or 2-parent families in which one or both of the parents are temporarily incapacitated.

(l) “Irrevocable trust” means a trust that cannot in any way be revoked by the grantor.

(m) “Level of eligibility” means the following types of assistance for which an individual might be eligible:

(1) “Categorically needy” medical assistance as defined in 42 CFR 435.4;

(2) “Medically needy” medical assistance as defined in 42 CFR 435.4; and

(3) “Medicare Savings Program” as defined in He-W 801.05 below.

(n) “Liable relative” means an individual who by law or regulation might be required to contribute to the support of an applicant or recipient of medical assistance.

(o) “Licensed” means approved by the department as meeting federal or state standards.

(p) “Medicaid for employed adults with disabilities (MEAD)” means the medicaid eligibility category defined in 42 USC 1396a(a)(10)(A)(ii)(XV) and established by RSA 167:3-i.

(q) “Medicaid” means the Title XIX and Title XXI programs administered by the department that makes medical assistance available to eligible individuals.

(r) “Medicaid expansion group” means individuals defined in 42 USC 1396a(a)(10)(A)(i)(VIII).

(s) “Medicaid for employed older adults with disabilities (MOAD)” means a category of eligibility that allows certain individuals age 65 or older, who are working to either retain or obtain medicaid eligibility.

(t) “Medicare Savings Program (MSP)” means the 4 medical assistance eligibility groups that serve certain low-income medicare beneficiaries. These groups include the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualifying Individual (QI), and Qualified Disabled, and Working Individual (QDWI), each separately codified in 42 CFR 435.123 through 42 CFR 435.126.

(u) “Modified adjusted gross income (MAGI)” means MAGI based income defined in 42 CFR 435.603(e).

(v) “Net earned income” means an individual's monthly gross earned income minus all allowable employment-related disregards.

(w) “Net income” means gross income minus all allowable disregards and deductions.

(x) “Non-applicant” means an individual who is not seeking an eligibility determination for the individual’s own self and is instead included in an applicant’s or beneficiary’s household to determine eligibility for such applicant or beneficiary.

(y) “Non-applicant spouse” means the spouse of an OAA, ANB, MEAD, MOAD, or APTD individual who lives with the individual in an independent living arrangement and who is:

(1) Not applying for and not receiving OAA, ANB, MEAD, MOAD, or APTD medical assistance; or

(2) Applying for or currently receiving medical assistance offered by the department other than OAA, ANB, MEAD, MOAD, or APTD.

(z) “Non-citizen” means any individual who is not a citizen of the United States (U.S.).

(aa) “Notice of decision (NOD)” means a computer-generated or manually-prepared form which advises applicants and recipients of the results of eligibility determinations, increase or decrease in the amount of assistance, level of eligibility, or other change.

(ab) “Nursing facility" means a licensed or certified medical facility which provides health-related care and services on a daily inpatient basis in accordance with He-E 802.

Source. #13836, eff 12-28-23

He-W 801.06 Definitions: O–Q.

(a) “Outpatient” means a patient of an organized medical facility, or distinct part of that facility, who is expected by the facility to receive, and who does receive, professional services for less than a 24-hour period regardless of the hour of admission, and whether or not a bed is used or whether or not the patient remains in the facility past midnight.

(b) “Overpayment” means medical assistance received by an AG that is in excess of what the AG is actually entitled to receive.

(d) “Parental support or care” means financial support, guidance, physical care, or supervision of a dependent child.

(e) “Patient” means an individual who is receiving needed professional services that are directed by a licensed practitioner of the healing arts toward maintenance, improvement, or protection of health, or lessening of illness, disability, or pain.

(f) “Payment from a trust” means any disbursal from the corpus of a trust, or from income generated by a trust, which benefits the party receiving it, regardless of whether the benefit is monetary, or nonmonetary, or property disbursements, such as the right to use and occupy real property.

(g) “Penalty period” means the length of time during which payment for services is denied.

(h) “Period of ineligibility” means the length of time an individual is ineligible for assistance due to excess resources or receipt of a lump sum.

(i) “Permanently and totally disabled” means permanent physical or mental impairment, disease, or combination thereof, which substantially precludes an individual from engaging in useful occupations within their competence, as determined by the department, in accordance with RSA 167:6, VI.

(j) “Personal interview” means a conference between the applicant, recipient, or AR and the department staff member, in order to:

(1) Discuss all circumstances which have a bearing on eligibility;

(2) Advise the applicant, recipient, or AR of the eligibility requirements and their rights and responsibilities; and

(3) Afford applicants, recipients, and ARs an opportunity to ask any questions about the department's programs.

(k) “Personal property” for purposes of reimbursement means “personal property resources" and personal effects such as furnishings, tools, and equipment.

(l) “Personal property resources” means a form of cash or an item which can readily be converted to cash, including such items as bank accounts, stocks, or bonds.

(m) “Plan to achieve self-support (PASS)” means a time limited arrangement or accomplishing financial independence, which is approved by the Social Security Administration and allows a recipient who is visually impaired, disabled, or elderly to set aside income and resources for a work goal.

(n) “Pregnant women (PW)” means medical coverage provided by the department to pregnant women whose income meets eligibility requirements for categorically needy medical assistance, pursuant to RSA 167:68.

(o) “Primary wage earner (PWE)” means the parent or caretaker relative in a 2-parent household who earned the highest income in the 24 months prior to the application for medical assistance, for eligibility of parent and other caretaker relative medical assistance.

(p) “Private institution” means a facility that provides shelter, custody, or care to 2 or more persons and is managed entirely or partially by private funds.

(q) “Protected income level (PIL)” means the amount, based on AG size, against which net income is compared in determining eligibility as medically needy for medical assistance when the AG has applied for medical assistance as medically needy only or is found to be financially ineligible for financial assistance.

(r) “Public institution” means a facility, other than a child care or medical institution, which affords shelter, custody, or care to 2 or more persons and is managed entirely or partially by or through any public instrumentality, official, or employee acting in an official capacity.

(s) “Questionable” means, with regard to verifying factors of eligibility, any verbal or written statement made by an AG member which is inconsistent with:

(1) Other statements made by the same AG member or another AG member;

(2) Information provided on current or past applications for assistance; or

(3) Any information received by the department from any other source.

Source. #13836, eff 12-28-23

He-W 801.07 Definitions R–S.

(a) “Real property resources” means resources that are in the form of real estate, including land and buildings.

(b) “Recipient” means any individual who has been determined eligible and is currently receiving medical assistance.

(c) “Recoupment” means the collection or recovery by the department for the value of assistance erroneously paid to an individual regardless of the cause.

(d) “Resident” means an individual who lives in the state voluntarily, pursuant to RSA 21:6.

(e) “Resources” means property owned by an individual, and includes both personal and real property resources.

(f) “Responsible parent” means a biological parent, adoptive parent, stepparent, or grandparent who, by state law, is liable for the support of a child who receives medical assistance.

(g) “Retroactive month” means any one of the 3 months directly preceding the application beginning the day prior to the application date back to the same date in each of the preceding 3 months.

(h) “Revocable trust” means a trust that can be revoked by the grantor, including trusts that are called irrevocable but which will terminate if some action is taken by the grantor.

(i) “Similar legal device” means any instrument, device, or arrangement which cannot be called a trust under state law, but which exhibits the general characteristics of a trust as defined in He-W 801.08(d), such as escrow accounts, investment accounts, pension funds, annuities, and other similar instruments managed by an individual or entity with fiduciary responsibilities.

(j) “Specified relative” means father, mother, grandfather, grandmother, brother, sister, stepfather, stepmother, stepbrother, stepsister, uncle, aunt, first cousin, nephew, or niece, including relatives of half-blood, relatives of preceding generations as denoted by the prefixes of grand, great, or great-great, adoptive parents and their relatives to the same degree as blood relatives, and spouses of the above relatives even after the marriage is terminated by death or divorce, who provides care and parental control to a dependent child.

(k) “Standard disregard” for adult category assistance means a flat amount which is subtracted from unearned income.

(l) “Standard of need” means the amount of income necessary for recipients to have a reasonable level of subsistence for categorically needy medical assistance.

(m) “Stepparent” means an individual who is currently legally married to a child's biological or adoptive parent but has no biological or adoptive parental relationship to the child.

(n) “Student” means an individual who is officially enrolled in, and regularly attending, an elementary or secondary school, college, university, or a technical or vocational training program which has the main objective of training individuals for gainful employment.

(o) “Sworn statement” means a statement made under oath or affirmation reciting facts which are personally known by the signer, and which are sworn to and notarized by either a notary public or justice of the peace.

Source. #13836, eff 12-28-23

He-W 801.08 Definitions: T–V.

(a) “Temporary absence” means “temporary absence” as defined in RSA 167:78, XXIV, namely “any assistance group member who is temporarily away from the home for, but not limited to, the following reasons: school attendance, vacation, illness, or work.”

(b) “Termination” means the discontinuance of assistance or benefits received by an individual or AG when the conditions of eligibility for receipt of such assistance are no longer met.

(c) “Title IV-D requirements (IV-D)” means the assignment of rights to medical support and cooperation in establishing paternity and obtaining support as a condition of eligibility for medical assistance, as established under 42 USC 608.

(d) “Trust” means any arrangement in which a grantor transfers property to a trustee(s) with the intention that it be held, managed, or administered by the trustee(s) for the benefit of the grantor or certain designated beneficiaries, which is valid under state law and manifested by a valid trust instrument or agreement, and where the trustee(s) hold a fiduciary responsibility to manage the trust's corpus and income for the benefit of the beneficiaries.

(e) “Trustee” means any individual, individuals, or entity, such as an insurance company or bank, who manage a trust, or similar device, and who has fiduciary responsibilities.

(f) “Uncompensated value” means the difference between the fair market value at the time of transfer, less any outstanding loans, mortgages, or other financial claims against the asset, and the amount received for the asset.

(g) “Unearned income” means all contributions, payments, pensions, benefits, loans, awards, or other income which are not received as compensation for work performed.

(h) "Unearned income-in-kind" means a contribution which does not represent compensation for a job performed.

Source. #13836, eff 12-28-23

PART He-W 802 PROGRAM COVERAGES AND LIMITATIONS

He-W 802.03 Telephone Application.

(a) Applicants for any program of medical assistance except for medical assistance as described in He-W 858.05 and He-W 858.06, who request assistance via the telephone, shall be considered to have submitted an application as described in He-W 601.01(p).

(b) The telephone application process pursuant to (a) above shall only be available as funding and resources within the current state fiscal year are available.

(c) All the application requirements that apply when an individual submits a written application shall apply when an individual requests assistance via (a) above, including:

(1) Verification requirements described in He-W 806;

(2) Interview requirements described in He-W 636.01 and He-W 644.01; and

(3) All program requirements as described in He-W 800.

Source. #12552, eff 6-20-18

He-W 802.04 Categorically Needy and Medically Needy Medical Assistance.

(a) The department shall provide medical assistance under the provisions of 42 USC 1396a (a)(10)(A)(i).

(b) Categorically needy medical assistance shall be provided to the following coverage groups pursuant to 42 USC 1396a(a)(10)(A)(ii):

(1) Individuals who would be eligible for, but are not receiving, financial assistance under one of the department's financial assistance programs, in accordance with 42 CFR 435.210;

(2) Individuals who would be eligible for, but are not receiving, financial assistance under one of the department's financial assistance programs due to their medical institutional status, in accordance with 42 CFR 435.211;

(3) Children for whom public agencies are assuming full or partial financial responsibility or who are in a foster home or private institution, as defined in He-W 801.06;

(4) Children whose adoption is being subsidized in full or part by a public agency;

(5) Individuals receiving adult category financial assistance;

(6) Individuals in institutions who are eligible under a special income level, in accordance with 42 CFR 435.236;

(7) Individuals who would be eligible for medical assistance if they were in a medical institution, but are instead receiving home and community based services in accordance with 42 CFR 435.217;

(8) Children with severe disabilities who meet the requirements, in accordance with RSA 167:3-e, RSA 167:3-f, RSA 167:3-g and 42 CFR 435.225; or

(9) Deemed newborn children as described in 42 CFR 435.117.

(c) Medically needy medical assistance shall be provided to any individual who meets the general, categorical, and technical requirements for categorically needy medical assistance, provided the individuals meet the financial requirements for medically needy medical assistance and not the financial requirements for categorically needy medical assistance.

(d) Medical assistance shall be provided to individuals age 65 or older who are patients in institutions for mental diseases, in accordance with 42 CFR 441.101.

Source. #13833, eff 12-23-23

PART He-W 803 INDIVIDUAL RIGHTS AND RESPONSIBILITIES

He-W 803.01 Authorized Representative.

(a) A individual who chooses an authorized representative (AR), as defined in He-W 601.01(w), to help with some or all the responsibilities of applying for or receiving medical assistance shall provide all of the following information in writing:

(1) The name, address, and telephone number of the AR;

(2) The duties that the AR will carry out, as specified in (c) below;

(3) The individual's relationship to the AR;

(4) A statement signed and dated by the individual acknowledging:

a. His or her responsibility for any errors, omissions, failures to report information to DHHS, or inaccurate information reported to DHHS by the AR;

b. That if the AR uses the individual’s benefits without permission, these benefits will not be replaced by DHHS;

c. That the person the individual names as the AR will continue to act for the individual until the individual or the AR tells DHHS of a change; and

d. Comprehension of the individual’s choice of AR and the duties assigned to that AR; and

(5) A statement signed and dated by the AR:

a. Agreeing to accept the responsibilities designated by the individual;

b. Acknowledging that the AR understands that:

1. Proof of the AR’s identity is required;

2. If disqualified for a program violation, the person identified as the AR can no longer act as an AR unless there is no one else suitable to represent the individual; and

3. The AR will continue to act as an AR for the individual until the AR or the individual tells DHHS of a change.

(b) To qualify as an AR, an individual shall be an adult who has:

(1) Expressed concern for the individual's wellbeing;

(2) Sufficient knowledge about the individual's circumstances to assist the individual in applying for or receiving assistance; and

(3) The capability to obtain information about the individual's circumstances.

(1) Obtaining DHHS applications and other forms or DHHS paperwork, and completing these for the individual;

(2) Attending eligibility interviews for the individual;

(3) Providing DHHS with verification of the individual's income, resources and other case circumstances;

(4) Reporting and verifying changes in the individual's case circumstances to DHHS;

(5) Receiving the individual's medical assistance identification card and other DHHS mail;

(6) Asking for, attending, and representing the individual at administrative appeals for the individual;

(7) Communicating with the individual’s managed care organization or qualified health plan; and

(8) Any other duties regarding eligibility for medical assistance an individual chooses to designate to an AR.

(d) If designated pursuant to (a)(2) above, ARs shall:

(1) Sign DHHS forms completed on behalf of the individual; and

(2) Co-sign DHHS forms they assist the individual in completing.

Source. #11042, eff 2-24-16

He-W 803.02 Individual Responsibility to Supply Accurate Information. Individuals shall supply complete and truthful answers to all written and verbal questions to establish eligibility or fulfill an eligibility requirement, pursuant to RSA 167:17-b.

Source. #11042, eff 2-24-16

He-W 803.03 Individual Responsibility to Report Changes. Failure to report changes no later than 10 calendar days after the change takes place, pursuant to RSA 167:17, shall result in the recoupment of any resultant overpayments or a corrective payment for any resultant underpayments.

Source. #11042, eff 2-24-16

PART He-W 804 CASE DECISIONS

He-W 804.01 Case Decisions. Except where otherwise noted or specifically prohibited, an assistance group shall be eligible for medical assistance only when all general, categorical, technical, and financial requirements for the category and type of assistance requested are met and verified.

Source. #13765, eff 10-5-23

He-W 804.02 Notice of Decision.

(a) Except where otherwise specified, increases in the level of eligibility shall take effect on the first of the following month after the change is processed, as determined by computer processing cut-off dates.

(b) When positive and negative changes occur or are reported simultaneously, the changes shall be processed together and the combined effect of the changes shall determine the advance notice period requirements as described in He-W 804.03.

Source. #13765, eff 10-5-23

He-W 804.03 Advance Notice Period.

(a) The advance notice period (ANP) shall be one of the following:

(1) Five calendar days when terminating or reducing benefits due to fraud;

(2) Ten calendar days before the date of action to discontinue, terminate, suspend, or reduce assistance; or

(3) No advance notice period shall be provided in accordance with 42 CFR 431.213, as described in (d) below or when the situations described in (e) below apply.

(b) For 12-month extended medical assistance (EMA), a 10-calendar day advance notice shall be provided when a client is moving out of state.

(c) Changes in assistance group (AG) circumstances that occur or are reported during an ANP shall not be processed until the ANP has expired.

(d) The department shall not provide an ANP when federal regulations allow the option of dispensing with the ANP when:

(1) Factual information confirms the death of a recipient;

(2) A recipient provides a written, dated, and signed request to terminate assistance or gives written information which will result in the termination or decrease in the level of eligibility or amount of assistance;

(3) A recipient has been admitted or committed to an institution and is no longer eligible for assistance;

(4) A recipient’s location is unknown and the department’s mail is returned by the postal service indicating no forwarding address is on file; and

(5) The recipient has been accepted for assistance in another state.

(e) The department shall not provide an ANP when no action is taken or it would be impossible to provide an ANP to the AG, including, but not limited to, in the following situations:

(1) A recipient is placed in a nursing facility or requires long term hospitalization;

(2) All recipients in the AG have died;

(3) A recipient or AG is closed in one case and opened in another, and the eligibility level and benefit amount remain the same; and

(4) A child is removed from the home as a result of a judicial determination or is voluntarily placed in foster care by the child’s legal guardian.

(f) For 12-month EMA, advance notice shall not be provided for the following situations:

(1) There is no longer a dependent child in the 12-month EMA AG;

(2) The individual does not meet the employment requirements;

(3) The individual requests termination of benefits; or

(4) If the result of gross earned income, minus child care costs, for all AG members exceeds the EMA income limit.

Source. #13765, eff 10-5-23

He-W 804.04 Electronic Notification.

(a) Notices of decision (NOD), as defined in He-W 801.05, may be accessed electronically by the casehead, as defined in He-W 801.02, if the casehead:

(1) Chooses to access NODs electronically;

(2) Has an email account able to receive notifications from the department;

(3) Provides the department with an email address; and

(4) Activates a user account through the department’s eligibility web portal.

(b) If the casehead chooses to only access NODs electronically, no paper NODs shall be sent to the casehead via the United States Postal Service (USPS).

(c) If the casehead chooses to only access NODs electronically, the casehead shall be responsible for the security and validity of the email account information provided to the department.

(d) All information included in paper NODs shall also be included in electronic NODs.

(e) If the casehead prefers to reestablish generation of paper NODs sent via the USPS and chooses not to use the department’s eligibility web portal to make this change, the casehead shall submit a request to the department in writing and include the following information:

(1) The casehead’s printed name;

(2) The request to reestablish generation of paper NODs;

(3) The case number or recipient identification number assigned to the casehead’s case; and

(4) The casehead’s signature.

(f) The date the department receives the completed request described in (e) above shall be the casehead’s filing date for the request to reestablish paper NODs.

(g) Paper NODs shall be mailed to the casehead’s mailing address within 10 days of the casehead’s filing date described in (f) above.

Source. #10729, eff 11-25-14; ss by #14220, eff 3-26-25

He-W 804.05 Electronic Account Access.

(a) Electronic accounts that contain the casehead’s electronic notices of decision (NOD) and other confidential case information shall be activated through the department’s eligibility web portal by:

(1) The casehead;

(2) The casehead’s guardian, conservator, or protective payee;

(3) An authorized representative (AR) or power of attorney chosen by the casehead; or

(4) An organization acting as the casehead’s guardian, conservator, protective payee, AR, or power of attorney.

(b) If an organization acting as the casehead’s guardian, conservator, protective payee, AR, or power of attorney chooses to access a casehead’s electronic account, the organization shall:

(1) Obtain the casehead’s permission to access the electronic account; and

(2) Register with the department by providing the following information:

a. The organization’s name, phone number, both physical and mailing addresses, and email address;

b. The name of a designated administrator for the organization who is responsible for maintaining confidentiality for the entire organization;

c. A 4-digit pin, chosen by the administrator, for security purposes; and

d. The administrator’s dated signature signifying an agreement to abide by the confidentiality and safeguarding information policies, pursuant to RSA 167:31, RSA 167:32, and 42 CFR 431.300-42 CFR 431.307.

(c) A casehead shall not have access to an electronic account through the department’s eligibility web portal once the casehead has given permission to an organization to access the casehead’s electronic account.

(d) If the organization chooses to only access NODs electronically, with no paper NOD sent via the United States Posal Service (USPS), the organization shall be responsible for the security and validity of the email account information provided to the department.

(e) All information included in a paper NOD shall also be included in electronic NODs.

(f) If the organization prefers to reestablish paper NODs sent via the USPS, the organization shall do so using the department’s eligibility web portal to make this change.

Source. #10729, eff 11-25-14; ss by #14220, eff 3-26-25

PART He-W 805 RESERVED

PART He-W 806 VERIFICATIONS

Revision Note:

Document #10743, effective 12-12-14, readopted with amendments He-W 606.89 titled “In and Out Medically Needy Medical Assistance” and renumbered the rule as He-W 806.89 titled “Verification Requirements for In and Out Medically Needy Medical Assistance”. The source note information for He-W 806.89 prior to Document #10743 includes the documents filed under He-W 606.89.

Although He-W 606.89 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 806.89 in Document #10743, effective 12-12-14.

He-W 806.01 General Verification Requirements - All Categories of Medical Assistance and Low-Income Subsidy Assistance.

(a) All general, categorical, technical, and financial factors related to the determination of eligibility and level of benefit for low-income subsidy assistance, pursuant to 42 USC 1396u-5, and all categories of medical assistance, shall be verified at:

(1) Initial determinations;

(2) Redeterminations of eligibility;

(3) Whenever a change occurs; or

(4) When questionable as, defined in He-W 801.06.

(b) Providing acceptable verification shall be the sole responsibility of the individual, except where otherwise noted.

(c) Failure to verify any factor required for the determination of eligibility or level of benefit shall result in denial or termination of assistance for the entire assistance group, except where otherwise noted.

Source. #13875, eff 2-21-24

He-W 806.02 – He-W 806.09 RESERVED

He-W 806.10 Residency.

(a) For all categories of medical assistance, the individual's written or verbal statement of current address shall be accepted as verification of New Hampshire residence, unless conflicting evidence is present.

(b) If conflicting evidence is present, the department shall request additional evidence of residence, including, but not limited to:

(1) Mail sent to the individual at the stated address;

(2) Utility or other bills addressed to the individual at the stated address; or

(3) Receipts from a landlord or mortgage company showing the current address.

(c) Failure to supply the additional evidence or failure of the additional evidence to verify residence, shall result in denial or termination of benefits as described in He-W 806.01.

Source. #13875, eff 2-21-24

He-W 806.11 through He-W 806.17 RESERVED

He-W 806.18 Institutional Residence.

(a) The department of health and human services (DHHS) shall verify institutional residence and the individual's status within the institution by written or verbal contact with the institution.

(b) Individuals who received medical assistance but whose assistance was terminated at the time of admission to New Hampshire Hospital (NHH) shall have medical assistance redetermined pursuant to He-W 684.01 without a personal interview, as defined in He-W 601.06(l), if the individual meets the criteria in (c) below.

(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

He-W 806.19 Presence of a Dependent Child. If conflicting evidence is present, refusal or failure of the parent or caretaker relative to verify the presence of a dependent child shall result in the denial or termination of categorically needy medical assistance for:

(a) Each child whose presence is not verified; and

(b) The parent or caretaker relative, if it cannot be verified that any dependent children are present.

Source. #13875, eff 2-21-24

He-W 806.20 Deprivation Due to Death.

(a) The individual shall provide verification of the parent's death whenever death is the cause of deprivation.

(b) The following documentation shall be acceptable for verifying death, provided the deceased is named on the document:

(1) Death certificate;

(2) Medical records or signed statement from the physician of the deceased;

(3) Statement or bills from the undertaker or funeral home;

(4) Legal documents that refer to the parent's death; or

(5) Documents issued by other agencies, such as Social Security Administration, Veterans Affairs, or insurance companies, which refer to the death of the parent.

(c) Refusal or failure to verify the parent's death shall result in the denial of categorically needy medical assistance for the parent or other caretaker relative when deprivation is not verified.

Source. #13875, eff 2-21-24

He-W 806.21 Deprivation Due to Continued Absence.

(a) Refusal or failure to provide verification of continued absence shall result in the denial or termination of categorically needy medical assistance for the parent or other caretaker relative when deprivation is not verified.

(b) The individual shall verify that continued absence of a parent currently exists, pursuant to He-W 828.01.

Source. #13875, eff 2-21-24

He-W 806.22 Verification of Unemployment Status. For the determination of eligibility for parent or other caretaker relative medical assistance based on deprivation due to unemployment of at least one parent pursuant to He-W 828.03, the applicant shall provide written documentation or self-attest that at least one parent is unemployed or working less than 100 hours per month.

Source. (See Revision Note #1 at chapter heading for He-W 600) #5171, eff 6-26-91; EXPIRED 6-26-97

New. #7084, eff 8-26-99; ss by #8970, eff 8-25-07; ss by #10163, eff 7-26-12; ss by #13617, eff 4-26-23 (formerly He-W 606.22) (see Revision Note #2 at part heading for He-W 806)

He-W 806.23 Living with a Specified Relative.

(a) The relationship to a specified relative shall be verified:

(1) At the initial determination of eligibility;

(2) When a child is added to the assistance group;

(3) When the specified relative changes; or

(4) Whenever the relationship is questionable.

(b) The following shall be considered acceptable verification of the relationship between the specified relative and the child:

(1) Birth, court, school, hospital, or medical records;

(2) Marriage certificate;

(3) Insurance policies; or

(4) Written statements from 2 or more individuals who have direct knowledge of the family relationship.

(c) Refusal or failure to adequately verify the relationship between the child and the specified relative shall result in the denial or termination of medical assistance for each specified relative for whom the relationship is not verified.

(d) The living arrangement of the child and specified relative shall be verified through statements obtained during the application process.

(e) If the living arrangement of the child is questionable, the following shall be considered acceptable verification:

(1) School, medical, legal, or child care center records;

(2) Other records which indicate where and with whom the child lives; or

(3) Written statements from 2 or more individuals who have direct knowledge of the family relationship.

(f) Refusal or failure to adequately verify that a child is living with a specified relative shall result in the denial or termination of medical assistance for the specified relative when verification is not provided.

Source. #13875, eff 2-21-24

He-W 806.24 Age.

(a) The age of each child in a medical assistance group shall be verified using electronic data sources at that child's initial determination of eligibility or whenever additional evidence indicates incorrect age.

(b) If conflicting evidence is present, refusal or failure to verify age shall result in the denial or termination of medical assistance for each child for whom age is not verified.

Source. #13875, eff 2-21-24

He-W 806.25 through He-W 806.36 RESERVED

He-W 806.37 RESERVED

Source. #11026, eff 1-23-16; rsvd #14379, eff 9-20-25

He-W 806.38 through He-W 806.40 RESERVED

He-W 806.41 Pregnant Women. Self-attestation shall be acceptable verification of pregnancy, expected date of delivery, and the number of fetuses the pregnant woman is carrying for pregnant women medical assistance.

Source. #13875, eff 2-21-24

He-W 806.42 Old Age Assistance (OAA) Age Requirements.

(a) Age shall be verified using electronic data sources at the initial determination of eligibility, and whenever conflicting evidence indicates an incorrect age.

(b) If conflicting evidence is present, refusal or failure to verify age shall result in the denial or termination of OAA medical assistance for the individual whose age is not verified.

Source. #13875, eff 2-21-24

He-W 806.43 - 806.54 RESERVED

He-W 806.55 Deemed Income. Income deemed from a parent or legal guardian to a minor casehead, when the casehead lives with the parent or legal guardian, shall be verified in the same manner as income of an adult category assistance group member, unless otherwise designated.

Source. #13414, eff 7-26-22

He-W 806.56 to He-W 806.58 RESERVED

He-W 806.59 Treatment of Specific Types of Income. If the recipient's name and benefit amount are on the document, acceptable verification of Social Security Administration (SSA) or Supplemental Security Income (SSI) benefits shall be the following:

(a) Current SSA or SSI check;

(b) Current SSA or SSI check stub;

(d) For SSA benefits only, the current SSA Beneficiary and Earnings Data Exchange computer crossmatch listing supplied to the department from SSA; or

(e) For SSI benefits only, the current SSA State Data Exchange computer crossmatch listing supplied to the department from SSA.

Source. #13875, eff 2-21-24

He-W 806.60 Verification of Educational Income - Adult Categories. Acceptable verification of specific types of educational income shall be provided to the department, as follows:

(a) For U.S. Secretary of Education scholarships and grants:

(1) Written or verbal contact with the financial aid officer at the individual's school; or

(2) A letter of award;

(b) For work/study income:

(1) Written or verbal contact with the financial aid officer at the individual's school;

(2) Written or verbal contact with the individual’s employer to obtain earnings information; or

(3) Pay stubs;

(1) Written or verbal contact with the financial aid officer at the individual's school; or

(2) A letter of award;

(d) For veterans' educational assistance benefits:

(1) A written or verbal statement from the Department of Veterans Affairs;

(2) A letter of award which states the amount and that benefits are contingent upon regular school attendance; or

(3) A check or check stub to verify the amount; and

(e) For student loans:

(1) Written or verbal contact with the financial aid officer at the individual's school; or

(2) A loan agreement or other loan document.

Source. #10699, eff 10-24-14

He-W 806.61 through He-W 806.64 RESERVED

He-W 806.65 Plan to Achieve Self Support (PASS) Income and Resources.

(a) Acceptable verification of income and resources set aside under a PASS, as defined in He-W 801.06, shall be written documentation from the Social Security Administration that indicates:

(1) The individual is participating in the PASS;

(2) The amount of income and resources to be excluded; and

(3) The begin and end dates of the plan.

(b) Money set aside under a verified PASS plan, pursuant to (a) above, shall be treated as follows for all categories of medical assistance:

(1) PASS accounts are excluded as resources; and

(2) Supplemental Security Income allocated into a PASS account is excluded as income.

Source. #13875, eff 2-21-24

He-W 806.66 through He-W 806.67 RESERVED

He-W 806.68 Adult OAA, APTD, and ANB Employment Expense Disregard.

(a) Verification of employment expenses shall not be required for use in the cost of care computation for OAA, APTD, or ANB applicants and recipients requesting nursing facility, choices for independence (CFI), home and community-based care for the developmentally disabled (HCBC-DD), home and community-based care for individuals with an acquired brain disorder (HCBC-ABD), and home and community-based care for in-home supports (HCBC-IHS) assistance, if the individual's claimed monthly employment expenses are $18.00 or less.

(b) Acceptable verification of the amount of employment expenses for use in the cost of care computation for OAA, APTD or ANB applicants and recipients requesting nursing facility, CFI, HCBC-DD, HCBC-ABD, and HCBC-IHS assistance, shall be:

(1) For social security taxes, pay stubs, a letter or other written information from the employer which specifies the amount of social security taxes withheld from earnings;

(2) For railroad retirement, pay stubs or a letter from the employer verifying the employment expense;

(3) For federal withholding:

a. Pay stubs or a letter from the employer verifying the employment expense; or

b. For self-employed individuals, IRS tax forms or other documents which indicate the amount of federal withholding taxes being paid;

(4) For transportation costs:

a. A statement signed by the individual indicating whether reimbursement is received and the amount and source of the reimbursement;

b. If child care related transportation costs are claimed, a statement signed by the child care provider attesting to the fact that it is necessary for the individual to provide the child's transportation;

c. If the individual's own vehicle is used, a signed statement indicating the number of miles claimed and that such mileage is the shortest necessary to travel to and from work;

d. If the individual rides in another person's privately owned vehicle, the documentation in c. above, and a statement signed by the driver which indicates the amount and frequency of the charge for transportation; or

e. If the individual uses public transportation, a statement signed by the provider of the transportation which indicates the amount normally charged to the public and whether the charge is for one-way or round-trip;

(5) For special clothing, paid receipts for purchased clothing which substantiate that the costs are recurring; and

(6) For child care costs:

a. If the individual is being reimbursed for child care costs through the department of health and human services (DHHS) child care assistance program, the amount, if any, of the child care fee which the client must pay as shown on the DHHS invoice; or

b. If there is no DHHS child care assistance program involvement with child care costs, acceptable documentation shall be:

1. A statement signed by the individual indicating whether reimbursement is received and the amount and source of the reimbursement;

2. A written statement signed by the child care provider indicating the amount and frequency of the child care cost; or

3. DHHS verbal contact with the child care provider indicating the amount and frequency of the child care cost.

(c) If the individual fails or refuses to provide verification of a claimed expense, the amount of the unverified expense shall not be an allowable employment expense.

Source. #11026, eff 1-23-16

He-W 806.69 Impairment Related Work Expenses.

(a) When claiming impairment related work expenses (IRWE’s), APTD applicants and recipients shall furnish the department of health and human services (DHHS) with documentation of the need for and the unreimbursed cost of one or more of the IRWE’s described in 20 CFR 416.976.

(b) Acceptable documentation of the need for IRWE’s shall be a signed statement from a physician, psychologist, vocational rehabilitation counselor, or other medical health professional which:

(1) Indicates that the expense is related to the applicant or recipient’s impairment and is necessary for employment; and

(2) Is dated within 30 days of the date that the documentation is provided to DHHS.

(c) Acceptable documentation of the unreimbursed cost of the expense shall be a paid receipt, canceled check or other documentation that demonstrates that the applicant or recipient has paid for the item or service out of his or her own funds, and has not and will not be reimbursed for the expense.

(d) For an applicant or recipient wishing to claim mileage expenses for his or her specially equipped vehicle, the applicant or recipient shall provide documentation of:

(1) The ownership, make, and model of the vehicle;

(2) The specific modifications that were made to the vehicle; and

(3) The number of miles traveled to and from work.

(e) Refusal or failure to provide verification of an IRWE shall result in the expense not being allowed as a deduction from earned income.

(f) OAA recipients with an IRWE deduction at the time their case is transferred from APTD to OAA shall furnish documentation pursuant to (a) above.

Source. #11026, eff 1-23-16

He-W 806.70 through He-W 806.73 RESERVED

He-W 806.74 Allowable Deductions.

(a) Acceptable verification of allowable deduction amounts for medical assistance programs that do not determine income pursuant to 42 CFR 435.603 shall include:

(1) For training expenses:

a. The same documentary evidence required under He-W 606.68 for transportation costs, special clothing, child care costs, and other allowable expenses; and

b. A letter from an official of the training program which states that the expense is required and a receipt or other verification showing the amount which is required to be paid for the expense;

(2) For court-ordered child support, a copy of the most current court order;

(3) For court-ordered alimony, a copy of the most current court order;

(4) For garnishments, a letter from the employer; and

(5) For incurred current medical expenses and prior medical debts of an individual residing in a nursing facility:

a. Provider bills, reminder notices and collection agency notices which are dated within 30 days of the month to which the debt is expected to be applied;

b. A statement from the insurance company of the intent to pay covered charges, as indicated by an explanation of medical benefit;

c. The medical service provider's bill showing insurance payment;

d. District office collateral verification by letter or telephone with the insurance or medical provider of the charges and allowances toward medical services; or

e. Historical data previously known to the district office which documents the amount of the charges and allowances toward recurring medical services.

(b) For all medical assistance programs, if the individual refuses or fails to provide verification of a claimed expense, the amount of the unverified expense shall not be considered an allowable deduction.

Source. #10895, eff 7-22-15

He-W 806.75 Allocated Income for Non-MAGI Categories of Medical Assistance.

(a) If the individual refuses or fails to verify a claimed allocation, the unverified amount shall not be an allowable deduction.

(b) An institutionalized individual, as defined in 801.05, who has a spouse living in the community, shall provide verification of the following:

(1) The need for institutionalization of at least 30 days;

(2) The income and shelter expenses of the spouse who resides in the community, if applicable;

(3) Marital status;

(4) Incurred medical expenses of the institutionalized individual, if applicable;

(5) Legal dependent status and income of individuals claimed as dependents, if applicable;

(6) Identity of the dependent and relationship of the dependent to the institutionalized individual or spouse who supports the dependent, if applicable; and

(7) Court ordered support against the institutionalized individual, if applicable.

(1) A signed and dated statement from the admitting physician, caseworker, hospital social worker, bureau of elderly and adult services social worker, or representative of the institution, which indicates that based on available medical data, the institutionalized individual requires a minimum of 30 days of institutionalization;

(2) Documentation that substantiates the amount and frequency of income, as specified in He-W 806.59;

(3) A marriage certificate, a record of marriage from the town clerk's office, or other document that provides proof of marriage;

(4) Documentation which is no more than 2 months old and which substantiates the community spouse's shelter expenses, such as:

a. Rent receipts that indicate the amount and frequency of payment;

b. A bill or receipt for the mortgage payment;

c. Property taxes;

d. Fire insurance premiums;

e. Manufactured housing lot rent;

f. Utility expenses; or

g. Condominium fees;

(5) Bills or receipts that substantiate that the institutionalized spouse has incurred non-reimbursable medical expenses and the frequency of such expenses;

(6) A copy of the most recent filed internal revenue service income tax return or other documentation that substantiates legal dependency status;

(7) A driver's license, military record, voter registration card, school or hospital record, or any other document that establishes the identity of the dependent;

(8) A birth certificate, baptismal record, marriage certificate, or other documentation which establishes the relationship between the dependent and the spouse who provides support; and

(9) A copy of the court order or other documentation that substantiates that the institutionalized spouse has been ordered to pay support and which indicates the amount and frequency of such support payments.

(d) The allocation from the institutionalized individual's income to the community spouse shall take effect in the month that the institutionalized individual provides documentation of the items cited in (b) above.

(e) If documentation described in (d) above is provided within 10 calendar days of the department request, the allocation shall take effect the month in which the request was made.

Source. #13875, eff 2-21-24

He-W 806.76 Resources - Basic Principles. If excluded resources have been commingled with countable resources, the individual shall provide proof of the portion which is excluded.

Source. #13875, eff 2-21-24

He-W 806.77 - RESERVED

He-W 806.78 Personal Property Resources.

(a) For medical assistance categories that have a resource test:

(1) The following documents shall be used to verify that a resource is legally unavailable to the applicant or recipient:

a. For irrevocable trust funds, the trust instrument or agreement;

b. For irrevocable burial funds, the bank account, agreement, trust instrument, or similar document which clearly states that the burial funds are not legally available to the individual; and

c. For property in probate, written or verbal contact with the register of probate in the appropriate county indicating that the property is currently in probate and legally unavailable to the applicant or recipient or a letter from the attorney handling the property indicating the property is legally unavailable to the applicant or recipient;

(2) Acceptable verification of income tax refunds or lump sum earned income tax credit payments shall be a copy of the tax refund check or the applicant’s or recipient’s submitted tax return;

(3) Acceptable verification of the value of IRA and non-contractual Keogh accounts and penalty for early withdrawal shall be a written statement from the financial institution where the account was issued indicating the current balance in the account and penalty for withdrawal of the entire amount in the account;

(4) Acceptable verification of the type of Keogh account, such as contractual or non-contractual, shall be a written statement from the individual's employer or the financial institution where the account was issued indicating whether it involves a contractual relationship with other individuals and if money can be withdrawn without affecting the other individuals involved;

(5) Acceptable verification of the face value of life insurance shall be:

a. The actual policy itself; or

b. Written or verbal contact with the insurance company when the face value cannot be determined using the actual policy;

(6) Acceptable verification of the equity value of life insurance shall be determined by written or verbal contact with the insurance company;

a. Using the cash value or non-forfeiture of benefits table, if there is no loan on the policy; or

b. Written or verbal contact with the insurance company, if there is a loan on the policy;

(7) Acceptable verification of lump sum death benefits shall be a letter of award, written contact with the agency providing the benefit or with the funeral director arranging for payment of the benefit, or if written documentation cannot be furnished, department of health and human services (DHHS) verbal contact with the agency or funeral director;

(8) Acceptable verification of resources resulting from an accumulation of types of income which are excluded by federal mandate shall be letters of award, written statements from the source providing benefits, or, if written documentation cannot be furnished, DHHS verbal contact with the source providing the benefits;

(9) Acceptable verification of stocks and bonds shall be the market value of the stock or bond in the financial section of a current newspaper or, if written documentation cannot be located, DHHS verbal contact with a stock broker; and

(10) Good faith effort to sell a personal property asset that cannot be readily converted to cash shall be newspaper clippings or evidence of other means of advertising showing that the asset is for sale at a price commensurate with the property’s fair market value.

(b) For verification of resources for medical assistance categories that have a resource test, the following shall apply:

(1) For equity value of a vehicle:

a. The fair market value of an automobile or truck shall be verified by using the “trade-in value” in the most recent edition of the NADA Official Used Car Guide, also known as the “Blue Book”;

b. The fair market value shall not be increased because of special equipment for the handicapped, low mileage, or optional equipment;

c. If the applicant or recipient states that the fair market value in the Blue Book does not apply to the vehicle because of body damage or other factors, the individual shall present verification of the true fair market value of the vehicle from an auto dealer or an individual who is engaged in a vehicle sales or service business; and

d. If a vehicle is custom made, too old, or too new to be included in the Blue Book, the applicant or recipient shall verify its fair market value by:

1. Obtaining an appraisal from an automobile dealer or an individual who is engaged in a vehicle sales or service business;

2. Submitting a tax assessment on the vehicle indicating its value; or

3. Submitting a newspaper advertisement which indicates the amount for which like vehicles are being sold;

(2) The applicant’s or recipient’s written statement shall be acceptable verification of the fact that a vehicle is a junk vehicle, provided the statement gives an accurate and complete description of the vehicle's condition; and

(3) Acceptable verification of the fact that farm machinery and vehicles are necessary for subsistence, maintenance, or employment shall be a written statement from the applicant or recipient.

(c) Acceptable verification of incurred unpaid medical expenses for medical assistance shall be bills which substantiate the amount of unpaid medical expenses that the applicant or spouse have incurred and that the applicant or spouse is still liable for the unpaid medical expenses.

Source. #11141, eff 7-22-16

He-W 806.79 –through He-W 806.82 RESERVED

He-W 806.83 Verification of Shelter and Living Arrangement.

(a) The minimum verification information for a rental situation shall consist of the:

(1) Date tenancy began;

(2) Rent amount;

(3) Payment period;

(4) Home address;

(5) Housing or rent subsidy type;

(6) Gross family contribution for tenants receiving deep subsidy rental assistance;

(7) Basic rent for tenants in unsubsidized housing and urban development 236 housing; and

(8) Number of people living in the unit.

(b) If the individual is unable to provide the documentation required in (a) above, the department shall request the required information directly from the landlord, property manager, or housing authority with a requested return date 10 calendar days later.

(c) If the landlord, property manager, or housing authority does not respond within the timeframe specified in (b) above, a the department shall request a written statement from the individual with a requested return date 10 calendar days later.

(d) Acceptable verification of home ownership shall be:

(1) A copy of the mortgage or deed;

(2) A written statement on the letterhead of the bank or lending institution that specifies the terms of the mortgage payment; or

(3) Bills or receipts for the mortgage payment, property taxes, homeowners insurance premiums, manufactured housing lot rental, or other expenses attributable to owning the home, such as condominium association fees.

(e) Acceptable verification of rooming, boarding, shared, or provided shelter arrangements, shall be a signed and dated statement from the individual providing or sharing the shelter, which contains:

(1) An explanation of the exact nature of the shelter arrangement; and

(2) The cost(s) to the individual.

(f) In situations where the liability for the mortgage payment is shared with an individual who is not an assistance group member, acceptable verification of home ownership shall be:

(1) A signed statement from the individual who shares the liability but is not an assistance group member; or

(2) A letter from an attorney, certified public accountant, or lending institution, certifying the extent of liability of the individual in the assistance group.

Source. #13875, eff 2-21-24

He-W 806.84 Adult Category Verification of Shelter and Living Arrangement.

(a) Acceptable verification of living arrangement and assistance group size shall be the individual’s statement.

(b) If questionable, the individual shall verify the living arrangement pursuant to He-W 806.83.

Source. #13875, eff 2-21-24

He-W 806.85 through He-W 806.88 RESERVED

He-W 806.89 Verification Requirements for In and Out Medically Needy Medical Assistance.

(a) When requested to do so by the department in accordance with He-W 878.01, the client shall provide documentation of the following:

(1) Incurred current medical expenses and obligated prior medical debts, including those of individuals of a family, as defined in He-W 601.04(c), or family members, as defined in He-W 601.04(f), who reside in the same living unit as the client or for whom the client is liable;

(2) Medical services and amounts that are subject to third party reimbursement or insurance coverage; and

(3) The relationship between the client and the individual for whom medical expenses are claimed.

(b) Acceptable documentation of the above criteria shall include, but not be limited to:

(1) Provider bills, reminder notices and collection agency notices which are dated within 30 days of the month to which the debt is expected to be applied;

(2) A statement from the insurance company of the intent to pay covered charges, or the medical service provider's bill showing insurance payment;

(3) Department collateral verification by letter or telephone with the insurance or medical provider of the charges and allowances toward medical services;

(4) Historical data previously received by the department which documents the amount of the charges and allowances toward recurring medical services; and

(5) A birth certificate, baptismal record, marriage certificate, or other document that establishes the relationship between the client and the individual for whom medical expenses are claimed.

Source. (See Revision Note #1 at Chapter heading for He-W 600) #5171, eff 6-26-91; ss by #5508, eff 12-1-92; ss by #6865, eff 10-3-98; ss by #8684, eff 7-21-06; ss by #10743, eff 12-12-14 (See Revision Note at Part heading for He-W 806)

He-W 806.90 Retroactive Medical Assistance. All factors of eligibility shall be verified using self-attestation for each retroactive month for which assistance is requested.

Source. #13875, eff 2-21-24

He-W 806.91 RESERVED

He-W 806.92 Telephone Redetermination.

(a) Current recipients of any program of assistance except for medical assistance as described in He-W 858.05 and He-W 858.06, who reapply for assistance via the telephone, shall be considered to have requested a redetermination as described in He-W 684.01(a).

(b) The telephone redetermination process pursuant to (a) above shall only be available as funding and resources within the current state fiscal year are available.

(c) All general, categorical, technical, and financial requirements that apply when eligibility for assistance is redetermined whether based on federal or state law, federal regulation, or published department rules, shall apply when an individual requests a redetermination pursuant to (a) above.

Source. #12714, eff 1-23-19

He-W 806.93 through He-W 806.97 RESERVED

He-W 806.98 Twelve-Month Extended Medical Assistance.

(a) The parent or caretaker relative shall provide documentation of the following as an eligibility requirement for receipt of 12-month extended medical assistance:

(1) Evidence which substantiates a good cause claim for failure to return a complete quarterly report on time, as required in 42 USC1396r-6;

(2) Evidence which substantiates a good cause claim for failure to be employed;

(3) Earned income of all household members whose earnings are countable, for each month in the quarter; and

(4) Child care costs for each month in the quarter.

(b) Acceptable documentation for failure to return a complete quarterly report on time due to a mail delay shall be:

(1) The envelope for the quarterly report form which was post marked prior to the due date; or

(2) The quarterly report form which was date stamped by the department on or before the due date.

(c) Acceptable documentation for failure to return a complete quarterly report on time due to illness shall be the parent’s, caretaker relative's, or physician's signed and dated statement describing:

(1) The duration and nature of the illness; and

(2) How the illness specifically resulted in a late quarterly report.

(d) Acceptable documentation for failure to be employed or to return a complete quarterly report on time due to an emergency shall be the parent’s or caretaker relative's signed and dated statement describing:

(1) The emergency; and

(2) How it specifically resulted in the failure to be employed or in the late submission of the quarterly report.

(e) Acceptable documentation for failure to be employed due to involuntary loss of employment shall be:

(1) A layoff or firing notice;

(2) A signed and dated statement from the employer that indicates that the parent or caretaker relative's termination of employment was involuntary;

(3) Proof of receipt of unemployment benefits or a statement from the department of employment security indicating that the parent or caretaker relative is eligible for unemployment benefits; or

(4) A notarized statement from another individual who has direct knowledge of the circumstances that caused the parent’s or caretaker relative's involuntary loss of employment.

(f) Acceptable documentation for failure to be employed due to illness of a family member shall be the parent’s, caretaker relative's, or physician's signed and dated statement describing:

(1) The duration and nature of the illness; and

(2) How the illness specifically resulted in the parent or caretaker relative's lack of employment.

(g) Acceptable documentation of earned income shall be pay stubs or a statement from the employer that provides the amount and frequency of earnings for each of the 3 months in the quarter.

(h) Acceptable documentation of child care costs shall be a receipt or bill which provides:

(1) The amount and frequency of child care costs for each of the 3 months in the report period; and

(2) A statement from the third party payor indicating the amount subject to third party reimbursement, if applicable.

Source. #13875, eff 2-21-24

He-W 806.100 Redetermination of Eligibility.

(a) For a desk review, as defined in He-W 801.03, the individual shall provide the required verification of the change in case circumstances no later than 10 calendar days from the date on the notice requesting the required verification.

(b) For a full redetermination, for individuals whose eligibility cannot be renewed based on the information known to the department, individuals shall provide the required verification no later than 10 calendar days from the date on the notice requesting the required verification.

Source. #13875, eff 2-21-24

PARTS He-W 807 through He-W 815 - RESERVED

PART He-W 816 CITIZENSHIP AND ALIEN STATUS

He-W 816.01 Sponsored Aliens Who Apply for Medical Assistance. For an alien who has been sponsored by an agency or an organization to be eligible for medical assistance, the following conditions shall be met:

(a) The alien shall provide a signed and dated affidavit, on which the sponsoring agency or organization has provided the following:

(1) The name of the alien;

(2) The alien’s date of entry into the United States;

(3) The name and address of the sponsor;

(4) The amount of money the sponsor contributed to the alien, if any;

(5) The reason the sponsor cannot meet the alien’s total needs; and

(6) A statement that the sponsor agrees to a financial audit when needed to substantiate conflicting information;

(b) The sponsor shall be considered to be not meeting the alien’s total needs, if:

(1) The sponsor is contributing no money to the alien; or

(2) The amount contributed is not enough to render the case ineligible for medical assistance due to excess income; and

(1) A written, signed, and dated statement indicating the name and former address of the sponsor;

(2) A statement that the sponsor no longer exists; and

(3) The reason the sponsor no longer exists, if known.

Source. #13857, eff 1-23-24

He-W 816.02 Eligibility of Qualified Aliens. As long as all other eligibility requirements are met, medical assistance shall be provided to qualified aliens as defined in 8 USC 1641(b), under the following conditions:

(a) The qualified alien entered the United States with a status within the meaning of the term “qualified alien” before August 22, 1996; or

(b) For qualified aliens who enter the United States on or after August 22, 1996, a period of 5 years has elapsed since the date of the alien’s entry into the United States with a status within the meaning of the term “qualified alien.”

Source. #13526, eff 1-24-23

He-W 816.03 Eligibility of Lawfully Residing Pregnant Women and Children.

(a) As long as all other eligibility requirements are met, medical assistance shall be provided to lawfully residing pregnant women and children under age 19.

(b) A child or pregnant woman shall be considered lawfully residing if the child or pregnant woman is:

(1) A qualified alien as defined in 8 USC 1641;

(2) An alien in nonimmigrant status who has not violated the terms of the status under which the child or pregnant woman was admitted or to which the child or pregnant woman’s status has changed after admission;

(3) An alien who has been paroled into the United States pursuant to section 212(d)(5) of the Immigration and Nationality Act (INA) pursuant to 8 USC 1182(d)(5) for less than one year, except for an alien paroled for prosecution, for deferred inspection, or pending removal proceedings;

(4) An alien who belongs to one of the following classes:

a. Aliens currently in temporary resident status pursuant to section 210 or 245A of INA 8 USC 1160 or 8 USC 1255a;

b. Aliens currently under Temporary Protected Status (TPS) pursuant to section 244 of INA 8 USC 1254a, and pending applicants for TPS who have been granted employment authorization;

c. Aliens who have been granted employment authorization pursuant to 8 CFR 274a.12(c)(9), (10), (16), (18), (20), (22), or (24);

d. Family unity beneficiaries pursuant to section 301 of Pub. L. 101-649, as amended;

e. Aliens currently under Deferred Enforced Departure pursuant to a decision made by the president of the United States;

f. Aliens currently in deferred action status; or

g. Aliens whose visa petition has been approved and who have a pending application for adjustment of status;

(5) A pending applicant for asylum under section 208(a) of the INA 8 USC 1158 or for withholding of removal under section 241(b)(3) of the INA 8 USC 1231 or under the United Nations Convention Against Torture (UNCAT) who has been granted employment authorization, and such an applicant under the age of 14 who has had an application pending for at least 180 days;

(6) An alien who has been granted withholding of removal under UNCAT;

(7) A child who has a pending application for Special Immigrant Juvenile status as described in section 101(a)(27)(J) of INA 8 USC 1101(a)(27)(J);

(8) An alien who is lawfully present in the Commonwealth of the Northern Mariana Islands under 48 USC 1806(e); or

(9) An alien who is lawfully present in American Samoa under the immigration laws of American Samoa.

Source. #14084, eff 9-26-24

PARTS He-W 817 through He-W 819 RESERVED

PART He-W 820 ASSET TRANSFERS

He-W 820.01 Purpose. These rules describe the treatment of transfers of assets. When an individual applies for or receives nursing facility (NF), medical assistance or any category of home and community based care (HCBC) waiver services, the department of health and human services (DHHS) will use these rules to determine if that individual transferred, assigned, or disposed of the ownership of an asset within the look back period in accordance with 42 USC 1396p(c).

Source. #12217, eff 6-22-17

He-W 820.02 Definitions. As used in this section, the following terms shall have the meanings indicated:

(a) “Assets” means “assets” as defined in 42 USC 1396p(h)(1), that is, all income and resources of the individual and of the individual’s spouse. The term includes any income or resources to which the individual or the individual’s spouse is entitled but does not receive because of any action by the individual, the individual’s spouse, or 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 any person, including a court or administrative body, acting at the direction or upon the request of the individual, or the individual’s spouse.

(b) “Fair market value” means the current market value of an asset at the time the asset is transferred. The current market value is the selling price for which it can reasonably be expected to sell on the open market in the geographic area involved.

(c) “Home and community based care (HCBC)” means community services that individuals might need in order to prevent institutionalization as described under subsection (c) or (d) of Section 1915 of the Social Security Act.

(d) “Income” means “income” as described in 42 USC 1382a of the Social Security Act. The term includes both earned and unearned income.

(e) “Institution” means a hospital, nursing facility, intermediate care facility for individuals with intellectual disabilities, or any other provider which is an institution as defined by 42 CFR 435.1010.

(f) “Institutionalized individual” means any individual who is an inpatient in a nursing facility, including an intermediate care facility for individuals with intellectual disabilities, or who is an in-patient in a medical facility and is receiving a level of care provided in a nursing facility, or who is receiving care, services, or supplies pursuant to a waiver under subsection (c) or (d) of Section 1915 of the Social Security Act.

(g) “Penalty period” means the period of time in which an individual is ineligible for institutional or HCBC waiver services due to a transfer of an asset for less than fair market value.

(h) “Resources” means “resources” as described in 42 USC 1382b of the Social Security Act, except for, in the case of an institutionalized individual, the homestead exclusion provided for in subsection (a)(1) of that section.

(i) “Transfer” means any action or failure to act which has the effect of changing an ownership interest in an asset from the individual to another person, or preventing an ownership interest the individual would have otherwise enjoyed. A transfer includes any direct or indirect method of disposing of an interest in an asset.

(j) “Unearned income” means all contributions, payments, pensions, benefits, loans, awards, or other income which is not received as compensation for work performed.

(k) “Valuable consideration” means that an individual received in exchange for his or her right or interest in an asset some act, object, service, or other benefit which is tangible and has intrinsic value to the individual that is roughly equivalent to or greater than the value of the transferred asset.

Source. #12217, eff 6-22-17

He-W 820.03 Asset Transfers.

(a) Asset transfers described in this rule shall:

(1) Be in addition to and shall not supersede transfers described in 42 USC 1396p(c)(2)(A), (B), (C), and (D);

(2) Include every type of income and resource, unless otherwise noted in this rule; and

(3) Apply to transfers made by:

a. Individuals applying for or receiving nursing facility (NF) medical assistance or any category of HCBC services furnished under a waiver granted under 42 USC 1396n(c), pursuant to He-W 856.01(d); and

b. The individual’s spouse.

(b) Pursuant to 42 USC 1396p(c)(2)(A)(iv), DHHS shall not penalize the transfer of an individual’s primary residence to his or her child if the child resided in the individual’s home for a period of at least 2 years immediately before the date the individual became an institutionalized individual, and the child provided care to such individual which permitted such individual to reside at home on a continuous basis rather than in such an institution or facility.

(1) At least one letter signed by a medical professional who cared for the individual prior to admission to the medical institution stating that the child provided the kind and quality of care necessary to maintain the individual at home rather than in a medical institution for at least 2 years immediately before the individual’s admission to the medical institution;

(2) A statement from the child describing the type or level of care provided; and

(3) Medical records consistent with the information described in (b) above.

(d) Pursuant to RSA 167:4, I(b) and 42 USC 1396p(c)(1), a transfer of assets shall be considered to have been made if, within 60 months prior to the date of application or at any time while receiving NF medical assistance or any category of HCBC waiver services, the individual or the individual’s spouse:

(1) Takes action that reduces or eliminates an individual's ownership or control of such assets;

(2) Gives another person 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 such individual's ownership;

(3) Executes an instrument to transfer title of an asset to another person at a future date and delivers the instrument to the person who is to receive title;

(4) Transfers title or ownership of the individual’s home, or its associated land, to another person or entity;

(5) Transfers title of real property, including income-producing real property;

(6) Transfers assets into an irrevocable trust or similar legal device, from which no payment could under any circumstances be made to the individual;

(7) Obtains a reverse mortgage, a home equity conversion mortgage, or a similar loan on any home or other real property and transfers the proceeds to another person;

(8) Is entitled to an asset but does not receive the asset because of action:

a. By the individual or the individual's spouse;

b. By a person, including a court or administrative body, with legal authority to act in place of or on behalf of the individual or such individual's spouse; or

c. By any person, including any court or administrative body, acting at the direction or upon the request of the individual or such individual's spouse;

(9) Purchases a promissory note, loan, or mortgage, unless such note, loan, or mortgage:

a. Provides a repayment term that is actuarially sound pursuant to (j)(3) below;

b. Provides for payments to be made in equal amounts during the term of the loan with no deferral and no balloon payments; and

c. Prohibits the cancellation of the balance upon the death of the lender; or

(10) Purchases a life estate interest in another individual’s home, unless they have resided in the home for a period of at least one year after the date of the purchase.

(e) Actions by the individual or the individual’s spouse which would cause income or resources not to be received shall include but not be limited to:

(1) Irrevocably waiving pension income or any other form of income;

(2) Waiving an inheritance;

(3) Not accepting or accessing injury settlements, judgments, or court awards;

(4) Diverting of tort settlements by the defendant into a trust or similar device to be held for the benefit of the plaintiff; or

(5) Refusal to take legal action to obtain a court ordered payment that is not being paid, such as child support or alimony, unless the individual is being, has been, or is at risk of being, battered or subjected to extreme cruelty as described in 42 USC 608(a)(7)(c) and corroboration is provided by the documentation described below including a:

a. Court, medical, criminal, child protective services, psychological, or law enforcement record, or a statement from a social service provider;

b. Written statement from a social worker from a public or private social service agency; or

c. Sworn statements from an individual with knowledge of the circumstances.

(f) For individuals applying for or receiving medical assistance, the department of health and human services (DHHS) shall evaluate asset transfers to determine if the individual derived fair market value, as defined in He-W 820.02(b) above, from the transfer.

(g) DHHS shall evaluate the transfer to determine if the individual derived fair market value, as defined in He-W 820.02(b) above, whenever an individual applying for or receiving medical assistance has transferred, assigned or disposed of title or ownership of an otherwise excluded home to another individual or entity.

(h) Asset transfers from which the individual receives fair market value or other valuable consideration shall require no further evaluation for asset transfer.

(i) A transfer of assets for love and consideration, or which is made for similar reasons, shall not be considered to be a transfer for fair market value.

(j) A transfer of assets to a relative for care provided in the past shall not be a transfer for fair market value. Although relatives may be legitimately paid for providing care, any services provided for free in the past shall be assumed to have been intended to have been provided without compensation unless it can be rebutted with tangible evidence that a compensation arrangement had been agreed to in writing at the time services were provided.

(k) When determining whether an individual has received fair market value for a transfer when a life estate has been established, DHHS shall:

(1) Determine what the fair market value of the asset was at the time of transfer;

(2) Take into account the individual’s age at the time of the transfer; and

(3) Calculate the value of the life estate using the life estate tables found in the Supplemental Security Income (SSI) Program Operations Manual System (POMS), section SI 01140.120 as follows:

a. The life estate value shall be established by multiplying the market value of the asset by the life estate factor that corresponds to the individual’s age at the time of the transfer;

b. The value of the life estate shall be subtracted from the value of the asset transferred; and

c. The difference between the value of the life estate and the amount the individual was reimbursed for the remainder interest shall be the portion of the asset transferred for less than fair market value.

(l) When determining whether an individual or spouse has received fair market value for a transfer of assets into an annuity, DHHS shall:

(1) Determine the fair market value of the asset at the time of transfer into the annuity;

(2) Determine if the expected return on the annuity is commensurate with a reasonable estimate of the life expectancy of the beneficiary to determine whether the annuity is actuarially sound;

(3) Use the life expectancy tables published by the office of the chief actuary of the social security administration, pursuant to 42 USC 1396p(c)(1)(G)(ii)(II);

(4) Determine that the individual has received fair market value for the annuity if the average number of years of expected life remaining for the individual coincides or exceeds the life of the annuity; and

(5) Determine that the individual did not receive fair market value for the annuity if the average number of years of expected life remaining for the individual is less than the life of the annuity.

(m) The background information of the asset transfer shall be evaluated further to determine if assets might have been transferred for purposes of qualifying for medical assistance if DHHS determines that the individual did not receive fair market value from the transfer.

(n) Factors to be evaluated in assessing asset transfers referred to in (l), shall include:

(1) Timeframes between the transfer of assets and the date of application;

(2) The individual's health at the time of the transfer; and

(3) The individual's economic situation at the time of the transfer.

(o) The transfer shall be considered questionable if the evaluation of background information of the transfer suggests that the individual transferred assets for purposes of qualifying for medical assistance or results in qualifying earlier than otherwise would have been possible if the individual had retained all of the asset(s).

(p) The individual shall provide additional information and documentation to DHHS upon request to demonstrate that assets were not transferred for purposes of qualifying for medical assistance, if the transfer is considered questionable.

(q) Reasons for transferring assets for purposes other than qualifying for medical assistance shall include:

(1) The individual transferred the asset to prevent foreclosure or sale of the asset by the lien holder, thus preventing total loss of the asset;

(2) The individual transferred the asset for self-support because the individual's income and resources were insufficient to meet basic needs or to maintain upkeep of the asset, such as taxes and repairs, and the individual's basic needs were provided for in return for the transfer, or the individual lived off the proceeds of the asset;

(3) The individual transferred the asset to meet the terms of a written agreement, including debts arising from such agreement;

(4) The individual transferred the asset to meet the terms of an oral agreement, including debts arising from such agreement;

(5) The individual is not able to afford to take the necessary action to obtain the asset or the cost of obtaining the asset is greater than the asset is worth, resulting in a case of failure to cause assets to be received; or

(6) The individual is being, has been, or is at risk of being battered or subjected to extreme cruelty as described in 42 USC 608(a)(7)(c) and as corroborated by the documentation described He-W 820.01(d)(5).

(r) The burden of proof for substantiating the fact that assets were not transferred for purposes of qualifying for medical assistance shall rest with the individual.

(s) If the individual refuses or fails to prove that assets were not transferred for purposes of qualifying for medical assistance, DHHS shall determine that the assets were transferred for the purposes of qualifying for medical assistance and the individual shall be ineligible pursuant to (s) below for the following institutionalized care:

(1) Nursing facility services;

(2) A level of care in any institution equivalent to that of nursing facility services; and

(3) HCBC furnished under a waiver granted under 42 USC 1396n(c).

(t) To determine the number of months of ineligibility for the services described in (r) above for an individual who has transferred property for purposes of qualifying for medical assistance the following methodologies shall be used:

(1) The penalty period start date for all individuals who transfer assets for less than fair market value to make themselves eligible for medical assistance as of February 8, 2006, shall be whichever is later:

a. The first day the individual met all other eligibility criteria and would be eligible but for the transfer, provided that the date does not occur during an existing penalty period as described in (4) below; or

b. The first day of a month after which assets have been transferred provided that the date does not occur during an existing penalty period as described in (4) below;

(2) When an individual or an individual’s spouse makes multiple fractional transfers of assets in more than one month for less than fair market value, the penalty shall be based on the total cumulative uncompensated value of all such transfers, pursuant to 42 USC 1396p(c)(1);

(3) The penalty period shall be based solely on the value of the assets transferred;

(4) When a countable transfer takes place during an existing penalty period, a new penalty period shall not begin until the existing penalty period has expired;

(5) When an individual makes a series of transfers within one month, the total value of the individual transfers for the month shall be used to calculate the penalty;

(6) The penalty period shall be the number of months equal to:

a. The uncompensated value of assets transferred by the individual, divided by the average statewide monthly nursing facility private rate; and

b. The average statewide daily nursing facility rate shall be established by dividing the average statewide monthly nursing facility private rate, as determined and updated annually by the division's bureau of audits and rate setting, by 30.42;

(7) When the penalty period consists of any number of full months and a partial month, the partial month penalty period shall apply in accordance with (9) below;

(8) When the amount of the transfer is less than the average statewide monthly nursing facility private rate, a partial month penalty shall apply;

(9) To determine the number of days the partial month penalty shall be in effect, the uncompensated value of assets transferred by the individual shall be divided by the average daily nursing facility rate described in (6)b. above;

(10) When assets have been transferred so that the penalty periods overlap, the individual penalty periods shall be calculated and imposed sequentially;

(11) When multiple transfers are made in such a way that the penalty period for each transfer will not overlap, each transfer shall be treated as a separate event, each with its own penalty period;

(12) When a spouse of an individual transfers an asset that results in a penalty for the individual, the penalty period shall be apportioned between the spouses when:

a. The spouse either is, or becomes, eligible for medical assistance;

b. A penalty could be assessed against the spouse; and

c. Some portion of the penalty against the individual remains at the time the above conditions are met;

(13) When the penalty period for an individual is interrupted due to the death of the individual or the individual’s discharge from institutionalized care, the remaining penalty period in (12) above, which is applicable to both spouses shall be served by the remaining spouse; and

(14) A penalty period imposed for a transfer of assets shall run continuously from the first date of the penalty period, regardless of whether the individual remains institutionalized.

(u) A penalty shall not be assessed for transfers of assets for less than fair market value under any of the following circumstances:

(1) The individual intended, and attempted to dispose of the asset either at fair market value or for other valuable consideration, and circumstances caused the individual to transfer the asset for less than fair market value;

(2) The individual transferred the assets for a purpose other than to qualify for medical assistance; or

(3) All of the assets transferred for less than fair market value have been returned to the individual.

(w) Individuals claiming that circumstances caused the asset to be transferred for less than fair market value pursuant to (u)(1) above, shall provide documentation of:

(1) The individual’s attempt to dispose of the asset at fair market value, or for other valuable consideration; and

(2) The value at which the asset was disposed.

(x) Individuals claiming that assets were transferred for a purpose other than to qualify for medical assistance pursuant to (u)(2) above, shall provide documentation of:

(1) The specific purpose for which the asset was transferred; and

(2) The reason it was necessary to transfer the asset for less than fair market value or other valuable consideration.

(y) If a penalty was assessed for transferring an asset for less than fair market value or other valuable consideration and the asset was returned to the individual, then DHHS shall:

(1) Generate a retroactive adjustment back to the beginning of the penalty period if the individual met all other eligibility criteria; or

(2) Redetermine the penalty period pursuant to (s) above, when only part of an asset, or its equivalent value, has been returned.

(z) Asset transfer penalties shall not be imposed due to undue hardship pursuant to RSA 167:4, III-a and 42 USC 1396p(c)(2)(D).

Source. #12217, eff 6-22-17

PART He-W 821 TECHNICAL REQUIREMENTS FOR NURSING FACILITY (NF) AND HOME AND COMMUNITY BASED CARE (HCBC) SERVICES

Revision Note:

Document #12217, effective 6-22-17, readopted with amendments He-W 621 titled “Technical Requirements for Nursing Facilities (NF) and Home and Community Based Care (HCHC) Services” and renumbered the rule as He-W 821 titled “Technical Requirements for Nursing Facility (NF) and Home and Community Based Care (HCHC) Services”. The source note information for the rules He-W 821.01 through He-W 821.03 in He-W 821 prior to Document #12217 includes the documents filed under He-W 621.01 through He-W 621.03, respectively.

He-W 821.01 Asset Transfer Penalty Undue Hardship Waiver.

(a) As used in this section, the following terms shall have the meanings indicated:

(1) “Discharge” means “discharge” as defined in RSA 151:19, I-a, namely, the “movement of a patient from a facility to a non-institutional setting or the termination of services by a home health care provider when the discharging facility or home health care provider ceases to be legally responsible for the care of the patient”;

(2) “Good cause” means any circumstance beyond a person’s control that prevents that person from complying with a requirement, including:

a. A death in the person’s immediate family;

b. Personal injury or serious illness of the person or an immediate family member; or

c. Another compelling reason or justification;

(3) “Individual” means the person who applied for or is receiving services from the nursing facility (NF) or under the home and community based (HCBC) waiver program.

(4) “Necessities of life” means those things a person needs to live, including but not limited to, heat, hot water, electricity, gas service, or cooking fuel;

(5) “Sworn statement” means a statement made under oath or affirmation reciting facts which are personally known by the signer, and which are sworn to or affirmed and notarized by either a notary public or justice of the peace; and

(6) “Undue hardship” means a hardship that imposes an unreasonable or disproportionate burden on the individual, as described in RSA 167:4, III-a, and 42 USC 1396p(c)(2)(D).

(b) Requests for an asset transfer penalty undue hardship waiver shall include all of the following:

(1) The individual’s name, address, and telephone number;

(2) The name, address, telephone number, and relationship to the individual, of the individual’s legal guardian, authorized representative (AR), power-of-attorney, or attorney, if any;

(3) Identification of the specific reason(s) for the request for an asset transfer penalty undue hardship waiver from the following list:

a. The asset was transferred by a person representing the individual and it can be demonstrated that the individual lacked the mental capacity to comprehend the disqualifying nature of the transfer;

b. The application of the asset transfer penalty would result in the individual being deprived of, and otherwise unable to obtain, necessary care such that the individual’s health or life would be endangered; and

c. The application of the asset transfer penalty would result in the individual being deprived of, and otherwise unable to obtain, food, clothing, shelter, and/or other necessities of life; and

(4) The printed name and dated signature of the individual, or, if filed by the individual’s agent or representative, the printed name and dated signature of the agent or representative, and their relationship to the individual.

(1) If the request for an undue hardship waiver was filed by the individual’s agent or representative, a copy of the legal documentation shall be provided that authorizes the agent or representative to act on behalf of the individual, such as an authorized representative declaration, court order appointing a guardian, power of attorney, etc.;

(2) The following verifications shall be required in all cases in the form of written documentation or other evidence that a good faith effort was made to recover the asset(s) transferred or to make the asset(s) available to the individual, such as, but not limited to:

a. Any written request for the asset(s) to be returned to the individual;

b. Any demand letter(s);

c. Any response letter(s) from any recipient of the transferred asset(s);

d. Any documents or other evidence showing that legal action has been initiated to recover the asset(s); or

e. Any document or other evidence that demonstrates that action has been taken to recover the asset(s) or to make the asset(s) available to the individual to help pay for the cost of the individual’s stay in the NF or to pay for HCBC services;

(3) The following verifications shall be required if the request for an asset transfer penalty undue hardship waiver is based upon a claim that the individual lacked the mental capacity to comprehend the disqualifying nature of the transfer, pursuant to (b)(3)a. above:

a. A written, dated, and signed statement from a licensed physician stating that the individual was mentally incapacitated at the time of the transfer, along with supporting medical records or an order of findings from a probate court concerning the individual’s competency at the time of the transfer; and

b. Financial records that demonstrate that the asset(s) was transferred by the individual’s agent or representative.

(4) The following verifications are required if the request for an asset transfer penalty undue hardship waiver is based upon a claim that the individual’s health or life will be endangered pursuant to (b)(3)b. above:

a. For NF services:

1. A dated and signed statement from the NF that documents:

(i) The individual is currently residing in the NF;

(ii) The individual’s current arrearage owed to the NF; and

(iii) The monthly amount currently being paid to the NF by the individual;

2. A sworn, signed, and dated statement from the individual or the individual’s agent or representative that documents:

(i) The individual lacks the income and resources to pay for the NF services and documentation of what measures have been taken to explore alternatives for payment; and

(ii) A list of the individual’s health insurance(s) plan coverage;

3. A signed and dated statement from a licensed physician or licensed nurse practitioner that documents:

(i) He or she is the individual’s primary care provider (PCP);

(ii) The specific services that the individual requires and receives in the NF;

(iii) Services that the individual would need if discharged from the NF;

(iv) The specific needs of the individual that cannot be met in the community if the individual is discharged from the NF;

(v) A brief explanation of the consequences to the individual if deprived of NF services and why the individual’s life or health will be endangered; and

(vi) Appellant’s diagnoses, his or her prognosis, and the severity of his or her condition; and

4. Evidence that the NF has, in good faith, initiated the process to discharge the individual due to a lack of payment; and

b. For HCBC services documents that show the individual lacks the income and resources to pay for the HCBC services, as follows:

1. For applicants a statement dated and signed by the individual’s PCP that documents:

i. The medical services that the individual requires;

ii. A brief explanation of why the imposition of an asset transfer penalty will deprive the individual of medical care such that the individual’s life or health will be endangered; and

iii. A list of the individual’s health insurance(s) plan coverage; or

2. For recipients a statement dated and signed by the individual’s PCP that documents:

i. The medical services that the individual requires;

ii. The services that the individual will lose if the asset transfer penalty is imposed, if any;

iii. A brief explanation of why the imposition of an asset transfer penalty will deprive the individual of medical care such that the individual’s life or health will be endangered; and

iv. A list of the individual’s health insurance(s) plan coverage; and

(5) The following verifications shall be required if the request for an asset transfer penalty undue hardship waiver is based upon a claim that the individual will be deprived of food, clothing, shelter, or other necessities of life pursuant to (b)(3)c. above:

a. A signed and dated statement from the individual, or the individual’s agent or representative, explaining how the imposition of a penalty period will result in the deprivation of food, clothing, shelter, or other necessities of life; and

b. Signed and dated statements from the NF or HCBC service providers describing the specific services that the individual needs to avoid being deprived of food, clothing, shelter, or other necessities of life.

(d) Requests for an asset transfer penalty undue hardship waiver, including required verifications, shall be filed no later than 30 calendar days from the date on the notice of asset transfer penalty.

(e) Upon receipt of a request for an asset transfer penalty undue hardship waiver, the department of health and human services (DHHS) shall:

(1) Review the request, attachments, verifications, and any other supporting documentation provided with the request;

(2) Determine whether the request establishes that the individual will suffer an undue hardship if the asset transfer penalty is imposed; and

(3) Notify the individual, or the individual's agent or representative who submitted the request for an asset transfer penalty undue hardship waiver, of DHHS' decision on the request, including the individual's appeal rights.

(f) Failure to comply with the requirements for an asset transfer penalty undue hardship waiver request shall result in the request being denied, unless DHHS determines that there was good cause for the non-compliance.

Source. #9136, eff 4-22-08; ss by #11058, INTERIM, eff 3-24-16, EXPIRED: 9-20-16

New. #12217, eff 6-22-17 (See Revision Note at Part heading for He-W 821)

He-W 821.02 Hardship Waiver for Individuals with Substantial Home Equity.

(a) To request a waiver of being denied for or terminated from NF or HCBC services due to excess home equity pursuant to He-W 856.05(d), the individual shall:

(1) Submit a request for a waiver of the eligibility criteria described in He-W 856.05(d), pursuant to (b) below; and

(2) Identify the specific reason(s) for the request from the following list:

a. Being denied for or terminated from NF or HCBC services due to excess home equity would result in the individual being deprived of, and otherwise unable to obtain, necessary care such that his or her individual’s health or life would be endangered; and

b. Being denied for or terminated from NF or HCBC services due to excess home equity would result in the individual being deprived of, and otherwise unable to obtain, food, clothing, shelter, and/or other necessities of life.

(b) The requests for a waiver described in (a) above shall include all of the following:

(1) The individual’s name, address, and telephone number;

(2) Identification of the specific reason(s) for the undue hardship waiver request, pursuant to (a)(2) above;

(3) The name, address, telephone number, and relationship to the individual of the individual’s legal guardian, authorized representative (AR), power-of-attorney, or attorney, if any; and

(4) The printed name and dated signature of the individual or, if filed by the individual’s agent or representative, the printed name and dated signature of the agent or representative, and their relationship to the individual.

(d) The date the department of health and human services (DHHS) receives the completed request described in (b) and (c) above, shall be the individual’s filing date for a waiver.

(e) The filing date pursuant to (d) above shall be no later than 30 calendar days from the date on DHHS’ notice of a denial or termination of NF or HCBC services.

(f) Individuals shall verify the undue hardship described in (a)(2)a. above by submitting the documentation described in He-W 821.01(c)(1) and:

(1) He-W 821.01(c)(4)a. for NF services; or

(2) He-W 821.01(c)(4)b. for HCBC services.

(g) Individuals shall verify the undue hardship described in (a)(2)b. above by submitting the documentation described in He-W 821.01(c)(1) and:

(1) A signed and dated statement from the individual, or the individual’s agent, or representative, explaining how the imposition of a penalty period due to home equity exceeding the limit will result in the deprivation of food, clothing, shelter, or other necessities of life; and

(2) A signed and dated statement from the NF or HCBC service providers describing the specific services that the individual must retain to avoid being deprived of food, clothing, shelter, or other necessities of life.

(h) Upon receipt of a request for a hardship waiver, DHHS shall:

(1) Review the request, attachments, and any other supporting documentation provided with the request;

(2) Determine whether the request establishes that the individual will suffer an undue hardship if the excess home equity penalty is imposed; and

(3) Notify the individual, or the individual's agent or representative who submitted the request, of DHHS' decision on the request.

(i) Failure to comply with the requirements for the waiver request will result in the request being denied, unless DHHS determines that there was good cause for the non-compliance.

Source. #9136, eff 4-22-08; ss by #11058, INTERIM, eff 3-24-16, EXPIRED: 9-20-16

New. #12217, eff 6-22-17 (See Revision Note at Part heading for He-W 821)

He-W 821.03 Administrative Appeals. Individuals denied waivers described in He-W 821.01 and He-W 821.02 may appeal the department of health and human services’ decision and request an administrative appeal pursuant to He-C 200.

Source. #9136, eff 4-22-08; ss by #11058, INTERIM, eff 3-24-16, EXPIRED: 9-20-16

New. #12217, eff 6-22-17 (See Revision Note at Part heading for He-W 821)

PARTS He-W 822 through He-W 823 - RESERVED

PART He-W 824 INSTITUTIONAL RESIDENCE

He-W 824.01 Institutional Residence.

(a) The following individuals shall not be considered inmates of public institutions or private institutions primarily engaged in treating mental or emotional disorders or tuberculosis:

(1) Individuals who are admitted to the New Hampshire Hospital for purposes of evaluation only, for a period not to exceed 3 months;

(2) Individuals who, while remaining under the general supervision of a public institution as an official inmate of that institution, physically reside outside the institution;

(3) Individuals under age 22 or age 65 or older who are certified for care at a designated receiving facility as defined in He-M 405.02(f);

(4) Patients at the psychiatric unit of the Dartmouth - Hitchcock Medical Center;

(5) Children in placement in foster homes or other approved child caring institutions;

(6) Children who participate in the special education program at the Sununu Youth Services Center;

(7) Adults in residential care facilities and community living residences; and

(8) Inmates committed by a court order to a NH correctional facility, who require inpatient care at a medical institution as defined in 42 CFR 435.1010.

(b) Individuals who are patients at the Glencliff nursing facility unit of the New Hampshire Hospital shall be considered as residing in a nursing facility.

Source. #11042, eff 2-24-16

PART He-W 825 TECHNICAL REQUIREMENTS FOR MEDICAL ASSISTANCE

He-W 825.01 Application for Social Security Numbers.

(a) Medical assistance applicants or recipients who do not have a social security number (SSN), or are unable to furnish their SSN, shall apply for an original SSN or replacement card.

(b) The individual shall provide verification of an SSN or application for an SSN as specified in 42 CFR 435.910.

(c) The department shall grant good cause for failure to furnish an SSN or to apply for an SSN card when the individual is unable to furnish or apply for an SSN card or submit the required verification, despite good faith efforts to do so.

(d) Good cause for failure to furnish or apply for an SSN card shall include, but not be limited to, the following:

(1) Delays in obtaining required verification because another agency, such as the town clerk's office, is not able to process the individual’s request for documents in a timely manner; or

(2) The agency is not able to provide documents because its records have been destroyed.

(e) The individual shall complete the SSN application requirements for a child by the child's first birthday, pursuant to 42 CFR 435.117.

Source. #13713, eff 8-3-23

PARTS He-W 826 and He-W 827 – RESERVED

PART He-W 828 DEPRIVATION OF PARENTAL SUPPORT OR CARE FOR MEDICAL ASSISTANCE

He-W 828.01 Deprivation Due to Continued Absence.

(a) For a child to be considered deprived of parental support or care due to continued absence, one or both parents shall be physically absent from the child for at least 30 continuous days, beginning with and including the day of separation, in conjunction with any one of the circumstances listed below:

(1) The parents are divorced or legally separated;

(2) A parent has filed for a divorce, legal separation, or annulment and such application has been pending in the court for at least 30 days;

(3) The court has issued an injunction or restraining order forbidding a parent to visit the spouse or child for at least 30 days, or if for an indefinite period of time, with a reasonable expectation that the order will be in effect for 30 days or more;

(4) The parent is not legally able to return to the home because of confinement in a correctional institution or mental hospital which will continue or is reasonably expected to continue for at least 30 days; or

(5) The parent has deserted the child or there is mutual separation, and the absence of one or both parents has been continuous for at least 30 days.

(b) The 30-day continuous absence period shall be applied as follows:

(1) If the 30 days have not elapsed at the time of the initial eligibility determination interview, but the absence is expected to last for 30 days or more, medical assistance shall be initiated prior to the end of the 30-day continuous absence period if all other eligibility factors are met;

(2) The 30-day continuous absence period shall not be interrupted if:

a. The absent parent returns home to visit the children; or

b. The parents have attempted reuniting the family within the 30 days or within the temporary adjustment period as defined in He-W 601.08(c), but this attempt has failed; and

(3) Counting for the 30-day continuous absence period shall begin again if:

a. Reunited parents separate following the termination of the temporary adjustment period; or

b. Deprivation is being determined for a different absent parent.

(1) At the initial eligibility determination;

(2) At each subsequent redetermination; and

(3) Whenever the individual, absent parent, or third party reports to the department that the absent parent has returned to the home.

(d) To verify continued absence pursuant to (c) above, the individual shall complete a document which includes all of the following:

(1) The individual’s name and dated signature;

(2) Certification of current absence that has existed or is expected to exist for at least 30 continuous days; and

(3) The name of the absent parent.

Source. #13629, eff 5-10-23, EXPIRES: 5-10-33

He-W 828.02 Deprivation Due to Incapacity.

(a) A child shall be considered to be deprived of support or care due to the parent’s physical or mental incapacity when the incapacity is expected to last for at least 30 days, and the parent:

(1) Is eligible for or receiving supplemental security income (SSI) or social security disability income (SSDI) disability benefits;

(2) Provides currently dated documentation from a licensed physician, licensed physician assistant (PA), licensed advanced practice registered nurse (APRN), board-certified psychologist, master licensed alcohol and drug counselor (MLADC), licensed pastoral psychotherapist (LPP), licensed independent clinical social worker (LICSW), licensed clinical mental health counselor (LCMHC), or licensed marriage and family therapist (LMFT) certifying an incapacity of at least 30 continuous days;

(3) Has been determined by the department’s bureau of family assistance (BFA), disability determination unit (DDU) as permanently disabled or blind;

(4) Reapplies for assistance within 90 days of being terminated from a case in which incapacity had been established, provided termination was not related to incapacity or earnings from employment;

(5) Is convalescing after being treated in an institution for the mentally ill, or was discharged within 90 days prior to applying for assistance; or

(6) Is needy and intellectually disabled, has resided in a state-operated intermediate care facility for individuals with intellectual disabilities (ICF/IID), and was officially discharged within 90 days of applying for assistance.

(b) The individual shall verify physical or mental incapacity:

(1) At the initial eligibility determination;

(2) At each subsequent redetermination; and

(3) Whenever a change in the incapacity occurs.

(c) To verify incapacity pursuant to (a)(2) above, the individual shall provide currently dated documentation which includes all of the following:

(1) The individual’s name; and

(2) A statement by a licensed physician, licensed PA, licensed APRN, board-certified psychologist, MLADC, LPP, LICSW, LCMHC, or LMFT which indicates:

a. That the current incapacity has existed, or is expected to exist, for at least 30 days;

b. The date when the incapacity began, ended, or is expected to end;

c. The diagnosis, examination date, and current and recommended medical treatment; and

d. The name, address, phone number, profession, and dated signature of the licensed physician, licensed PA, licensed APRN, board-certified psychologist, MLADC, LPP, LICSW, LCMHC, or LMFT.

Source. #13629, eff 5-10-23, EXPIRES: 5-10-33

He-W 828.03 Deprivation Due to Unemployed Parent.

(a) A child in a 2-parent household shall be considered to be deprived of parental support or care due to unemployment for eligibility for parents and other caretaker relatives medical assistance when the primary wage earner (PWE):

(1) Currently works less than 100 hours per month on average, using a best estimate as described in (e) below;

(2) Expects to continue working less than 100 hours per month on average, using a best estimate;

(3) Has a work or education history or an unemployment compensation history that meets the requirements of (m) through (o) below;

(4) Has not refused an offer of employment within 30 days prior to receipt of assistance if such offer is at a wage that is customary for the specific position in the community according to the department of employment security;

(5) Has not refused a specific training opportunity at a specific location within 30 days prior to the receipt of assistance;

(6) Is currently eligible for unemployment compensation benefits in New Hampshire or unemployment compensation benefits from another state even if not actually receiving such benefits; and

(7) Is willing to apply for and receive unemployment compensation benefits.

(b) When determining which parent is the PWE, the following shall apply:

(1) The PWE shall be the parent who earned the higher income in the previous full 24 months preceding the month of application;

(2) The earnings of both parents shall be counted for the previous full 24 months in determining the PWE regardless of when their relationship began;

(3) If both parents had identical income for the previous full 24 months, the household shall designate the PWE;

(4) When one of the parents has been designated as the PWE, that parent shall remain the PWE for purposes of determining deprivation due to unemployment; and

(5) If the family files a new application after a break in eligibility, the PWE status shall be re-determined pursuant to (b)(1) through (4) above.

(c) Parent or other caretaker relative medical assistance shall end when the employment criteria in (a)(1) above is no longer met.

(d) The average of 100 hours in (a)(1), (a)(2), and (c), above, shall be determined by deriving a best estimate of hours.

(e) A best estimate of the monthly current hours in (a)(1), (a)(2), and (c) above, shall be determined as follows:

(1) If the hours worked in the current month are less than 100 hours and are representative of anticipated future hours based on documentation provided by the individual, then the best estimate shall be the number of hours worked in the current month;

(2) If the hours worked in the current month are less than 100 hours and are not representative of anticipated future hours based on documentation provided by the individual, then the best estimate shall equal the number of hours per month anticipated to be worked in the future based upon documentation provided by the individual; and

(3) If the hours worked in the current month are greater than 100 hours, then the hours worked in the previous 2 month period shall be considered in determining the best estimate as follows:

a. The hours worked in both of the previous 2 months shall be less than 100 hours;

b. Documentation provided by the individual regarding future anticipated hours shall be less than 100 hours;

c. The best estimate shall be equal to the number of hours anticipated to be worked in the future based upon documentation provided by the individual; and

d. If the number of hours worked in the current and previous 2 month period are greater than 100 hours per month, or if the anticipated future number of hours will be greater than 100 hours per month based on documentation supplied by the individual, then deprivation due to unemployment shall not exist and the application for parent or other caretaker relative medical assistance shall be denied.

(f) For purposes of this rule, a non-significant change means a temporary or short-term variation in the number of hours worked caused by a situation which is not ongoing.

(g) Non-significant changes shall not be used to determine the best estimate.

(h) For purposes of this rule, a significant change means a variation in the number of hours worked that is expected to continue for more than one month.

(i) For continued eligibility for parent or other caretaker relative medical assistance, if the derived estimate in (e) above results in a current or anticipated average of 100 hours or more of employment per month, deprivation due to unemployment for purposes of the parent or other caretaker relative medical assistance program shall no longer exist when the advance notice period pursuant to 42 CFR 431.211 expires.

(j) Fluctuating hours shall be converted to a monthly amount by averaging monthly hours for the previous 2 months.

(k) The 2 month average shall not be used when one of the following circumstances applies:

(1) If fluctuating hours have been worked for less than 2 months, the hours shall be based on the actual number of hours worked in the most recent month; and

(2) If the income in the previous 2 months is higher or lower than current or anticipated earnings and does not reflect a best estimate of current and future hours as determined in (e) above, a new best estimate shall be determined for the remainder of the current period of eligibility that is based on anticipated hours to be worked in the future.

(l) When a currently eligible individual is verified to have worked more than 100 hours in any one month, a best estimate shall be made to determine if the individual expects to continue working more than 100 hours per month for more than one month.

(m) If the individual described in (l) above will work 100 hours or more for longer than one month and provides the department with documentation of hours anticipated to work, deprivation as described in (a) and (c) above shall no longer exist when the advance notice period pursuant to 42 CFR 431.211.

(n) To determine if the work history requirement pursuant to He-W 828.03(a)(3) has been met, all of the following shall apply:

(1) The PWE shall have worked at least 6 calendar quarters in a period of 13 consecutive calendar quarters ending within one year prior to the completion and submission of the application for assistance and have earned at least $50 for each quarter;

(2) Calendar quarters shall be periods of 3 consecutive months dated as follows:

a. January 1 through March 31;

b. April 1 through June 30;

c. July 1 through September 30; and

d. October 1 through December 31;

(3) A self-employed PWE shall be credited with calendar quarters worked within a calendar year by:

a. Determining the PWE’s countable earned income for a calendar year;

b. Dividing by $50; and

c. Taking the result, in whole numbers, to equal the number of calendar quarters that can be credited in a calendar year up to a maximum of 4; and

(4) If the self-employed PWE can be credited with less than 4 quarters, the quarters shall be credited within the year in a way that is most beneficial to the PWE when determining if the requirement in (1) above has been met.

(o) For eligibility for parent or other caretaker relative medical assistance based upon educational history, educational activities shall be substituted for no more than 4 quarters of work when the activities consist of one of the following:

(1) Full-time elementary or secondary school attendance;

(2) Full-time participation in a vocational or technical training program that is preparatory to employment; or

(3) Participation in a postsecondary education or vocational skills training activity as defined in He-W 637.01.

(p) A history of unemployment compensation shall be substituted for a history of work or education if the PWE met one of the following conditions at any time during the calendar year immediately prior to applying for parent or other caretaker relative medical assistance:

(1) Received unemployment compensation benefits; or

(2) Was eligible for unemployment compensation benefits, but not receiving the benefit due to:

a. Recoupment due to an overpayment; or

b. A diversion of the benefit to the Internal Revenue Service (IRS), child support services, or another party.

(q) A PWE shall be considered eligible for unemployment compensation benefits, although not receiving them due to disqualification by the New Hampshire department of employment security, if the PWE is:

(1) Seeking or receiving unemployment compensation benefits in another state;

(2) Leaving self-employment, such as closing one's business or failing to return to self-employment; or

(3) Unavailable for employment outside the home for any reason for a period of 30 days or less.

(r) The PWE shall not be considered to be eligible for unemployment compensation benefits if the PWE:

(1) Was discharged for misconduct associated with work, including:

a. Neglect of duty due to recurring careless or negligent acts; or

b. Willful misconduct due to a deliberate violation of a company rule designed to protect the legitimate interests of the employer;

(2) Failed to accept or apply for suitable employment without good cause determined in accordance with He-W 637.07;

(3) Was unavailable for work outside the home for more than 30 days;

(4) Was separated from the PWE’s last employer due to a disciplinary layoff;

(5) Was separated from the PWE’s last employer due to participation in a labor dispute as determined by the commissioner of the department of employment security, pursuant to RSA 282-A:36;

(6) Was discharged due to intoxication or use of controlled drugs on the job;

(7) Was discharged due to arson, sabotage, or dishonesty connected with the job; or

(8) Voluntarily quit a job through no fault of the employer.

(s) A PWE shall no longer be considered to have voluntarily quit a job when new employment is obtained, at comparable wages or hours, then lost through no fault of the PWE.

(t) A PWE shall be willing to apply for and accept unemployment compensation benefits in New Hampshire or another state, if potentially eligible for these benefits.

(u) The department shall advise the PWE of the PWE’s right to appeal a department of employment security disqualification determination.

Source. #13629, eff 5-10-23, EXPIRES: 5-10-33

PART He-W 829 – RESERVED

PART He-W 830 LIVING WITH A SPECIFIED RELATIVE

He-W 830.01 Living with a Specified Relative.

(a) For purposes of determining the assistance group for parent caretaker relative medical assistance, "dwelling" means:

(1) An individual's principal residence or place of abode;

(2) The family setting maintained or in the process of being established as a home, as evidenced by assumption, continuation, and exercise of responsibility for day-to-day care and control of the child by the relative with whom the child is living; and

(3) A living unit as defined in (1) and (2) above with no more than one postal address.

(b) If the dwelling has a separate living unit attached to it with a separate postal address, this living unit shall not be considered part of the same dwelling.

(c) The department shall consider a child to be living with a specified relative as defined in RSA 167:78,XXIII when the child lives in the same dwelling as defined in (a) above as the specified relative unless the conditions in (e) apply.

(d) The department shall consider the specified relative in (c) above to be the casehead for the assistance group.

(e) If a child lives in the same dwelling as both the child's parent and a non-parent specified relative, the department shall consider the child to be living with the parent.

(f) The department shall consider the parent in (e) above to be the casehead in the assistance group unless the conditions in (g) below apply.

(g) If the non-parent specified relative in (e) above is the legal guardian of the child pursuant to RSA 169-C:3,XIV, the department shall:

(1) Consider the non-parent specified relative to be the casehead in the assistance group; and

(2) Consider the parent to be a member of the assistance group pursuant to RSA 167:79,II and He-W 601.01(u).

Source. #13415, eff 7-26-22

PART He-W 831 RESERVED

PART He-W 832 AGE

He-W 832.01 Parents and Other Caretaker Relatives.

(a) For initial determination of eligibility for parents and other caretaker relative medical assistance, the parent or caretaker relative shall be providing care for a dependent child, as defined in 42 CFR 435.4 , on the first day of eligibility.

(b) Terminations of parents and other caretaker relatives’ medical assistance solely as a result of the dependent child attaining the age of 19 shall be effective the day following the child’s birthday.

Source. #13767, eff 10-7-23

PARTS He-W 833 to He-W 836 – RESERVED

PART He-W 837 GRANITE ADVANTAGE HEALTH CARE PROGRAM

He-W 837.01 Definitions.

(a) “Beneficiary” means an individual determined eligible for the granite advantage health care program.

(b) “Commissioner” means the commissioner of the NH department of health and human services, or his or her designee.

(c) “Community engagement requirement” means a condition of continuing eligibility for the granite advantage health care program that requires beneficiaries to engage in 100 hours per calendar month in one or more community engagement activities.

(d) “Cure” means meeting the community engagement requirement by making up deficit hours, demonstrating good cause for deficit hours, or providing certification of an exemption status.

(e) “Dating violence” means violence committed by a person who is or has been in a social relationship of a romantic or intimate nature with the victim.

(f) “Deficit hours” means the number of hours below 100 hours that the beneficiary did not participate in community engagement activities in a calendar month.

(g) “Department” means the New Hampshire department of health and human services.

(h) “Disability” means disability as defined by the Americans with Disabilities Act (ADA), Section 504 of the Rehabilitation Act, or Section 1557 of the Patient Protection and Affordable Care Act.

(i) “Disenrollment” means the termination of medicaid eligibility at the annual redetermination of a suspended beneficiary.

(j) “Domestic violence” means domestic violence as defined in RSA 631:2-b.

(k) “Granite advantage health care program (granite advantage)” means the granite advantage health care program established under RSA 126-AA which provides medicaid coverage to adults eligible under Title XIX of the Social Security Act 1902(a)(10)(A)(i)(VIII).

(l) “Good cause” means circumstances that prevented the beneficiary from meeting the community engagement requirement pursuant to He-W 837.10.

(m) “Homeless” means a situation in which an individual lacks a fixed, regular, and adequate nighttime residence such as living in a publicly or privately operated shelter, or living in a public or private location not meant for human habitation, and includes a situation in which an individual is in peril of losing his or her primary residence, no subsequent residence has been identified, and the individual lacks support networks to obtain permanent housing.

(n) “Immediate family member” means a spouse, child(ren), mother-in-law, father-in-law, parent(s), step-parent(s), step-child(ren), step-brother(s), step-sister(s), grandparent(s), grandchild(ren), brother(s), sister(s), legal guardian(s), daughter(s)-in-law, son(s)-in-law, brother(s)-in-law, sister(s)-in-law, and foster child(ren).

(o) “Licensed medical professional” means a physician, an advanced practice registered nurse (APRN), a behavioral health professional who is able to determine eligibility for community mental health services pursuant to He-M 401.04, a physician assistant, a licensed alcohol and drug counselor (LADC), a master of licensed alcohol and drug counselor (MLADC), nurse case manager, or a board-certified psychologist.

(p) “Medicaid” means the Title XIX program administered by the department, which makes medical assistance available to eligible individuals.

(q) “Medically frail” means a beneficiary, as defined in 42 CFR 440.315(f), with a disabling mental disorder, chronic substance use disorder (SUD), serious and complex medical condition, or a physical, intellectual, or developmental disability that significantly impairs the ability to perform one or more activities of daily living as certified by a licensed medical professional.

(r) “Noncompliant” means a status where a beneficiary failed to meet the 100 hour per calendar month community engagement requirement in a single month.

(s) “Redetermination” means the annual medicaid eligibility renewal process required by 42 CFR 435.916, He-W 606, and He-W 684.

(t) “Stalking” means engaging in a course of conduct directed at a specific person that would cause a reasonable person to fear for the person’s individual safety or the safety of others or suffer substantial emotional distress.

(u) “Sexual assault” means sexual assault as defined in RSA 632-A:4.

(v) “Voluntary” means a community engagement status in which a beneficiary is not required to participate in the community engagement requirement but chooses to do so.

Source. #12733, INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19

He-W 837.02 Community Engagement Requirement.

(a) Unless exempted under He-W 837.03 below or able to demonstrate good cause under He-W 837.10, beneficiaries shall engage in 100 hours per calendar month in one or more of the community engagement activities listed in He-W 837.05 below.

(b) A beneficiary shall have until the first full month following 75 calendar days from the date of the eligibility determination or the expiration of an exemption to come into compliance 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 837.03)

He-W 837.03 Exemptions.

(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)

He-W 837.04 Request for Exemption; Duration of Exemptions.

(a) All beneficiaries requesting an exemption shall complete and submit BFA Form 330 “Exemption Request Form Granite Advantage Health Care Program” (06/19).

(b) Beneficiaries requiring certification by a licensed medical professional in (c) below shall have a licensed medical professional certify on BFA Form 330 to the following:

“As a licensed medical professional caring for this beneficiary, I hereby certify (based on the description of the exemptions provided in the instructions to this form) that the beneficiary meets the qualifications for the exemption(s) requested in Section II.”

(c) Beneficiaries shall provide the following third party certification or documentation to the department for the indicated exemption types:

(1) For beneficiaries unable to participate due to illness, incapacity, or treatment under He-W 837.03(a)(1) above, provide a certification by a licensed medical professional specifying the duration and limitations of the illness, incapacity, or treatment. The duration of the exemption shall be one month or the date range specified by the licensed medical professional, whichever is longer;

(2) For beneficiaries participating in a state certified drug court program under He-W 837.03(a)(2) above, provide a copy of the legal documentation requiring the beneficiary to participate in the drug court program. The duration of this exemption shall be one year from the date that the required documentation is received;

(3) For a parent or caretaker under He-W 837.03(a)(3) above, provide a certification by a licensed medical professional that specifies the duration that such care is required. Unless specified otherwise by the licensed medical professional, the duration of this exemption shall be one year from the date that the required documentation is received;

(4) For a parent or caretaker of a dependent child under 6 years of age under He-W 837.03(a)(4) above, provide a self-attestation and the child’s date of birth;

(5) For a custodial parent or caretaker of a child with developmental disabilities under He-W 837.03(a)(5) above, provide a certification by a licensed medical professional of the child’s developmental disability. The duration of this exemption shall be for as long as the particular circumstance continues to exist;

(6) For beneficiaries with a disability under He-W 837.03(a)(7) above, provide an annual certification by a licensed medical professional of the beneficiary’s inability to meet the community engagement requirement for reasons related to the disability. The duration of this exemption shall be one year from the date that the required documentation is received or the date range specified by the licensed medical professional, whichever is less;

(7) For beneficiaries residing with an immediate family member with a disability under He-W 837.03(a)(8) above, provide an annual attestation of the beneficiary’s inability to meet the community engagement requirement for reasons related to the family member’s disability and an annual certification by the family member’s licensed medical professional specifying the family member’s disability. The duration of this exemption shall be one year from the date that the required documentation is received or the date range specified by the licensed medical professional, whichever is less;

(8) For beneficiaries unable to participate due to hospitalization or serious illness under He-W 837.03(a)(9) above, provide copies of discharge summaries, or financial or billing information, documenting the hospitalization or serious illness or dates of stay. The duration of this exemption shall be one month or the date range specified by the licensed medical professional, whichever is longer;

(9) For beneficiaries who are unable to participate due to hospitalization or serious illness of an immediate family member under He-W 837.03(a)(10) above, provide copies of the family member’s discharge summaries, or financial or billing information, documenting the hospitalization or serious illness. The duration of this exemption shall be one month or the date range specified by the licensed medical professional, whichever is longer; and

(10) For medically frail beneficiaries under He-W 837.03(a)(11) above, an annual completion and submission of a. and b. below:

a. BFA Form 320A “Beneficiary Authorization for Licensed Medical Professional to Release Protected Health Information - Granite Advantage Health Care Program” (05/19) permitting and authorizing disclosure of protection health information as follows:

“I hereby authorize the following licensed medical professional to disclose my protected health information for the purposes described above.”

“In addition, I hereby authorize the following specific disclosures (place your initials on the line by those statements which apply)

I specifically authorize the release of my mental health treatment records.

I specifically authorize the release of my HIV and AIDS results and/or treatment.

I specifically authorize the release of my alcohol and/or drug abuse treatment records in accordance with 42 CFR Part 2.”

“I give authorization for my protected health information to be released to the following individual or organization:

Name: Granite Advantage Health Care Program Manager

Organization: Department of Health and Human Services

Address: DHHS, Granite Advantage Health Care Program, P.O. Box 3778, Concord, NH 03302-3778 or Fax # 603-271-5623

I understand this authorization may be revoked by notifying the Department of Health and Human Services in writing to the address above”; and

b. BFA Form 331 “Licensed Medical Professional Certification of Medical Frailty Granite Advantage Health Care Program” (05/19) indicating that the beneficiary is unable to comply with the work and community engagement requirement as a result of their condition including the duration of such disability. The duration of this exemption shall be one year from the date that the required certification is received or the date range specified by the licensed medical professional, whichever is less. The licensed medical professional shall certify as follows:

“As a licensed medical professional caring for this beneficiary, I hereby certify that the beneficiary is medically frail based on the beneficiary having one or more of the conditions identified above.”

(d) To the extent practicable, third party certification or documentation shall be submitted to the department with the form required in (a) above.

(e) A request for an exemption under this section shall not be considered complete until all of the required documentation is received by the department.

(f) For pregnant women, the beneficiary may report pregnancy by completing and submitting BFA Form 330 or by informing the department.

Source. #12733, INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W 837.05); BFA form 330 in (a) amd by #12828

He-W 837.05 Qualifying Activities. The following activities shall qualify as activities for the community engagement requirement:

(a) Unsubsidized employment including by non-profit organizations;

(b) Subsidized private sector employment;

(d) On-the-job training;

(e) Job skills training related to employment;

(f) Enrollment at an accredited community college, college, or university that is counted on a credit hour basis;

(g) Job search and job readiness assistance, including but not limited, to participation in job search or job training activities offered through the department of employment security or through other job search or job readiness assistance programs such as the Workforce Innovation and Opportunity Act (WIOA) or work ready New Hampshire. Time spent in any assessment, training, enrollment, or case management activity that is necessary for participation in a job search or job readiness program shall be credited as job search and job readiness assistance hours;

(h) Vocational educational training not to exceed 12 months with respect to any beneficiary;

(i) Education directly related to employment, in the case of a beneficiary who has not received a high school diploma or certificate of high school equivalency;

(j) Attendance at secondary school or in a course of study leading to a certificate of general equivalence, in the case of a beneficiary who has not completed secondary school or received such a certificate;

(k) Community, volunteer, or public service except that community, volunteer, or public service under this part shall not include services provided to or on behalf of a political organization or campaign;

(l) Caregiving services for a non-dependent relative or other person with a disabling medical, mental health, or developmental condition;

(m) Participation in ASAM Level 1 outpatient SUD services, including medication assisted treatment, and recovery supports, as set forth in ASAM Criteria (2013);

(n) Participation in and compliance with SNAP employment requirements;

(o) Participation in and compliance with the TANF employment requirements;

(p) Participation in and compliance with the employment requirements of the refugee resettlement program pursuant to 45 CFR 400.75; or

(q) Self-employment.

Source. #12733, INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W 837.06)

He-W 837.06 Reporting of Community Engagement Activities and Crediting of Hours.

(a) The following types of community engagement activities shall be reported by completing and submitting BFA Form 321 “Reporting Education Participation for Community Engagement – Granite Advantage Health Care Program” (06/19):

(1) For job skills training related to employment under He-W 837.05(e), the beneficiary shall provide documentation of enrollment that includes the duration and the number of hours per month the beneficiary is participating in the activity;

(2) For enrollment at an accredited community college under He-W 837.05(f), the beneficiary shall provide documentation of enrollment that includes a copy of the beneficiary’s class schedule, the number of credit hours assigned for the enrolled class(es), and the semester begin and end date. The number of community engagement hours to be credited shall be determined by multiplying the number of credit hours assigned for the enrolled class(es) by 4.33;

(3) For vocational educational training under He-W 837.05(h), the beneficiary shall provide documentation of enrollment that includes the duration of the activity and a copy of the beneficiary’s enrollment in the program. Community engagement hours shall be credited at 100 hours per month for the duration of the beneficiary’s verified participation in the activity not to exceed 12 months;

(4) For education directly related to employment under He-W 837.05(i), the beneficiary shall provide documentation of enrollment that includes the duration of the activity. Community engagement hours shall be credited at 100 hours per month for the duration of the beneficiary’s verified participation in the activity; and

(5) For study leading to a certificate of general equivalence under He-W 837.05(j), the beneficiary shall provide documentation of enrollment that includes the duration of the activity. Community engagement hours shall be credited at 100 hours per month for the duration of the beneficiary’s verified participation in the activity;

(b) The types of community engagement activities listed in (c) below shall be reported on a completed and submitted BFA Form 320 “Reporting Monthly Participation in Community Engagement Activities - Granite Advantage Health Care Program” (06/19).

(c) Beneficiaries shall provide the requested information on the form in (b) above, and the hours reported on the form in (b) above shall be credited toward the community engagement requirement as follows:

(1) For time spent participating in job search and job readiness efforts under He-W 837.05(g), the beneficiary shall report the type, duration of the activity, and total number of hours per month;

(2) For community, volunteer, or public service under He-W 837.05(k), the beneficiary shall report where and when the community, volunteer, or public service was performed, the number of hours performed, and the contact information for the organization or individual the service was performed for;

(3) For caregiving services under He-W 837.05(l), the beneficiary shall report the name and contact information for the non-dependent relative or other person cared for, a description of the services provided, and the number of hours of caregiving services provided;

(4) For participation in ASAM Level 1, as set forth in ASAM Criteria (2013), outpatient SUD services under He-W 837.05(m), the beneficiary shall report the name of the agency or organization the services were received from, and the number of hours that the beneficiary participated in the services up to 40 hours per month. For participation in any other ASAM level treatment, see exemption He-W 837.03(a)(1);

(5) For beneficiaries experiencing a temporary increase in monthly employment hours for seasonal work or for other such work greater than the beneficiary’s average monthly employment hours as credited pursuant to (d)(4) below, the beneficiary shall report the increased hours which shall be limited to 2 consecutive months; and

(6) For beneficiaries who are self-employed and work more hours than calculated by the department’s eligibility system(s), the beneficiary shall report the additional hours worked, and a description of the hours work and tasks performed.

(d) The indicated community engagement activities below shall be credited as follows if the activity is verified by the department’s eligibility system(s):

(1) For system-verified participation in and compliance with SNAP employment requirements, community engagement hours shall be credited at 100 hours per month for the duration of the beneficiary’s verified participation in the program;

(2) For system-verified participation in and compliance with TANF employment requirements, community engagement hours shall be credited at 100 hours per month for the duration of the beneficiary’s verified participation in the program;

(3) For participation in and compliance with the employment requirements of the refugee resettlement program pursuant to 45 CFR 400.75, systemic verification of legal status and enrollment in the program. and community engagement hours shall be credited at 100 hours per month for 12 months from the date of the beneficiary’s entry into the United States; and

(4) Employment information gathered during the application or redetermination process or in the department’s eligibility system(s) shall be used to determine a beneficiary’s average monthly employment hours and shall be credited towards the community engagement requirement for employment activities listed in He-W 837.05(a)-(d).

Source. #12733, INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W 837.07); BFA form 321 in (a) and BFA form 320 in (b) amd by #12828

He-W 837.07 Beneficiaries with Disabilities: Reasonable Modification.

(a) A beneficiary with a disability shall be entitled to reasonable modifications related to meeting the community engagement requirement.

(b) Reasonable modifications shall include:

(1) Modification in the number of community engagement hours required where the beneficiary is unable to participate in the required number of hours; or

(2) Assistance with understanding granite advantage to include, but not be limited to, departmental notices, eligibility requirements, exemption requirements, how to apply for an exemption, program benefits, how to establish eligibility, and how to meet and report community engagement activities to maintain eligibility.

Source. #12733, INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W 837.08)

He-W 837.08 Opportunity to Cure.

(a) If a beneficiary fails to meet the required community engagement hours, the beneficiary shall satisfy the community engagement requirement by making up the deficit hours for the noncompliant month by doing one of the following:

(1) Curing the deficit hours by engaging in the activities listed in He-W 837.05 above in the following month for only the number of deficit hours for the noncompliant month. For example:

a. A beneficiary engaged in 60 hours of community engagement activities in January, resulting in a 40-hour deficit. The beneficiary worked 100 hours in February. The beneficiary’s noncompliance for January shall be cured, and the beneficiary shall be considered compliant with February; or

b. A beneficiary engaged in 60 hours of community engagement activities in January, resulting in a 40-hour deficit. The beneficiary shall only need to complete 40 hours of community engagement activities in February to cure January’s deficit. The beneficiary worked 60 hours in February. The beneficiary shall be considered compliant for January, and shall be considered noncompliant for February with a 40-hour deficit;

(2) Demonstrating good cause for the failure to meet the community engagement requirement as described in He-W 837.10; or

(3) Providing documentation of an exemption pursuant to He-W 837.04.

(b) Within 10 days following the noncompliant month, the department shall provide written notice to the beneficiary of failure to meet the community engagement requirement to include:

(1) How a beneficiary can cure the noncompliance as described in (a) above; and

(2) Information regarding potential suspension pursuant to He-W 837.9 below.

Source. #12733, INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W 837.09)

He-W 837.09 Suspension.

(a) If a beneficiary does not cure the deficit hours as described in He-W 837.08(a), the department shall suspend the beneficiary’s eligibility effective the first of the month following the one-month opportunity to cure, subject to appeal pursuant to He-W 837.17.

(b) Prior to suspension, the department shall provide, at a minimum, a ten-day written notice to the beneficiary that his or her medicaid eligibility shall be suspended due to noncompliance, and shall include all applicable notice requirements found in 42 CFR 431, Subpart E, and appeal rights pursuant to He-W 837.17.

(1) Satisfying within a single calendar month the deficit hours from the noncompliant month or by satisfying within a single calendar month the deficit hours from the cure month, whichever is less;

(2) Demonstrating within a single calendar month enough good cause hours pursuant to He-W 837.10 and He-W 837.11 to fully cover the number of deficit hours;

(3) Demonstrating within a single calendar month a combination of community engagement hours and good cause hours sufficient to fully cover the number of deficit hours;

(4) Providing documentation of an exemption pursuant to He-W 837.04; or

(5) Becoming eligible for medicaid under an eligibility category that is not subject to the community engagement requirement.

(d) Reactivation shall be effective:

(1) On the date that the deficit hours are reported to the department;

(2) On the date the department receives the required attestation or third party certification or documentation to establish good cause or an exemption; or

(3) On the date that the beneficiary was admitted to the hospital where the beneficiary was found to have good cause pursuant to He-W 837.10(a)(8) or an exemption under He-W 837.03, and has good cause or an exemption within 30 calendar days of the date of their hospital discharge.

(e) Upon reactivation in (d) above, a beneficiary’s obligation to meet the community engagement requirement shall begin on the first full month following the month in which the beneficiary’s eligibility is reactivated.

(f) After suspension, a beneficiary shall not be required to complete a new medicaid application if she or he has met one of the requirements of (c) above.

Source. #12733, INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W 837.10)

He-W 837.10 Good Cause.

(a) Good cause shall include, but not be limited to, the following circumstances:

(1) The beneficiary experiences the birth or death of a family member residing with the beneficiary;

(2) The beneficiary experiences severe inclement weather, including a natural disaster, and was unable to meet the requirement;

(3) The beneficiary has a family emergency or other life-changing event such as divorce;

(4) The beneficiary is a victim of domestic violence, dating violence, sexual assault or stalking;

(5) The beneficiary is a custodial parent or caretaker of a child 6 to 12 years of age who, as determined by the commissioner on a monthly basis, is unable to secure child care in order to participate in community engagement activities either due to a lack of child care scholarship or the inability to obtain a child care provider due to capacity, distance, or another related factor;

(6) The beneficiary has a disability, and was unable to meet the community engagement requirement for reasons related to that disability;

(7) The beneficiary resides with an immediate family member who has a disability, and was unable to meet the community engagement requirement for reasons related to the family member’s disability, but did not request an exemption from the community engagement requirement;

(8) The beneficiary experienced a hospitalization, but did not request an exemption from the community engagement requirement;

(9) The beneficiary resides with an immediate family member who experienced a hospitalization or serious illness, but the beneficiary did not request an exemption from the community engagement requirement;

(10) The beneficiary is homeless; or

(11) Other good cause exists, such as circumstances beyond the beneficiary’s control which related to the beneficiary’s ability to obtain or retain a qualifying community engagement activity. Other good cause shall include an illness that did not require inpatient hospitalization.

(b) All beneficiaries requesting a finding of good cause shall complete and submit BFA Form 340 “Good Cause Request Form - Granite Advantage Health Care Program” (04/19) along with any required third party certification(s) to the department.

(c) Beneficiaries requiring certification by licensed medical professional for good cause in (d) below shall have the licensed medical professional certify on BFA Form 340 “Good Cause Request Form. Granite Advantage Health Care Program” (06/19) as follows:

“A showing of good cause for “disability” or “Caretaker residing with immediate family member with disability” requires certification by a licensed medical professional. As a licensed medical professional caring for this beneficiary or for a beneficiary’s family member with a disability, I hereby certify that: The beneficiary is disabled and unable to meet the community engagement requirement for reasons related to their disability; or the family member identified above is disabled.”

(d) A beneficiary’s request for a finding of good cause shall be attested to and certified as follows:

(1) For a beneficiary who experiences the birth or death of a family member residing with the beneficiary, attestation by the beneficiary of the event to include the name of the family member, the date of the event, the family member’s relationship to the beneficiary, and the number of days impacted;

(2) For a beneficiary who experiences severe inclement weather, including a natural disaster, and therefore was unable to meet the requirement, attestation by the beneficiary of the date(s) of the severe inclement weather or natural disaster, and the number of days impacted;

(3) For a beneficiary who has a family emergency or other life-changing event such as divorce, attestation by the beneficiary of the nature of the family emergency or life-changing event to include the date(s) and the number of days that the beneficiary was unable to participate due to the circumstance;

(4) For a beneficiary who is a victim of domestic violence, dating violence, sexual assault, or stalking, documentation of the date range specified in the court order or self-attestation to the number of days impacted;

(5) For custodial parents as described in (a)(5) above, a monthly attestation by the beneficiary of the inability to secure child care and the number of days impacted;

(6) For a beneficiary who has a disability, , and was unable to meet the requirement for reasons related to that disability the following shall be required:

a. Attestation by the beneficiary of the number of days the beneficiary was unable to meet the community engagement requirement for reasons related to the disability; and

b. The certification described in (c) above;

(7) For a beneficiary who resides with an immediate family member who has a disability, and was unable to meet the requirement for reasons related to the family member’s disability, but did not request an exemption from the community engagement requirement, the following shall be required:

a. Attestation by the beneficiary of the number of days the beneficiary was unable to meet the community engagement requirement for reasons related to that disability; and

b. The certification described in (c) above;

(8) For a beneficiary who experienced a hospitalization, but did not request an exemption from community engagement requirement, the following shall be required:

a. Attestation by the beneficiary of the number of days of the hospitalization and the admission date; and

b. Copies of the discharge summaries, or financial or billing information that would substantiate the hospitalization or certification by a licensed medical professional;

(9) For a beneficiary who resides with an immediate family member who experienced a hospitalization or serious illness, but the beneficiary did not request an exemption from community engagement requirement, the following shall be required:

a. Attestation by the beneficiary of the number of days of the hospitalization or serious illness or certification by a licensed medical professional; and

b. Copies of the family member’s discharge summary, or financial or billing information, or other medical records that would substantiate the hospitalization or serious illness;

(10) For a beneficiary who is homeless, attestation by the beneficiary of the beneficiary’s homelessness or inability to find stable housing and the number of days the beneficiary was unable to meet the community engagement requirement; or

(11) For a beneficiary to claim other good cause under (a)(11), attestation by the beneficiary of the circumstance beyond the beneficiary’s control which relate to the beneficiary’s ability to obtain or retain a community engagement activity to participate in, and the number of days the beneficiary was unable to meet the community engagement requirement.

(e) A request for a finding of good cause under this section shall not be approved unless the required attestation(s) and certification(s) are received by the department.

(f) The department shall use the documentation received to determine if the community engagement requirement would have been met if not for the good cause.

Source. #12733, INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W 837.11); BFA form 340 in (c) amd by #12828

He-W 837.11 Crediting a Finding of Good Cause.

(a) A finding of good cause shall be credited toward the monthly community engagement requirement as follows:

(1) For a beneficiary who experiences the birth or death of a family member residing with the beneficiary, 8 hours per day for each day the beneficiary attested being unable to participate;

(2) For a beneficiary who experiences severe inclement weather including a natural disaster, 8 hours per day for each day the beneficiary attested being unable to participate;

(3) For a beneficiary who has a family emergency or other life changing event such as divorce, 8 hours per day for each day the beneficiary attested being unable to participate;

(4) For a beneficiary who is a victim of domestic violence, dating violence, sexual assault, or stalking, 8 hours per day for each day the beneficiary attested being unable to participate or the date range specified in the court order;

(5) For a beneficiary who is a custodial parent or caretaker of a child 6 to 12 years of age who is unable to secure child care in order to participate in community engagement, 8 hours per day for each day the beneficiary attested being unable to participate;

(6) For a beneficiary with a disability who was unable to meet the requirement for reasons related to that disability, 8 hours per day for each day the beneficiary was unable to participate, or, if no date range is indicated, 100 hours per month for each month the beneficiary was unable to participate;

(7) For a beneficiary residing with an immediate family member who has a disability, and was unable to meet the requirement for reasons related to the family member’s disability, 8 hours a day for each day the beneficiary was unable to participate, or, if no date range is indicated, 100 hours per month for each month the beneficiary was unable to participate;

(8) For a beneficiary who experiences a hospitalization, but did not request an exemption the following shall apply:

a. For inpatient hospitalization, 100 hours per month for each month the beneficiary was unable to participate; or

b. For outpatient hospitalization, 8 hours per day for each day the beneficiary was unable to participate as documented through self-attestation or a certification by a licensed medical professional;

(9) For a beneficiary who resides with an immediate family member who experienced a hospitalization or serious illness, but the beneficiary did not request an exemption the following shall apply:

a. For inpatient hospitalization, 8 hours per day for each day the beneficiary attested being unable to participate; or

b. For outpatient hospitalization or serious illness, 8 hours per day for each day the beneficiary was unable to participate as documented through self-attestation or a certification by a licensed medical professional;

(10) For a beneficiary who is homeless or unable to find stable housing, 8 hours per day for each day the beneficiary attested being unable to participate; and

(11) For other good cause, 8 hours per day for each day the beneficiary attested being unable to participate.

(b) If the beneficiary’s good cause did not fully cover the number of deficit hours in that month, the beneficiary shall be determined noncompliant for the month, resulting in the beneficiary’s responsibility to cure as required in He-W 837.08(a).

Source. #12733, INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W 837.12)

He-W 837.12 Limitation on the Repeated Consecutive Use of Curing to Meet the Community Engagement Requirement.

(a) Beginning May 1, 2020, a beneficiary, who engages in the repeated consecutive use of cure for 12 months immediately prior to redetermination, shall be suspended at redetermination.

(b) Following suspension in (a) above, a beneficiary may reactivate eligibility under this section by providing 100 hours of community engagement within a single calendar month.

(d) After reactivation in (c) above, a beneficiary’s participation start date shall be the 1st of the month following the month in which the beneficiary’s eligibility is reactivated.

Source. #12733, INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W 837.13)

He-W 837.13 Extra Hours. A beneficiary shall not be permitted to carry-over hours in excess of the 100-hour requirement in order to satisfy 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 837.14)

He-W 837.14 Disenrollment and Reconsideration.

(a) A beneficiary who is suspended for noncompliance with the community engagement requirement, and fails to cure that suspension during redetermination, shall be disenrolled from granite advantage.

(b) A disenrolled beneficiary shall be re-enrolled as follows:

(1) Within 90 days of disenrollment, a beneficiary may return to granite advantage by providing 100 hours of community engagement within a single calendar month;

(2) Upon the department’s receipt of the reported 100 hours in (b)(1) above, the beneficiary’s eligibility shall be reopened as of the date that the hours are reported to the department; and

(3) The beneficiary’s participation start date shall be the 1st of the month following the report in (b)(2) above.

(c) A beneficiary who is compliant with the community engagement requirement at redetermination but whose eligibility is terminated at redetermination for other reasons may, within 90 days of disenrollment, return to granite advantage by:

(1) Satisfying any outstanding medicaid redetermination requirements pursuant to 42 CFR 435.119, 42 CFR 435.916, He-W 606, and He-W 684;

(2) Upon satisfying any outstanding redetermination requirements in (c)(1) above, the beneficiary’s eligibility shall be reactivated to the date of closure; and

(3) The beneficiary shall resume the reporting of community engagement hours the 1st of the month following the month that the outstanding redetermination requirements are met.

Source. #12733, INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W 837.15)

He-W 837.15 Re-Application.

(a) A beneficiary may reapply for medicaid at any time after disenrollment.

(b) If a beneficiary reapplies, the following shall apply:

(1) A beneficiary who was disenrolled at redetermination and who reapplies within 6 months and is determined eligible, shall begin to report community engagement hours on the 1st of the month following the month in which the application is filed;

(2) A beneficiary, who was disenrolled at redetermination and who reapplies 6 or more months thereafter and is determined eligible, shall in accordance with He-W 837.02 have until the first full month following 75 calendar days from the date of their eligibility determination before he or she is required to meet the 100-hour community engagement requirement; and

(3) For purposes of this section, the 6-month period shall be calculated using 365/2 rounded down equaling 182 days.

Source. #12733, INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W 837.16)

He-W 837.16 Screening for Other Bases of Medicaid Eligibility Prior to Suspension, Termination, Disenrollment, or Denial of Eligibility. Suspension, termination, disenrollment, or denial of eligibility shall only occur after a beneficiary is screened and determined to be ineligible for all other bases of medicaid eligibility and reviewed for eligibility for insurance affordability programs in accordance with 42 CFR 435.916(f).

Source. #12733, INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W 837.17)

He-W 837.17 Appeals.

(a) A beneficiary may appeal the department’s decision denying an exemption under He-W 837.04, denying a request for good cause under He-W 837.10, denying a reasonable modification under He-W 837.07, or suspending, denying, or terminating the beneficiary’s eligibility for failing to meet the community engagement requirement under He-W 837.02 by filing a request for an appeal with the department’s administrative appeals unit in accordance with He-C 200.

(b) The department shall not suspend, deny, or terminate the beneficiary’s eligibility under (a) above if the beneficiary:

(1) Submits a hearing request to the local district office within 30 days from the date on the written notice of adverse decision; and

(2) Submits a request to the local district office for a continuation of benefits during the appeal process within 15 days of the date on the written notice of adverse decision.

Source. #12733, INTERIM, eff 2-23-19, EXPIRES: 8-22-19; ss by #12796, eff 6-5-19 (formerly He-W 837.18)

He-W 837.18 Other Department Obligations.

(a) The department shall periodically assess compliance with the community engagement requirement in labor market areas, within the state, to assess whether mitigation strategies are needed so that the community engagement requirement is not unreasonably burdensome.

(b) The department shall examine the following:

(1) Areas that experience high rates of unemployment;

(2) Areas with limited economies and educational opportunities; and

(3) Areas with a lack of public transportation.

(c) The department shall provide information and assistance to beneficiaries, including oral and written explanations, regarding community engagement activities, exemptions from participation in the community engagement requirement, good cause exemptions, appeal rights, suspension, disenrollment, and termination, and the opportunity to cure to facilitate beneficiaries’ compliance with the program’s community engagement requirement, and any other information related to the community engagement requirement and this part.

(d) The department shall develop an eligibility and enrollment monitoring plan that includes metrics, timetables, and programmatic content to ensure processes are in place.

(e) The plan shall include the collection and analysis of data for the following data points:

(1) The number and percentage of beneficiaries who have requested exemption from the community engagement requirement;

(2) The number and percentage of beneficiaries who have been granted an exemption from the community engagement requirement;

(3) The number and percentage of community engagement good cause requested;

(4) The number and percentage of beneficiaries granted good cause from the community engagement requirement;

(5) The number and percentage of beneficiaries whose eligibility was terminated at redetermination for not meeting the community engagement requirement;

(6) The number and percentage of community engagement appeal requests; and

(7) The number and percentage of beneficiaries whose eligibility was suspended for failing to comply 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 837.19)

PARTS He-W 838 through He-W 840 – RESERVED

PART He-W 841 MEDICAID FOR EMPLOYED ADULTS AND OLDER ADULTS WITH DISABILITIES

He-W 841.03 Medicaid for Employed Adults with Disabilities (MEAD).

(a) In accordance with RSA 167:3-i, RSA 167:3-c, XII, RSA 167:6, IX, and 42 USC 1396a(a)(10)(A)(ii)(XV) relative to medical assistance for employed adults with disabilities, medical assistance shall be provided to any applicant who:

(1) Meets the general and technical requirements for aid to the permanently and totally disabled (APTD) or aid to the needy blind (ANB) as specified in He-W 600 and He-W 800;

(2) Is age 18 through 64;

(3) Meets the medical criteria for medicaid for employed adults with disabilities (MEAD) pursuant to He-W 504.02;

(4) Is employed for pay pursuant to He-W 841.03(b), or self-employed for pay pursuant to He-W 841.03(c), on the date of application, during the time of MEAD eligibility determination, and during the retroactive period, should the individual request this medical coverage period;

(5) Has net income determined by applying the APTD or ANB treatment and disregards to the applicant’s gross income, and if applicable, to the spouse’s gross income pursuant to He-W 654 and He-W 854, that when combined with spousal net income does not exceed 450% of the federal poverty guidelines, as published annually in the Federal Register and effective no later than the first of the month following the first complete month after the federal poverty income guidelines have been published in the federal register; and

(6) Has countable resources that do not exceed the 2002 limit of $20,000 for an individual or $30,000 for a married couple, the amounts of which shall be updated annually in accordance with (a)(5) above by the percentage that applies pursuant to the Consumer Price Index.

(b) To be considered employed for pay, an individual shall:

(1) Receive remuneration and contribute to the Federal Insurance Contributions Act (FICA); and

(2) Not be paid for participation in a program designed to enhance an individual’s ability to obtain paid employment.

(1) Meet the requirements of (b)(2) above; and

(2) Provide documentation that the individual makes regular payments based on earnings as required pursuant to the Self-Employment Contributions Act (SECA).

(d) The items listed below shall not be counted as a resource when determining MEAD eligibility:

(1) Retirement plans;

(2) Medical savings accounts established pursuant to 26 USC 220; and

(3) MEAD employability accounts specifically designated and set aside by the individual for the purpose of purchasing certain goods or services that:

a. Will enhance an applicant’s employability; and

b. Are not:

1. Covered by the medicaid program;

2. Otherwise reimbursable;

3. Specifically excluded pursuant to He-W 856; or

4. Already allowed as a deduction pursuant to He-W 654 or He-W 854.

(e) Goods or services for which MEAD employability accounts may be designated and set aside pursuant to (d)(3) above shall include, but not be limited to:

(1) Equipment, supplies, operating capital, and inventory required to establish a business;

(2) Any cost associated with an educational or occupational training facility, including, but not limited to, tutoring or counseling;

(3) Work-related attendant care services to enable the individual to prepare for work, including, but not limited to, bathing and dressing, or services provided in the workplace;

(4) Medical devices, which enable the applicant to work, including, but not limited to:

a. Wheelchairs;

b. Prosthetics;

c. Pacemakers; and

d. Respirators;

(5) Equipment or tools either specific to an applicant's condition or designed for general use;

(6) Uniforms, specialized clothing, and safety equipment;

(7) Least costly transportation cost(s) to and from work, such as weekly or monthly bus passes;

(8) Purchase of a private vehicle;

(9) Operational or accessibility modifications to buildings or vehicles to accommodate disability;

(10) Routine drugs or medical services to ameliorate disability that are not covered by medicaid;

(11) Diagnostic procedures related to evaluation, control, or treatment of a disabling condition;

(12) Prescribed non-medical appliances and devices essential for controlling the disabling condition at home or work such as air filtering equipment;

(13) Expendable medical supplies; and

(14) Guide dogs, dog food, licenses, and veterinary services.

(f) If an applicant uses funds in a MEAD employability account for items other than those described in He-W 841.03(d)(3), the remaining funds in the account shall be counted as a resource.

(g) Applicants who have been determined eligible for medical assistance pursuant to He-W 841.03(a) and who subsequently become unemployed but who intend to return to work shall remain eligible for MEAD for a 6-month extension period beginning with the date the individual becomes unemployed, if:

(1) The recipient was involuntarily terminated from employment, or seasonal work ended, and is currently seeking new employment; or

(2) The recipient voluntarily terminated employment with good cause in accordance with (i) below.

(h) A recipient who has completed the 6-month extension may obtain one additional 6-month extension if the recipient provides either:

(1) A written statement provided by a licensed medical professional regarding the individual’s medical condition as it relates to their inability to work; or

(2) Written documentation of proven job search through contacts made to employers, or employment agencies such as one-stops, vocational rehabilitation, or employment networks.

(i) The bureau of family assistance shall determine if good cause for leaving employment exists, in accordance with RSA 167:82, III(c)(1), (2), (4), (6), (7), and (8).

(j) A recipient shall be terminated from MEAD when 3 consecutive occurrences of employment by a recipient indicate that the date of hire occurred during the last month of each of the 6-month periods.

(k) Recipients who are eligible for private health insurance through employment or membership in an organization, at no cost to them, shall be enrolled in those insurance plans in order to remain eligible for MEAD.

Source. #13380, eff 5-25-22; ss by #13876, eff 2-21-24

PART He-W 842 CATEGORICAL REQUIREMENTS - ADULT MEDICAL ASSISTANCE

He-W 842.01 Reserved

He-W 842.02 Old Age Assistance Categorical Requirements.

(a) If an individual applies for medical assistance in the category of old age assistance (OAA) in the month in which the individual turns 65 years of age, the individual shall meet the age requirement as of the day the individual turns 65 years of age.

(b) If an individual is transferred to OAA medical assistance from another category of medical assistance, the individual shall receive assistance under OAA commencing in the month following the month in which the individual turns 65.

Source. #13893, eff 2-27-24

He-W 842.03 Aid to the Permanently and Totally Disabled Categorical Requirements.

(a) Applicants and recipients of aid to the permanently and totally disabled (APTD) medical assistance shall meet all aspects of the APTD disability requirement promulgated in RSA 167:6, VI for initial and continuing eligibility.

(b) Recipients of APTD medical assistance shall be transferred to OAA medical assistance the month following the month in which the recipient turns 65.

Source. #13893, eff 2-27-24

He-W 842.04 Aid to the Needy Blind Categorical Requirements. Applicants and recipients of aid to the needy blind (ANB) medical assistance shall meet all aspects of the ANB blindness requirement in He-W 502.02 for initial and continuing eligibility.

Source. #13893, eff 2-27-24

PART He-W 843 – RESERVED

PART He-W 844 Technical Requirements for Adult Medical Assistance

He-W 844.01 Personal Interview.

(a) A personal interview between the individual or authorized representative (AR) and a department staff member or contracted employee shall be required for:

(1) Each initial determination of eligibility for adult category medical assistance; and

(2) Each regularly scheduled redetermination of eligibility for all adult category individuals except for:

a. Individuals who receive in and out medically needy medical assistance pursuant to He-W 878.01;

b. Individuals residing in independent living arrangements and not receiving SNAP benefits; and

c. Individuals residing in nursing facilities or swing-bed hospitals, as defined in 42 CFR 413.114(b), and receiving payments for nursing care or who are only eligible for medical services other than a payment for nursing care.

(b) When required for nursing facility, choices for independence (CFI), home and community-based care for the developmentally disabled (HCBC-DD), home and community-based care for individuals with an acquired brain disorder (HCBC-ABD), and home and community-based care for in-home supports (HCBC-IHS) cases, a department staff member shall conduct a personal interview with one or more of the following:

(1) The individual;

(2) A representative of the nursing facility or swing-bed hospital as defined in 42 CFR 413.114(b); or

(3) The individual’s relative or AR.

(c) A personal interview shall be conducted for all adult category cases, including those exempted above in (a)(2), as a result of reported changes or the discovery of conflicting information related to eligibility.

(d) A personal interview shall be required once during a 12-month period for any adult category case on a more frequent redetermination of assistance schedule pursuant to He-W 684.02(d).

(e) The individual or the individual’s AR shall review the summary of the information provided during the interview with the department’s representative who conducted the interview, and:

(1) Make any corrections to the information; and

(2) Sign the summary attesting to the truthfulness and accuracy of the information provided.

Source. #12714, eff 1-23-19

PART He-W 845 CONTINUOUS ELIGIBILITY FOR PREGNANT WOMEN, CHILDREN, AND DEEMED NEWBORNS

He-W 845.01 12 Month Postpartum Coverage.

(a) All pregnant women who are receiving medical assistance shall:

(1) Remain eligible for medical assistance through the duration of the pregnancy and the 12 month postpartum period pursuant to RSA 167:68, IV(a); and

(2) Not be required to complete a redetermination until the end of the postpartum period.

(b) Eligibility for medical assistance shall remain in effect regardless of the individual’s change in circumstance except when the following occurs:

(1) The individual requests voluntary termination;

(2) The individual has moved out of New Hampshire;

(3) The department determines that eligibility was determined incorrectly at the most recent determination of eligibility because of an error made by the department;

(4) The department determines fraud, abuse, or perjury attributed to the individual; or

(5) The individual dies.

(c) Medical assistance shall terminate on the last day of the month in which the 12 month postpartum period ends, if no longer eligible for any other medicaid category, in accordance with 42 CFR 435.916(f).

Source. #13975, eff 5-23-24

He-W 845.02 12 Month Continuous Eligibility for Children Under Age 19.

(a) All children under age 19 receiving medical assistance shall:

(1) Remain eligible for medical assistance, beginning on the effective date of the individual's eligibility, pursuant to He-W 880, through the end of the 12 month continuous eligibility period; and

(2) Not be required to complete a redetermination until the end of the 12 month continued eligibility period as described in 42 CFR 435.926(c).

(b) Eligibility for medical assistance for children under age 19 shall remain in effect regardless of any change in circumstance, except when the following occurs:

(1) The child turns age 19;

(2) The child moves out of New Hampshire;

(3) The child or child’s representative requests a voluntary termination of eligibility;

(4) The department determines that eligibility was determined incorrectly at the recent determination of eligibility because of an error made by the department;

(5) The department determines fraud, abuse, or perjury attributed to the individual; or

(6) The child dies.

(c) Eligibility for medical assistance for children under age 19 shall terminate on the last day of the month in which the 12 month continuous eligibility ends, if no longer eligible for any other medicaid category, in accordance with 42 CFR 435.916(f).

Source. #13975, eff 5-23-24

He-W 845.03 12 Month Continuous Eligibility for Deemed Newborns.

(a) Pursuant to 42 CFR 435.117(b)(1), the agency shall provide Medicaid to children from birth until the child's first birthday, without application, if the child's mother was eligible for and received covered services at the time of birth, under the medicaid state plan in New Hampshire.

(b) Eligibility for medical assistance for deemed newborns shall remain in effect regardless of changes in circumstances until the child’s first birthday, except when the following occurs:

(1) The child moves out of New Hampshire;

(2) The child or the child’s representative requests a voluntary termination of eligibility; or

(3) The child dies.

(c) Redetermination of medical assistance shall not be required until the end of the 12 month period, and no more frequently than once every 12 months, as described in 42 CFR 435.916(a)(1).

(d) Eligibility for medical assistance shall terminate on the last day of the month in which the newborn 12 month continuous eligibility ends, if no longer eligible for any other medicaid category, in accordance with 42 CFR 435.916(f).

Source. #13975, eff 5-23-24

PARTS He-W 846 through He-W 847 – RESERVED

PART He-W 848 RESIDENTIAL CARE FACILITIES AND COMMUNITY RESIDENCES

He-W 848.01 RESERVED

He-W 848.02 Residential Care Facilities.

(a) Individuals living in residential care facilities, as described in RSA 151:2, I(e), shall meet all general, technical, categorical, and financial requirements for adult category medical assistance, in addition to the requirements below.

(b) Individuals living in residential care facilities shall be entitled to a different standard of need than individuals residing in independent living arrangements when the residential care facility is licensed by the department as meeting the standards for the care of residential care facility residents.

(c) Financial eligibility for individuals in residential care facilities shall be determined as an assistance group size of one.

(d) The standard of need for an individual in a residential care facility shall be adjusted annually as specified in He-W 648.04.

Source. #12179, eff 5-23-17

He-W 848.03 Community Residences.

(a) Individuals living in community residences, as defined in He-M 1001.02(k), shall meet all general, technical, categorical, and financial requirements for adult category medical assistance, in addition to the requirements below.

(b) Individuals living in community residences shall be entitled to a different standard of need than individuals residing in independent living arrangements when:

(1) The community residence is certified or licensed by the department;

(2) The individual has been determined appropriate for community residence care by a division of developmental services area agency case manager; and

(3) The individual has been placed in a community residence.

(c) Financial eligibility for individuals in community residences shall be determined as an assistance group size of one.

(d) The standard of need shall be adjusted annually, as specified in He-W 648.04, for individuals living in:

(1) Community residences, as defined in He-M 1001.02(k); and

(2) Family residences, as defined in He-M 1001.02(k) and He-M 1001.02(p).

Source. #12179, eff 5-23-17

PARTS He-W 849 –through He-W 851 RESERVED

PART He-W 852 INCOME – BASIC PRINCIPALS

He-W 852.02 Available Income.

(a) Available income for medical assistance shall be determined pursuant to 42 CFR 435.602 and 42 CFR 435.603.

(b) Income received which represents contributions or compensation for a period of more than one month, or which varies steadily from month-to-month, shall be averaged to obtain a monthly figure.

Source. #13856, eff 1-23-24

He-W 852.05 Conversion to Monthly Amounts.

(a) Income received weekly, bi-weekly, or semi-monthly, shall be converted to a monthly amount by multiplying by the following factors:

(1) For weekly amounts, multiply by 4.33;

(2) For bi-weekly amounts, multiply by 2.17; and

(3) For semi-monthly amounts, multiply by 2.

(b) The result shall be carried out to 2 decimal places and not be rounded up or down.

Source. #13856, eff 1-23-24

He-W 852.06 Fluctuating Income.

(a) "Best estimate" means an expectation of income to be received by an individual determined by evaluating past, present, and anticipated significant and non-significant income changes.

(b) "Fluctuating income" means:

(1) Earned income that varies from month to month such as when an individual works varying hours, overtime, or on a piece work basis; or

(2) Unearned income that varies from month to month due to changes in frequency or amount.

(c) "Non-significant changes" means any temporary or short-term variations in the amount of earned or unearned income caused by a situation which is not ongoing.

(d) "Significant changes" means changes in sources or amounts of earned or unearned income which are:

(1) Expected to continue into the future; or

(2) Short-term because it is caused by a situation which is not ongoing.

(e) The department of health and human services (DHHS) shall convert fluctuating income to a monthly amount pursuant to He-W 652.05 by averaging income for the most recent consecutive 4 weeks when such income represents a best estimate of future income pursuant to (a) above as verified by pay stubs or a statement from the employer.

(f) Income received during weeks with non-significant income changes pursuant to (c) above shall not be used to determine the average monthly amount.

(g) When the average monthly amount determined in (e) above does not represent a best estimate of future income pursuant to (a) above, the average monthly amount shall be determined as follows:

(1) Only data for weeks that accurately represent past earnings, up to a maximum of 8 weeks’ data, shall be included;

(2) The average weekly income shall be determined using the data from the weeks identified in (g)(1) above; and

(3) The appropriate multiplier under He-W 652.05 shall be used to convert average weekly income to a monthly amount.

(h) When income has been received for less than 4 consecutive weeks, the best estimate of future income pursuant to (a) above, shall be determined by computing a monthly average based on the actual number of weeks the income was received.

(i) The following shall apply to self-employment income:

(1) If self-employment income is the only income received from employment in a 12-month period, it will be averaged over a 12-month period;

(2) If self-employment income is the only income received from employment in a period of fewer than 12 months, it will be averaged over the number of months it was received; and

(3) If self-employment income is not the only income received from employment, it will be treated as income in the months received and will not be averaged.

(j) The estimated average monthly gross earned income as defined in He-W 601.04(m), shall be used until the next redetermination of eligibility.

(k) The estimated average monthly gross earned self-employment income as defined in He-W 601.04(n), shall be used for one year.

Source. #12616, eff 8-30-18

PART He-W 853 RESERVED

PART He-W 854 EVALUATION AND TREATMENT OF INCOME

He-W 854.01 Evaluation and Treatment of Income.

(a) Except where otherwise specified or specifically prohibited, income shall be evaluated and treated in the same manner for all adult categories of medical assistance.

(b) For self-employed individuals, if the cost of doing business exceeds gross self-employment income, the self-employment income amount shall be zero.

(c) Costs of doing business which exceed gross self-employment income shall not be an allowable deduction, nor subtracted from any other income that the individual may have.

(d) Income shall be considered to belong to the individual on whose behalf it is paid.

Source. #13715, eff 8-8-23

He-W 854.02 Income Computation.

(a) In computing eligibility and benefits, if any subtraction results in a negative amount, the result shall be considered to be zero instead of the negative amount.

(b) For individuals not living in nursing facilities who are applying for or receiving adult category medical assistance, and, if applicable, their applicant spouses, as defined in He-W 601.01(o), net income, as defined in He-W 601.05(v), shall be computed as follows:

(1) The amount of the individual’s and the individual’s applicant spouse’s countable gross earned income, as defined in He-W 601.04(m)-(n), shall be determined;

(2) For each individual, the earned income disregard for the adult category under which each individual is applying or receiving assistance, as specified in He-W 654.15, shall be computed and subtracted from each individual’s countable gross earned income to obtain each individual’s net earned income, as defined in He-W 601.05(u);

(3) The individual net earned income amounts shall be added together to obtain the assistance group’s (AG’s) net earned income amount;

(4) The countable gross unearned income, as defined in He-W 601.08(k), of each individual shall be added to the AG’s net earned income;

(5) From the total in (4) above, the adult standard disregard, as specified in He-W 854.16, and allowable deductions, as specified in He-W 854.20 and He-W 654.21, shall be subtracted; and

(6) The result shall be the AG’s net income.

(c) For individuals not living in nursing facilities who are applying for or receiving APTD or OAA medical assistance, and who live with their nonapplicant spouses, as defined in He-W 601.05(x), net income, as defined in He-W 601.05(v), shall be computed as follows:

(1) The countable gross earned incomes of the applicant and nonapplicant spouse shall be combined;

(2) The earned income disregard shall be subtracted from the combined gross earned income determined in (1) above to obtain the AG’s net earned income, except as follows:

a. For APTD medical assistance applicants, allowable impairment related work expenses (IRWEs), as described in 20 CFR 416.1112, shall be subtracted from the gross earned income of the applicant only, and not subtracted from the gross earned income of the nonapplicant spouse; and

b. For OAA medical assistance recipients, the IRWE deduction shall be subtracted only when the recipient’s case is transferred from APTD medical assistance to OAA medical assistance;

(3) The countable gross unearned income, as defined in He-W 601.08(k), of all AG members shall be added to the AG’s net earned income amount determined in (2) above;

(4) From the total in (3) above, the adult standard disregard, as specified in He-W 854.16, and allowable deductions, as specified in He-W 854.20 and He-W 654.21, shall be subtracted; and

(5) The result shall be the AG’s net income as defined in He-W 601.05(v).

(d) For individuals applying for or receiving ANB medical assistance who live with their nonapplicant spouses as defined in He-W 601.05(x), eligibility and level of benefits shall be computed as in (c) above, except that the individualized plan for employment work expenses subtracted from the applicant’s earned income shall be those described in He-W 654.15(d).

(e) For individuals living in nursing facilities who are applying for or receiving OAA, APTD or ANB, gross income for purposes of determining categorical eligibility for nursing facility care, as defined in He-W 858.05, shall be computed by adding together the individual’s countable gross earned income and countable gross unearned income.

(f) The amount of an individual’s net income for purposes of determining eligibility for nursing facility care as medically needy, as defined in He-W 858.05, shall be computed as follows:

(1) The earned income disregard for the adult category under which the individual is applying for or receiving assistance, as defined in He-W 654.15, shall be subtracted from the individual’s countable gross earned income to obtain the individual’s net earned income;

(2) The individual's countable gross unearned income shall be added to the net earned income; and

(3) The allowable deductions, as specified in He-W 854.20 and He-W 654.21, shall be subtracted, in order, from the amount in (2) above to arrive at the individual’s net income as defined in He-W 601.05(v).

Source. #12050, eff 11-19-16

He-W 854.03 Lump Sum Income.

(a) For medical assistance, lump sum income shall include, but not be limited to, non-recurring countable earned or unearned lump sum payments such as the following:

(1) Retroactive earned income;

(2) Retroactive lump sum social security benefits;

(3) Retroactive lump sum railroad retirement benefits;

(4) Unemployment compensation lump sum payments;

(5) Insurance settlements;

(6) Lump sum retirement benefits; and

(7) Windfalls such as inheritances, lotteries, and other financial prizes.

(b) Any amount received as a lump sum shall count as income for the month it is received if it is not excluded, in accordance with He-W 854.03(a) above.

(c) Notwithstanding He-W 854.03(a), any amount received as a lump sum in the form of a gift or inheritance, shall be excluded as income in the modified adjusted gross income categories of assistance.

Source. #13715, eff 8-8-23

He-W 854.05 Educational Income.

(a) Income from scholarships and grants that are not otherwise excluded by federal law or regulation shall be:

(1) Counted only to the extent that the income exceeds actual verified educational expenses during the period it is intended to cover; and

(2) Divided by the number of months it is intended to cover to calculate a monthly amount.

(b) Income from student loans, regardless of the source or the purpose to which it is used, shall not be counted when determining eligibility.

Source. #13715, eff 8-8-23

He-W 854.06 Educational Expenses - Adult Categories

(a) Repayment of a student loan shall not be an allowable deduction from educational income.

(b) Other educational expenses with the exclusion of (a) above shall be an allowable deduction from educational income if all of the following conditions are met:

(1) The expense is directly related to and necessary for school attendance;

(2) The student is responsible for the payment of the expense; and

(3) The expense has not been or will not be reimbursed from another source;

(c) If the educational expense has been or will be partially reimbursed, the remaining amount shall be allowed as a deduction from educational income; and

(d) Transportation costs to and from school shall be computed and verified in the same manner as for the employment expense disregard, specified in He-W 654.18.

Source. #13715, eff 8-8-23

He-W 854.11 Federally Mandated Excluded Income. All income that is considered excluded pursuant to a federal mandate shall be excluded for medical assistance.

Source. #13715, eff 8-8-23

He-W 854.12 Other Excluded Income.

(a) Loans for personal or business reasons shall be excluded income and disregarded when determining eligibility for all categories of medical assistance.

(b) For individuals receiving home and community based care services, the aid and attendance allowance shall be applied to the cost of care.

(c) Income set aside under a Social Security Administration approved plan to achieve self support shall be excluded for the duration of the plan.

Source. #13715, eff 8-8-23

He-W 854.15 Adult Category Earned Income Disregard.

(a) The earned income disregard shall be the first subtraction from earned income when computing net income for the adult categories of medical assistance.

(b) For aid to the permanently and totally disabled (APTD) or old age assistance (OAA) medical assistance applicants and recipients and for their applicant spouses who are also applying for APTD or OAA medical assistance, the earned income disregard for each individual shall consist of the amounts specified in 20 CFR 416.1112 for supplemental security income (SSI) recipients.

(c) For aid to the needy blind (ANB) medical assistance applicants and recipients and for their applicant spouses who are also applying for ANB, the earned income disregard for each individual shall be the first $85.00 of each individual's monthly gross earned income plus one half of the remaining amount.

(d) ANB medical assistance applicants and recipients shall have additional employment-related amounts added to the earned income disregard if:

(1) There is an individualized plan for employment for a specified period of time which has been approved by the New Hampshire department of education and meets the requirements cited in 29 USC 720 et. seq.; and

(2) The plan described in (1) above requires the use of additional disregards.

(e) For ANB medical assistance applicants and recipients with applicant spouses who are applying for APTD or OAA, the computation method for determining the amount of the earned income disregard for the spouse shall be the method to determine the APTD or OAA earned income disregard in (b) above for medical assistance.

(f) For APTD or OAA medical assistance applicants and recipients with applicant spouses who are applying for ANB, the computation method for determining the amount of the earned income disregard for the spouse shall be the method to determine the ANB earned income disregard in (c) and (d) above.

(g) For an adult category assistance group which includes a non-applicant spouse, as defined in He-W 601.05(t), the computation method for determining the amount of the earned income disregard to be applied to the medical assistance case shall be the method specified in 20 CFR 416.1112(c) for SSI recipients.

Source. #13525, eff 1-24-23

He-W 854.16 Adult Standard Disregard.

(a) For medical assistance applicants or recipients who do not reside in nursing facilities, a standard disregard shall be subtracted from income as described in He-W 654.02(c)(5).

(b) The amount of the disregard shall depend on the number of individuals whose needs are considered when determining eligibility, as follows:

(1) The standard disregard for one individual shall be $13.00;

(2) The standard disregard shall be $20.00 for an individual and applicant or nonapplicant spouse, or an individual and a needy essential person; and

(3) The standard disregard shall be $25.00 for an individual and applicant or nonapplicant spouse and a needy essential person.

Source. #11042, eff 2-24-16

He-W 854.17 Post-Eligibility Computation of Cost of Care for Nursing Facility Care.

(a) The amount of income that an eligible individual residing in a nursing facility is liable to contribute toward the cost of his or her nursing facility care shall be computed as follows:

(1) The amount of the applicant or recipient’s gross earned income as defined in He-W 601.04(m) shall be determined;

(2) The employment expense disregard, as specified in He-W 654.18, shall be subtracted from the individual's gross earned income to obtain the individual’s net earned income;

(3) The total amount of the individual's unearned income, as defined in He-W 601.08(k), shall be added to the net earned income to determine the individual’s net income;

(4) The allowable deductions, as defined in He-W 854.20 and He-W 654.21, shall be subtracted from the individual’s net income;

(5) The veterans affairs nursing facility pension, as defined in 38 U.S.C. 5503, if received, or the personal needs allowance, as described in (b) below, shall be subtracted from the amount in (4) above;

(6) The amount of income to be allocated to a spouse or dependents, as described in He-W 654.21, shall be subtracted from the amount in (5) above;

(7) The cost of the following medical expenses incurred by the recipient shall be subtracted from the amount in (6) above:

a. Health insurance premiums, including Medicare Part B, coinsurance payments, and deductibles;

b. Necessary and remedial care that would be covered by medical assistance except that allowable payment limits have been exceeded;

c. Necessary and remedial care that is recognized by state law, but not covered by medical assistance; and

d. Currently obligated, unpaid prior medical debt;

(8) The amount of any continuing SSI benefits, under 42 USC 1382(e), shall be subtracted from the amount in (7) above;

(9) If a physician has verified the stay in the nursing facility is to be 3 months or less and the individual is expected to return home, an amount equal to the FANF shelter payment allowance, as described in He-W 658.02, shall be subtracted from the amount in (8) above;

(10) The veterans affairs aid and attendance allowance shall be added to the amount in (8) or (9) above as required by 42 CFR 435.733(c); and

(11) The result in (10) above shall be the amount of income for which the individual is liable to remit to the nursing facility as payment toward the cost of his or her nursing facility care.

(b) The personal needs allowance (PNA) shall be equal to the minimum amount mandated by RSA 167:27-a, I and, pursuant to RSA 167:27-a, II, updated every 5 years by:

(1) Multiplying the current year’s PNA by the sum of the previous 5 years’ cost of living adjustments as described in 20 CFR 416.405;

(2) Rounding up the product derived in (b)(1) above to the next whole dollar; and

(3) Adding the rounded up product in (b)(2) above to the current year’s PNA.

(1) Only the following currently obligated, unpaid prior medical debts shall be allowed:

a. Non-nursing facility-related medical expenses; and

b. Nursing facility expenses at the Medicaid provider payment rate for the facility.

(2) Nursing facility expenses incurred during any penalty period pursuant to He-W 601.06(h), or period of ineligibility pursuant to He-W 601.06(i), except as noted in (c)(3) below, shall not be considered an allowable medical debt pursuant to (a)(7)(d) above; and

(3) Nursing facility expenses incurred during a period of ineligibility due to excess resources or receipt of a lump sum shall be considered an allowable medical expense pursuant to (a)(7)d. above, and in accordance with (c)(1)b. above.

Source. #11042, eff 2-24-16 (formerly He-W 654.17)

He-W 854.18 Adult Employment Expense Disregard.

(a) Expenses which are reasonably attributable to the earning of income shall be subtracted from the earned income of individuals living in nursing facilities who are receiving OAA, APTD or ANB when determining the amount of the individual’s cost of care liability as defined in He-W 854.17.

(b) The amount of the employment expense disregard shall be either a flat rate of $18.00 per month, or the amount of actual verified expenses if higher than $18.00 per month.

(c) The following expenses, if actually incurred and verified, shall be considered reasonably attributable to the earning of income:

(1) Social security taxes, at the rate set by SSA;

(2) Railroad retirement taxes;

(3) Federal withholding taxes, corresponding to the number of exemptions which the individual is legally entitled to claim;

(4) Mandatory retirement payments;

(5) Mandatory union dues;

(6) Other mandatory deductions from wages provided that the individual can document that the payroll deduction is not elective;

(7) Costs for transportation to and from work or to and from child care when child care is necessary for employment, subject to the following conditions:

a. To qualify as an allowable employment expense, the transportation used shall be the least expensive reasonable means available to the individual;

b. The amount of allowable transportation costs shall be computed by multiplying the average number of days per month an individual is employed, without deducting temporary absences of short duration, by the transportation cost for one day;

c. If the individual has been or will be reimbursed for transportation costs in any manner, the amount of the reimbursement shall be subtracted from the amount that would otherwise be allowed;

d. For travel incurred by an individual using his or her own vehicle, the allowable transportation cost shall be $0.21 per mile multiplied by the number of miles anticipated to be traveled in a month;

e. For travel provided in another person's privately owned vehicle, the allowable transportation cost shall be as charged up to the amount that would be allowed if the individual used his or her own vehicle; and

f. For travel provided by public transportation, such as by taxi or bus, the allowable transportation cost shall be the amount charged the public for such travel;

(8) Costs for uniforms and other unique clothing required for employment and not worn outside the work environment, subject to the following conditions:

a. Cleaning of uniforms shall not be an allowable employment expense unless the individual can document that a standard of cleanliness requires professional cleaning as a condition of employment;

b. The allowable expense shall be the amount actually paid by the individual for the special clothing;

c. If the amount varies monthly, an average shall be computed and applied until the next regularly scheduled redetermination; and

d. If the individual has been or will be reimbursed in any manner for a claimed special clothing expense, the reimbursed amount shall be subtracted from the amount which would otherwise be allowed; and

(9) Other mandatory employment related expenses claimed and verified by the individual.

Source. #12050, eff 11-19-16

He-W 854.19 Child Care Costs - Adult Categories.

(a) Child care costs incurred as the result of employment shall be an allowable deduction only when the individual taking care of the child or children is a licensed provider or does not require licensing under state law.

(b) Only that part of the child care expense which is not being reimbursed from another source, such as child care development funds, shall be an allowable expense.

Source. #13715, eff 8-8-23

He-W 854.20 Allowable Deductions.

(a) When determining eligibility and the amount of assistance for all categories of medical assistance, an allowable deduction from the income available to the assistance group shall be made, in an amount which has been or must be paid by an individual for non-employment-related types of expenses, including the following:

(1) Training expenses as described in (e) below;

(2) Garnishments from an individual’s earnings to repay a legal debt;

(3) Allocated income, as specified in He-W 654.21; and

(4) Any court-ordered payments, as described in (f) below, including but not limited to child support, alimony, and guardianship fees.

(b) The deduction described in (a) above shall be allowed for:

(1) Any individual whose needs are included in the assistance group; and

(2) Any individual whose income is counted even if his or her needs are not included in the assistance group.

(d) Allowable deductions shall be applied as follows:

(1) For medical assistance non-nursing facility cases in which there is a nonapplicant spouse, the allowable deductions shall be subtracted from the amount which represents the monthly combined earned income, less all applicable disregards to earned income as described in He-W 654.14 and He-W 654.15, plus all unearned income;

(2) For adult category non-nursing facility cases in which there is an applicant spouse, the allowable deductions shall be subtracted from the amounts which represent the individual monthly net incomes of the applicant and the applicant spouse; and

(3) For nursing facility cases, allowable deductions shall not be subtracted for the categorically needy eligibility determination as described in He-W 654.02, but shall be the first subtraction from the net income amount for the medically needy eligibility determination as described in He-W 654.02.

(e) Training expenses shall be an allowable deduction when all the following circumstances are met:

(1) The individual is enrolled in and regularly attending at least on a half-time basis, a program having an organized curriculum with the specific objective of training individuals for gainful employment;

(2) The training program is sponsored by public education or the federal government, or is offered by private schools for a particular trade;

(3) The individual has not received reimbursement for the training expense from any other source, or if partial reimbursement is made, the remaining expense shall be an allowable deduction;

(4) The training expense is not part of an employment expense disregard, because the individual has no earned income, or the training is totally unrelated to the individual's employment; and

(5) The expense occurs on at least a monthly basis.

(f) Any court-ordered payment which must be paid by an individual shall be an allowable deduction, regardless of whether the individual actually makes the payment.

Source. #11042, eff 2-24-16

PART He-W 855 RESERVED

PART He-W 856 RESOURCES

He-W 856.01 Resources - Basic Principles.

(a) Except where otherwise provided or specifically prohibited by federal law, resources shall be evaluated and treated the same for all categories of medical assistance that use a resource test in the eligibility determination process.

(b) The department's state spousal resource standard shall be the minimum standard required by 42 USC 1396r-5(f) and (g).

(c) As required by 42 USC 1396r-5(e)(2)(C), there shall be substituted for the community spouse resource allowance, pursuant to 42 USC 1396r-5(f)(2), an amount adequate to raise the community spouse's income up to the maximum maintenance allowance if all of the following conditions are met:

(1) The institutionalized spouse has allocated the maximum amount of income allowed pursuant to He-W806.75; and

(2) An administrative appeals officer determines that the community spouse resource allowance, in relation to the amount of income generated by such an allowance, is inadequate to raise the community spouse's income to the maximum maintenance allowance specified in 42 USC 1396r-5(d).

(d) For purposes of evaluating and treating resources, individuals applying for or receiving home and community-based care services shall not be considered institutionalized individuals except when evaluating asset transfers.

Source. #10924, eff 10-1-15; ss by #14394, eff 10-1-25, EXPIRES: 10-1-35

He-W 856.02 Treatment of Specific Types of Resources. Funds from an individual development account used for unqualified purposes, pursuant to 42 USC 604(h), shall be treated as lump sum payment in accordance with He-W 656.04(b)(10), for the adult categories of medical assistance.

Source. #12481, eff 2-21-18

He-W 856.03 Jointly Owned Resources.

(a) Personal property resources established prior to November 1, 1995, which an individual owns together with a non-assistance group member who is not receiving assistance, shall be considered to be shared equally among the owners, unless the individual verifies ownership of more or less than an equal share. If the individual verifies ownership of more or less than an equal share through documentary evidence, only the amount of the share actually owned by the individual shall count as a resource.

(b) Personal property resources established on or after November 1, 1995, which an individual owns together with an individual who is not an applicant or recipient, shall be considered to belong to the individual who is applying for or receiving assistance. If there is more than one individual who is applying for or receiving assistance that jointly owns the resource, it shall be assumed that each individual owns an equal share.

(c) If an individual wishes to rebut the ownership presumption in (b) above, the individual shall submit all of the following in (1) – (6) below to the department:

(1) A statement from the individual describing the portion of the personal property resources the individual claims to own, signed and dated under penalty of unsworn falsification pursuant to RSA 641:3;

(2) A corroborating statement from each other account holder, with each statement signed and dated under penalty of unsworn falsification pursuant to RSA 641:3;

(3) If the only other account holder is incompetent or a minor, a corroborating statement from a competent adult aware of the circumstances surrounding establishment of the account;

(4) Account records showing deposits, withdrawals, and interest in the months for which ownership is an issue;

(5) If the individual does not own any of the funds, documentary evidence showing that the individual can no longer withdraw funds from the account; and

(6) If the individual owns only a portion of the funds, documentary 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.

(d) Any resources that the evidence establishes were owned by the other account holder(s), as determined by the department, and that the individual can no longer withdraw from the account shall not be considered to be the individual's resources. However, such resources shall be deemed available to the individual if the account holder to whom they belong is someone whose resources would be used in determining the individual's eligibility.

(e) Jointly owned real property shall be excluded if the terms of ownership of the property prevent the individual from unilaterally liquidating the property and the other owner or owners refuse to agree to the sale. The addition of a joint owner shall be evaluated as an asset transfer in accordance with He-W 820.01.

(f) To verify the terms of ownership of the jointly owned real property which prevent the individual from unilaterally liquidating the property pursuant to (e) above, the individual shall submit to the department the deed, title, or other legally binding property document stating the terms of property ownership.

(g) To verify the other owner or owners refuse to agree to the sale pursuant to (e) above, the individual shall submit to the department a corroborating statement from each other account holder, with each statement signed and dated under penalty of unsworn falsification pursuant to RSA 641:3.

Source. #10982, eff 11-24-15; ss by #14394, eff 10-1-25, EXPIRES: 10-1-35

He-W 856.04 Personal Property Resources.

(a) For all non-MAGI categories of medical assistance except as specified in (11) and (12) below, personal property resources shall be treated as follows:

(1) At application and redetermination, the assistance group shall report and verify all resources;

(2) The value of accumulated interest, the equity value of life insurance policies and the value of stocks and bonds, when verified at application or redetermination, shall be considered unchanged until the next redetermination;

(3) Changes to the value of the resources identified in He-W 856.03(a) shall be reported between redeterminations;

(4) Individuals shall report the acquisition of new resources and the selling of existing resources, pursuant to RSA 167:17;

(5) The following resources shall not be counted when determining eligibility:

a. Borrowed money, except for when the individual transfers the proceeds or a portion of the proceeds of the loan to another individual pursuant to He-W 820.03(d)(7);

b. All household items;

c. Inaccessible personal property resources whose value is legally unobtainable by the individual, except as specified in (7) below;

d. Group, term, and fraternal life insurance policies which have no equity value and are only payable upon the death of the insured;

e. Lump sum death payments to cover funeral and burial expenses;

f. Resources resulting from an accumulation of types of income that are excluded by federal mandate;

g. Federal, state, and local income tax refunds; and

h. Keogh accounts which involve a contractual relationship with a non-assistance group member, provided the contract prevents the individual from withdrawing money from the account without affecting the employer or other employees;

(6) All Individual Retirement Accounts (IRA), one-person Keogh accounts, and non-contractual Keogh accounts shall be counted towards the resource limit as follows:

a. The balance in the account minus the penalty for early withdrawal for the entire account shall be counted; and

b. The balance amount and the amount of the penalty for early withdrawal shall be as specified on the date on which they are initially verified and these amounts shall remain in effect until the next redetermination;

(7) Trusts and similar legal devices shall be treated as follows:

a. Trusts and similar legal devices, including annuities, established after August 10, 1993, and trusts and legal devices that were established prior to August 11, 1993, but have been added to or otherwise augmented after August 10, 1993, shall be treated in accordance with 42 USC 1396p(d)(1)-(3);

b. No clause or requirement in the trust, no matter how specifically it applies to state or federal programs, shall preclude a trust from being considered in accordance with 42 USC 1396p(d)(1)-(3);

c. Any payments from revocable trusts, which are not made to, or on behalf of, the individual shall be considered assets disposed of for less than fair market value pursuant to He-W 820;

d. Payments of income or payments from the corpus of irrevocable trusts that are not made to or for the benefit of the individual, shall be treated as a transfer of assets for less than fair market value pursuant to He-W 820;

e. Irrevocable trusts where payments from some portions or all of the trust cannot under any circumstances be made to, or for the benefit of, the individual shall be treated as follows:

1. The portion of the corpus or income on the corpus which cannot be paid to the individual shall be treated as a transfer of assets and shall be treated in accordance with He-W 820;

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

3. In determining the value of the portion of the trust which cannot be paid to the individual for transfer purposes, any payments made, for whatever purpose, after the date the trust was established or, if later, the date payment to the individual was foreclosed, shall not be subtracted from the value of the trust;

4. If funds were added to that portion of the trust after these dates, those funds shall be considered to be a new transfer of assets, effective on the date the funds are added to the trust; and

5. The value of the transferred amount shall be no less than its value on the date of establishment or the date that access to the principal of the trust was restricted or eliminated;

f. When some portion of the corpus or income on the corpus of a trust is or can be paid to the individual, such portion or income shall be treated in accordance with the standards set forth in 42 USC 1396p(d)(3)(A) or (B), as applicable;

g. Payments shall be considered to be made to the individual when any amount from the trust, including an amount from the corpus, or income produced by the corpus, is paid directly to the individual, or to someone acting on the individual's behalf; and

h. Payments made for the benefit of the individual shall be payments of any sort, including an amount from the corpus, or income produced by the corpus, paid to another entity such that the individual derives some benefit from the payment;

(8) An irrevocable burial trust established by an individual for the purpose of paying, at some point in the future, for the various expenses associated with the individual's funeral and burial shall be an exempt trust if the individual has a signed contract with a funeral home and the corpus of the trust does not exceed the contracted amount;

(9) Annuities shall be excluded from the resource computation only if all of the following are true:

a. The expected return on the annuity is commensurate with the life expectancy of the beneficiary in accordance with He-W 820.03(l);

b. The annuity is owned by an individual applying for medical assistance on or after November 1, 2003, and the state of New Hampshire is selected as the:

1. Contingent beneficiary in the event that the individual’s spouse, minor child, or permanently and totally disabled child, if any, predeceases the individual; or

2. Secondary beneficiary if the individual has no spouse, minor child, or permanently and totally disabled child at the time the annuity is purchased; and

c. The annuity is owned by an individual applying for medical assistance on or after November 1, 2003, and the payment structure provides equal or nearly equal payments to the individual for the duration of the annuity;

(10) Annuities excluded from the resource computation pursuant to (9) above shall be treated as follows:

a. When an individual cannot access the principal of an annuity, the annuity shall be treated as an irrevocable trust;

b. If an annuity provides for payments to be made to the individual, those payments shall be considered unearned income to the individual;

c. Any portion of the principal of the annuity that is paid to or on behalf of the individual shall be considered unearned income to the individual; and

d. Portions of the annuity that cannot be paid to or for the benefit of the individual shall be treated as transfers of assets and shall be evaluated in accordance with He-W 820;

(11) Trusts described in 42 USC 1396p(d)(4)(A) shall continue to be excluded when determining eligibility for medical assistance-only even after the individual becomes age 65, except that any addition to the trust or augmentation of the trust after the individual turns age 65 shall be treated as a transfer of assets for less than fair market value;

(12) Trusts described in 42 USC 1396p(d)(4)(C) shall include a provision specifically providing for payment to the state pursuant to 42 USC 1396p(d)(4)(C)(iv); and

(13) Where application of the trust provisions discussed in 42 USC 1396p(d)(4)(A) and (C) would cause an undue hardship as specified in He-W 821.01(a)(6), those provisions shall not apply.

(b) For the adult categories of medical assistance, personal property resources, with the exception of additional resources of individuals eligible for medicaid for employed adults with disabilities (MEAD) pursuant to He-W 841.03, shall be treated as follows:

(1) The following resources shall not be counted when determining eligibility for the adult categories of medical assistance:

a. All vehicles such as but not limited to cars, trucks, boats, motorcycles and snowmobiles; and

b. Farm machinery, livestock, tools, and equipment;

(2) The equity value of the following resources shall be counted when determining eligibility for all adult categories of medical assistance:

a. Bank accounts, including checking accounts;

b. Stocks and bonds; and

c. Pre-paid debit card, such as Direct Express card;

(3) Accessible burial funds shall be treated in the following manner:

a. Up to $1500 of the burial funds shall not be counted when determining eligibility for the adult categories of medical assistance when the value of the burial funds, added to the individual’s other countable resources, exceeds the resource limits as specified in He-W 856.06;

b. The amount of the burial fund exclusion shall be reduced by:

1. The combined face value of any life insurance policies; and

2. Any irrevocable trusts or irrevocable funds identified as available to meet burial expenses;

c. Interest earned on excluded burial funds and appreciation on the value of excluded burial arrangements shall be excluded as a resource, if left to accumulate as part of the separately identified burial fund;

d. Interest earned on any portion of the burial fund not excluded as a resource shall be excluded only if inaccessible to the individual; and

e. Accumulated interest which is accessible to the individual shall be counted as a resource at each eligibility determination;

(4) Resources set aside under an SSA-approved PASS shall be excluded for the duration of the plan;

(5) Life insurance policies shall be:

a. A countable resource when the combined equity value of all an individual’s policies exceeds $1,500; or

b. An excluded resource when:

1. The total combined equity value of all the individual’s policies is equal to or less than $1,500; or

2. The combined equity value of the individual’s policies exceeds $1,500, but the state of New Hampshire has been made the beneficiary to the policies pursuant to RSA 167:4, IV(c);

(6) Applicants whose life insurance policies have a combined face value exceeding $1,500 shall be allowed to offset the excess equity value of life insurance for 3 months if:

a. The equity value of life insurance exceeds resource limits in He-W 856.06, but other countable resources do not exceed the resource limits; and

b. The applicant or the applicant's legal spouse who is living with the applicant has incurred and is liable for unpaid medical expenses;

(7) The excess value of life insurance shall be offset as follows:

a. Unpaid medical bills which were incurred before the period for which eligibility is requested shall be deducted from the equity value of the life insurance policies;

b. If there are not enough prior unpaid medical bills to offset the equity value of life insurance, unpaid medical bills incurred within the period of which eligibility is requested shall be deducted from the equity value of the life insurance policies in chronological sequence, starting with the earliest unpaid bill;

c. The medical expense offset shall occur prior to the determination of eligibility for in and out medical assistance described in He-W 878.01; and

d. No incurred unpaid medical bill shall be offset more than once;

(8) The period of offsetting incurred medical expenses shall begin on the date that the applicant provides verification to the department of health and human services (DHHS) of resources and incurred medical expenses, and shall end 3 months thereafter;

(9) At the end of the 3 month period, the equity value of life insurance shall be counted in full without any offset for medical expenses;

(10) Lump sum payments, with the exception of lump sum earned income and excludable lump sum payments paid to cover funeral expenses and portions of third party medical and other expenses directly associated with receipt of the lump sum, shall be counted as a resource when determining eligibility for the adult categories of medical assistance; and

(11) For medical assistance services described in He-W 820.03(s), entrance fees paid to a continuing care retirement community (CCRC) shall be considered available to the individual if:

a. The entrance fee may be used to pay for care;

b. The individual is entitled to a refund when the individual dies or terminates the CCRC; and

c. The entrance fee does not confer an ownership interest in the CCRC.

(c) For the parents and other caretaker relatives category of medically needy medical assistance, personal property resources shall be treated as follows:

(1) Liquid resources such as bank accounts, stocks, bonds, and savings certificates, owned by an alien's sponsor or sponsor's spouse, shall be deemed to be available to the alien when determining an alien's eligibility for parents and other caretaker relatives category of medically needy medical assistance;

(2) Liquid resources such as vehicles which are owned by an alien's sponsor or sponsor's spouse shall not be deemed to be available to the alien;

(3) Junk vehicles used only to supply parts for the individual's main vehicle, are in such dilapidated condition that they cannot be reasonably repaired for sale or use, or which can only be sold for scrap or parts, and vehicles which are jointly owned with a non-assistance group member, shall be excluded as a resource when determining eligibility for parents and other caretaker relatives category of medically needy medical assistance;

(4) Lump sum payments derived from converting a non-liquid resource to cash shall be counted as a lump sum resource when determining eligibility for parents and other caretaker relatives category of medically needy medical assistance;

(5) The remaining balance of the working checking account and pre-paid debit card on the day it is reviewed, reduced by the amount that represents the FANF payment standard for an assistance group of comparable size with no income, shall be counted as a resource for parents and other caretaker relatives category of medically needy medical assistance;

(6) The following special provisions shall apply to parents and other caretaker relatives category of medically needy medical assistance recipients whose countable resources exceed the allowable limit because their sole resources consist of personal property assets which cannot be readily converted to cash, or which consist of such assets and real property as follows:

a. Recipients shall reduce excess resources to within allowable limits no later than the month following the month in which resources first exceed the limit;

b. The recipient shall verify the recipient is making a good faith effort to sell the personal property resource which caused the resource limit to be exceeded; and

c. Medical assistance shall terminate if the recipient fails to reduce resources within the above time frames;

(7) The equity value of each individual’s life insurance policies shall be counted as a resource when determining eligibility for parents and other caretaker relatives category of medically needy medical assistance, when the total combined value of the policies is greater than $1,500;

(8) For the purposes of the vehicle exclusion specified in RSA 167:81,IV(b), the total number of vehicles excluded as a resource, regardless of ownership or value, should not to exceed the number of adult members of the assistance group; and

(9) The equity value of all life insurance policies shall be excluded as a resource when determining eligibility for parents and other caretaker relatives category of medically needy medical assistance, when:

a. The combined value of each individual's policies is $1,500 or less; or

b. The total combined value of each individual's policies exceeds $1,500, but the state of New Hampshire has been made the beneficiary to the policies pursuant to RSA 167:4,IV(c).

Source. #13395, eff 6-18-22

He-W 856.05 Real Property Resources.

(a) For the adult categories of medical assistance, real property resources shall be treated as follows:

(1) The home occupied by the individual shall not be counted when determining eligibility for adult categories of medical assistance;

(2) An unoccupied home shall not be counted during periods of temporary absence such as short term hospitalization or institutionalization;

(3) Income-producing property, which is real property not occupied by the individual, but producing income at least sufficient to meet the expenses of its ownership and maintenance shall not be counted;

(4) Any real property not otherwise excluded shall not be counted if it is necessary as the residence for the individual’s spouse, minor child, or disabled child;

(5) One burial plot per assistance group member shall not be counted; and

(6) The equity value of real property which is not specifically excluded above shall be counted as a resource when determining eligibility for adult categories of medical assistance, except during the 6 month disposal period described in subsection (b).

(b) For adult categories of medical assistance, the assistance group shall take action to dispose of the property within 6 months of being notified by the department of health and human services (DHHS) that the property must be liquidated, and:

(1) The equity value of the property shall not be counted during the disposal period; and

(2) The disposal period shall be extended as long as:

a. The individual verifies that action has been taken to sell the property and that there are valid reasons for inability to sell the property; or

b. The individual’s hospitalization or institutionalization, although long term, is not expected to be permanent and it is likely that the individual will return to the home.

(c) If disposal does not occur within the disposal period, as specified in (b) above, medical assistance shall be denied or terminated.

(d) Applicants and recipients of medical assistance described in He-W 820.01(q), whose equity interest in their primary residence exceeds the 2016 limit of $552,000, updated annually pursuant to 42 USC 1396p(f)(1)(C), shall not be eligible for such services, but shall remain eligible for other medical assistance services, unless the individual’s spouse, minor child or disabled child resides in the property.

Source. #12217, eff 6-22-17

He-W 856.06 Resource Limits.

(a) The resource limit for categorically needy medical assistance for home care for children with severe disabilities (HC-CSD) shall be $1,000, regardless of assistance group size.

(b) The resource limit for adult categorically-needy medical assistance shall be $1,500, with the exception of individuals eligible for medicaid for employed adults with disabilities (MEAD) pursuant to He-W 641.03.

(c) Except as described in (d) below, the resource limit for all categories of medically-needy medical assistance shall be as follows, based on the number of individuals in the assistance group:

(1) For a single individual, $2,500;

(2) For 2 individuals, $4,000; and

(3) For 3 or more individuals, add an additional $100 for each additional individual in the assistance group to the resource limit in (2) above.

(d) The resource limit for applicants for medical assistance long-term care services shall be $2,500 plus the value of coverage provided in a conforming long-term care insurance policy, pursuant to RSA 167:4, IV(d) and 42 USC 1396p(b).

Source. #12017, eff 10-25-16

He-W 856.07 Resource Disregard. For individuals ages 18 or older applying for or receiving nursing facility services or choices for independent (HCBS-CFI), developmental disability (HCBS-DD), acquired brain disorder (HCBS-ABD), or in home supports (HCBS-IHS) waiver services under the home and community-based services, a disregard shall be applied in the amount between the base resource standard for the group and $7,500.

Source. #14378, eff 9-20-25, EXPIRES: 9-20-35

PART He-W 857 RESERVED

PART He-W 858 STANDARD OF NEED

Revision Note #1:

Document #11169, effective 8-22-16, readopted with amendments He-W 658.04 titled “Protected Income Level” and renumbered the rule as He-W 858.04. The source note information for He-W 876.01 prior to Document #11169 includes the documents filed under He-W 658.04.

Although He-W 658.04 had last been filed under Document #9208, effective 7-19-08, this rule did not expire on 7-19-16 since it was extended pursuant to RSA 541-A:14-a until replaced by He-W 858.04 in Document #11169, effective 8-26-16.

Revision Note #2:

Document #12050, effective 11-19-16, included among other rules the readoption with amendments of He-W 658.05 titled “Eligibility for Adult Category Medical Assistance Nursing Care” and renumbered the rule as He-W 858.05. Document #12050 also included the readoption with amendments of He-W 658.06 titled “Eligibility for Adult Category Medical Assistance for Choices for Independence (CFI), Home and Community-Based Care for the Developmentally Disabled (HCBC-DD), Home and Community-Based Care for Individuals with an Acquired Brain Disorder (HCBC-ABD), and Home and Community-Based Care for In-Home Supports (HCBC-HIS)” and renumbered the rule as He-W 858.06, now re-titled as “Eligibility for Adult Category Medical Assistance for Home and Community-Based Care Choices for Independence (HCBC-CFI), Home and Community-Based Care for the Developmentally Disabled (HCBC-DD), Home and Community-Based Care for Individuals with an Acquired Brain Disorder (HCBC-ABD), and Home and Community-Based Care for In-Home Supports (HCBC-HIS)”.

The source note information for He-W 858.05 and He-W 858.06 prior to Document #12050 includes the documents filed under He-W 658.05 and He-W 658.06, respectively.

Although He-W 658.05 and He-W 658.06 had last been filed as regular rules under Document #9289, effective 10-3-08, these rules did not expire on 10-3-16 since they were extended pursuant to RSA 541-A:14-a until replaced by He-W 858.05 and He-W 858.06 in Document #12050, effective 11-19-16.

He-W 858.03 Adult Category Standard of Need.

(a) The standard of need for adult categorically needy medical assistance for individuals in independent living arrangements, as defined in He-W 801.05, shall be a fixed amount based on assistance group (AG) size.

(b) Adult category individuals shall be treated as an AG size of one when determining eligibility, except when an adult category individual lives with a spouse in an independent living arrangement, eligibility shall be determined as an AG size of 2.

(c) For each assistance group size, the standard of need for adult category individuals in independent living arrangements shall maintain the minimum payment level as specified by 42 USC 1382g.

(d) When supplemental security income (SSI) benefits change due to an SSI flat rate increase, the standard of need for adult category individuals in independent living arrangements shall not increase, as a portion of the SSI flat rate benefit increase is excluded in order to maintain the minimum payment level as described in (c) above.

(e) When SSI benefits change due to a cost of living increase, the following method shall be used to determine the standard of need for each AG size for adult category individuals in independent living arrangements:

(1) Amounts from SSI flat rate benefit increases which are excluded shall be subtracted from the SSI maximum benefit amount for AG sizes of one or 2 individuals;

(2) The adult standard disregard as specified in He-W 854.16, shall be subtracted from the minimum payment level;

(3) The amount determined in (e)(1) above shall be added to the amount determined in (e)(2) above; and

(4) The sum, by AG size, shall be the standard of need for adult category individuals who reside in independent living arrangements.

Source. #13761, eff 9-28-23

He-W 858.04 Protected Income Level.

(a) The department shall use a set of standards called the protected income levels (PIL) to determine eligibility for all categories of medically needy medical assistance, with the exception of individuals eligible for nursing facility care, whose eligibility for medically needy medical assistance shall be determined pursuant to He-W 858.05.

(b) The maximum monthly PIL shall be as listed in Table 600.11, protected income levels, below:

Table 600.11, Protected Income Levels

Assistance Group Size	Protected Income Levels
1	$888
2	$1,033
3	$1,177
4	$1,311
5	$1,444
6	$1,611
7	$1,744
8	$1,944
9	$2,055
10	$2,222
11	$2,411
12	$2,566

Source. (See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5530, eff 12-16-92; ss by #6865, eff 10-3-98; amd by #6952, eff 3-1-99; ss by #7226, eff 4-1-00; amd by #7451, eff 2-17-01; amd by #7622, INTERIM, eff 1-9-02 EXPIRED: 7-8-02; amd by #7693, eff 5-25-02; amd by #7803, INTERIM, eff 1-1-03, EXPIRED: 6-30-03; amd by #7876, eff 4-23-03; amd by #8015, eff 1-1-04, EXPIRED: 6-29-04; amd by #8092, eff 5-28-04; amd by #8252, eff 1-8-05; amd by #8433, eff 9-21-05 ss by #9111, INTERIM, eff 3-24-08, EXPIRES: 9-20-08; ss by #9208, eff 7-19-08; ss by #11169, eff 8-26-16 (See Revision Note #1 at Part heading for He-W 858); ss by #14092, eff 10-4-24

He-W 858.05 Eligibility for Adult Category Medical Assistance Nursing Care.

(a) The nursing facility cap shall be 300% of the maximum SSI benefit for an eligible individual as determined in accordance with 20 CFR 416.410, adjusted by cost-of-living increases pursuant to 20 CFR 416.405.

(b) The individual shall be income eligible for nursing facility care as categorically needy when the individual’s monthly gross income, as defined in He-W 601.04(o), is less than or equal to the nursing facility cap specified in (a) above.

(1) The individual's monthly gross income, as defined in He-W 601.04(o), exceeds the nursing facility cap specified in (a) above; and

(2) The individual’s net income, as defined in He-W 601.05(v), is less than or equal to the monthly medicaid nursing facility rate, as defined in He-E 806.01(aa).

(d) When determining resource eligibility for nursing facility care as categorically needy, $1,000 of the individual’s resources shall be disregarded.

Source. (See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #5316, eff 1-27-92; ss by #5561, eff 1-22-93; ss by #5790, eff 2-22-94; ss by #5966, eff 1-27-95; amd by #6969, eff 4-1-99; ss by #7824, eff 2-8-03; ss by #9289, eff 10-3-08; ss by #12050, eff 11-19-16 (See Revision Note #2 at Part heading for He-W 858)

He-W 858.06 Eligibility for Adult Category Medical Assistance for Home and Community-Based Services Choices for Independence (HCBS-CFI), Home and Community-Based Services for the Developmentally Disabled (HCBS-DD), Home and Community-Based Services for Individuals with an Acquired Brain Disorder (HCBS-ABD), and Home and Community-Based Services for In-Home Supports (HCBS-IHS).

(a) The individual shall be income eligible for HCBS-CFI, HCBS-DD, HCBS-ABD, or HCBS-IHS services as medically needy when:

(1) The individuals’ monthly gross income, as defined in He-W 801.04, exceeds the nursing facility cap specified in He-W 858.05(a); and

(2) The individual’s net income, as defined in He-W 801.05 is equal to or less than the protected income level (PIL), as specified in He-W 858.04.

(b) If the individual’s net income in (a)(2) above exceeds the PIL, medically needy income eligibility shall be determined in accordance with He-W 878.01.

Source. #7223, eff 3-30-00; ss by #9111, INTERIM, eff 3-24-08, EXPIRED: 9-20-08

New. #9289, eff 10-3-08; rpld by #9499, EMERGENCY RULE, eff 6-30-09; ss by #9289, eff 10-3-08, reinstated by REPEAL OF EMERGENCY RULE, #9524, eff 7-31-09; ss by #12050, eff 11-19-16 (See Revision Note #2 at Part heading for He-W 858); ss by #14378, eff 9-20-25, EXPIRES: 9-20-35

PARTS He-W 859 through He-W 863 & PARTS He-W 865 through He-W 875 RESERVED

PART He-W 864 MEDICALLY NEEDY MEDICAL ASSISTANCE

He-W 864.01 RESERVED

He-W 864.02 Parents and Other Caretaker Relatives Medically Needy Medical Assistance.

(a) The following individuals, who are residing in the same housing unit, shall be included in the budgetary unit, as defined in He-W 601.02(e), when determining an individual’s eligibility for parents and other caretaker relatives medically needy medical assistance:

(1) All children who meet the age criteria for dependent child, who are siblings, half siblings, and step siblings; and

(2) All of the children’s natural parents, stepparents, and caretaker relatives, as defined in He-W 601.02(h), who are receiving assistance.

(b) For pregnant women, in addition to the individuals listed in (a), the following shall be included in the budgetary unit:

(1) Unborn child(ren); and

(2) The father of the unborn child(ren) if he is married to and residing with the pregnant woman.

(c) Individuals listed in (a) or (b) above who are recipients of federal supplemental security income (SSI) or adult category financial assistance shall not be included in the budgetary unit except when their own eligibility is being determined.

(d) The countable net income of non-SSI spouses or parents shall be treated as follows in determining an individual’s eligibility:

(1) The countable net income shall be prorated according to the total number of individuals in the budgetary unit; and

(2) The prorated amount shall then be multiplied by the total number of individuals in the budgetary unit to determine each individual’s eligibility.

Source. #12773, eff 5-7-19 (formerly He-W 664.02)

PART He-W 876 NURSING FACILITIES

Revision Note:

Document #10895, effective 7-22-15, readopted with amendments He-W 676.01 titled “Financial Eligibility for Nursing Facilities” and renumbered the rule as He-W 876.01. The source note information for He-W 876.01 prior to Document #10895 includes the documents filed under He-W 676.01.

Although He-W 676.01 had last been filed under Document #8903, effective 6-28-07, this rule did not expire on 6-28-15 since it was extended pursuant to RSA 541-A:14-a until replaced by He-W 876.01 in Document #10895, effective 7-22-15.

He-W 876.01 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.

He-W 878.01 In and Out Medically Needy Medical Assistance.

(a) The department shall provide in and out medically needy medical assistance in accordance with 42 CFR 435.301 to individuals:

(1) Who meet all categorical, technical, and resource requirements for medically needy medical assistance;

(2) Whose income exceeds the protected income level for medically needy medical assistance; and

(3) Whose incurred medical expenses and obligated prior medical debts, including non-covered medical services incurred in an eligible month, which have not been used to offset a prior spenddown, are at least equal to the difference between their income and the protected income level for medically needy medical assistance.

(b) The department shall recognize the following incurred medical expenses, and currently unpaid, obligated prior medical debts toward the in and out spenddown:

(1) Medical insurance premiums, deductibles or co-insurance charges;

(2) Necessary medical or remedial care that would be covered by medical assistance including when allowable incurred amounts exceed service limits described in He-W 530.03; and

(3) Necessary medical or remedial care that is recognized by state law but not covered by medical assistance described in He-W 530.06(a).

(c) Incurred current medical expenses and obligated prior medical debts of individuals of a family, as defined in He-W 601.04(c), or family members, as defined in He-W 601.04(f), who reside in the same living unit as the client or for whom the client is liable, shall be used to satisfy the spenddown amount.

(d) Prior medical debts shall not be prioritized or required to be used in sequential order and shall be prorated at the client's option over several months if the total amount of the debt exceeds the spenddown amount.

(e) The department shall apply incurred, unpaid medical expenses and currently obligated medical debts toward the spenddown in the following order:

(1) Unpaid prior medical debts and uncovered medical expenses shall be applied on the first day of the month of the in and out period;

(2) Medical insurance premiums due during the month shall be applied on the first day of the month in which they are due; and

(3) Current medical expenses which are or would be covered by medical assistance shall be applied chronologically after uncovered expenses and may be applied to the following month if they remain unpaid on the first day of the following month and have not already been applied toward a spenddown.

(f) A medical expense or prorated expense described in (d) above shall be used only once to offset the spenddown.

(g) The client may choose either a one or 6 month spenddown period when the department determines eligibility for in and out medically needy medical assistance, subject to the following provisions:

(1) An application for in and out medically needy medical assistance shall be valid only for a maximum of 6 consecutive months;

(2) The client shall be given the spenddown amounts for both a one and 6 month spenddown period on their notice of decision;

(3) The client shall not be required to choose either a one or 6 month spenddown until they submit verification of medical expenses to the department and the case meets all eligibility criteria; and

(4) Once the client has elected a one month spenddown period and the case has been opened, they shall not have a 6 month spenddown period unless they reapply for assistance.

(h) When the client has chosen a one month spenddown period, the amount by which monthly income exceeds the protected income level as defined in He-W 601.06(s) shall be the client's spenddown amount, and the spenddown amount shall be computed separately for each month.

(i) When the client has chosen a 6 month spenddown period, the spenddown amount shall be equal to 6 times the difference between monthly income and the protected income level.

(j) Reported or known changes in case circumstances such as, but not limited to, changes in income, household composition, and increases in the protected income level shall affect the one month spenddown amount as follows:

(1) Before a case is opened for a one month period, changes in case circumstances which affect the spenddown amount shall be used to determine eligibility; and

(2) Once a case is opened for a one month period, changes in case circumstances shall not affect the spenddown amount.

(k) Reported or known changes in case circumstances, such as but not limited to changes in income, household composition, and increases in the protected income level which affect the 6 month spenddown amount shall be used to determine eligibility as follows:

(1) Before a case is opened for a 6 month period, all known changes affecting that 6 month period shall be taken into account prior to opening, and the department shall calculate the changes for the affected months and establish a new spenddown for the 6 months;

(2) Once a case has been opened for a 6 month spenddown period and has a change that would increase the spenddown amount, the department shall take the change into account and take action to review eligibility by computing a new spenddown amount and, if the case is ineligible, terminate in and out medically needy medical assistance; and

(3) Once a case has been opened for a 6 month spenddown period and has a change that would decrease the spenddown amount, the department shall determine if the decrease affects the original date of eligibility.

(l) Eligibility for in and out medically needy medical assistance shall begin on the day of the month in which incurred medical costs equal or exceed the amount of the spenddown.

(m) The client shall notify the department in person, in writing, or by telephone when he or she has incurred medical costs which equal or exceed the amount of the spenddown.

PART He-W 879 RESERVED

PART He-W 880 INITIATION OF MEDICAL ASSISTANCE

REVISION NOTE:

Document #13536, effective 1-26-23, readopted with amendment and renumbered He-W 680 titled “Initiation of Medical Assistance” as He-W 880, also titled “Initiation of Medical Assistance”. The filing history for the former rules in He-W 680 and the former rule numbers in Part He-W 680 are indicated in the source notes.

Part He-W 680 had last been filed in Document #10139, effective 7-1-12, but did not expire on 7-1-22 but was extended pursuant to RSA 541-A:14-a.

He-W 880.01 Initiation of Medical Assistance.

(a) Unless otherwise specified, eligibility for categorically needy and medically needy medical assistance shall begin the day of application if all eligibility requirements are met on that date.

(b) The monthly spenddown period for in and out medically needy medical assistance shall begin no earlier than the date of application and continue for one calendar month from that date.

(c) If all eligibility requirements are not met on the date of application, eligibility for categorically needy and medically needy medical assistance shall begin the day of the month in which all eligibility requirements are met.

(d) If a newborn child is added to the assistance group, eligibility shall begin on the date of birth.

(e) In and out medically needy medical assistance shall begin on the day of the month in which incurred medical costs equal or exceed the amount of the spenddown.

(f) If application is made for retroactive categorically needy or medically needy medical assistance, medical assistance shall be provided for each of the 3 retroactive months directly preceding the month of application for which eligibility has been established, pursuant to He-W 880.02 and 42 CFR 435.915.

(g) Eligibility for a retroactive month under (f) above shall be determined beginning with the day prior to the application date back to the same date in the retroactive month, if all eligibility factors are met at any time during that month.

(h) If application is made for retroactive in and out medically needy medical assistance under (f) above, medical assistance shall be determined separately for each of the 3 retroactive months, pursuant to 42 CFR 435.915.

(i) Eligibility for a retroactive month for in and out medically needy medical assistance under (f) above shall begin on the day of the month in which incurred medical costs equal or exceed the amount of the spenddown.

(j) When aid to the needy blind (ANB) or aid to the permanently and totally disabled (APTD) categorically or medically needy medical assistance is denied by the department of health and human services or the social security administration (SSA) decision and the department’s or the SSA’s decision is subsequently reversed, medical assistance shall be determined beginning on the date of application, provided that:

(1) All general, technical, and categorical eligibility requirements are met; and

(2) Any of the following apply:

a. The department’s reversal is based on review of medical information prior to an administrative appeal;

b. The SSA reversal is based on the reconsideration or appeal procedure required by SSA; or

c. The department’s decision is reversed in accordance with He-C 201.

Source. (See Revision Note #1 at chapter heading for He-W 600) #5171, eff 6-26-91; amd by #5749,INTERIM, eff 12-1-93, EXPIRED: 3-31-94; amd by #5806, eff 3-30-94; ss by #6195, eff 2-24-96; amd by #6614, eff 10-24-97; amd by #6925, eff 1-1-99; amd by #7666, eff 4-1-02; amd by #8113, eff 7-3-04; amd by #8452, eff 10-22-05; amd by #8783, INTERIM, eff 12-30-06, EXPIRES: 6-28-07; amd by #8903, eff 6-28-07; ss by #10139, eff 7-1-12; ss by #13536, eff 1-26-23 (formerly He-W 680.01) (see Revision Note at part heading for He-W 880)

He-W 880.02 Retroactive Medical Assistance.

(a) In order to receive retroactive medical assistance, the individual shall indicate the periods for which retroactive assistance is being requested.

(b) A request for retroactive medical assistance shall be made no later than 9 months from the first day of the retroactive month for which assistance is being requested.

(c) The person making application on behalf of a deceased individual shall be responsible for providing verification of eligibility factors.

Source. (See Revision Note #1 at chapter heading for He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #6925, eff 1-1-99; amd by #7666, eff 4-1-02; amd by #8452, eff 10-22-05; ss by #9664, eff 4-1-10; ss by #10139, eff 7-1-12; ss by #13536, eff 1-26-23 (formerly He-W 680.02) (see Revision Note at part heading for He-W 880)

PARTS He-W 881 RESERVED

PART He-W 882 Termination of Medical Assistance

Revision Note #1:

Document #11169, effective 8-22-16, readopted with amendments He-W 682.04 titled “Four Month Extended Medical Assistance Due to Increased Child Support” and renumbered the rule as He-W 882.04 titled “Four Month Extended Medical Assistance Due to New or Increased Spousal Support.” Document #11169 also readopted with amendments He-W 682.05 titled “Twelve Month Extended Medical Assistance” and renumbered the rule as He-W 882.05. The source note information for He-W 882.04 prior to Document #11169 includes the documents filed under He-W 682.04, and the source note information for He-W 882.05 prior to Document #11169 includes the documents filed under He-W 682.05.

Although He-W 682.04 and He-W 682.05 had last been filed under Document #9207, effective 7-19-08, these rules did not expire on 7-19-16 since they were extended pursuant to RSA 541-A:14-a until replaced by He-W 882.04 and He-W 882.05, respectively, in Document #11169, effective 8-26-16.

Revision Note #2:

Document #13528, effective 1-24-23, readopted with amendments He-W 682.01 titled “Termination of Medical Assistance” and renumbered the rule as He-W 882.01. The source note information for He-W 882.01 prior to Document #13528 includes the documents filed under He-W 682.01.

Although He-W 682.01 had last been filed under Document #10139, effective 7-1-12, this rule did not expire on 7-1-22 since it was extended pursuant to RSA 541-A:14-a until replaced by He-W 882.01 in Document #13528, effective 1-24-23.

He-W 882.01 Termination of Medical Assistance.

(a) Except where otherwise specified, medical assistance shall cease as of the last day of the advance notice period, as defined in He-W 601.01(e).

(b) If an individual is terminated for failure to submit the necessary information, the individual’s eligibility for medical assistance shall be reconsidered if the necessary information is submitted within 90 days from the date of termination. A new application shall not be required.

Source. (See Revision Note #1 at chapter heading for He-W 600) #5171, eff 6-26-91; amd by #6195, eff 2-24-96; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; amd by #6745, (HB 32), eff 5-1-98, EXPIRED: 12-31-98; ss by #6925, eff 1-1-99; ss by #8783, INTERIM, eff 12-30-06, EXPIRES: 6-28-07; ss by #8903, eff 6-28-07; ss by #10139, eff 7-1-12; ss by #13528, eff 1-24-23 (formerly He-W 682.01) (see Revision Note #2 at part heading for He-W 882)

He-W 882.02 through He-W 882.03 – RESERVED

He-W 882.04 Four Month Extended Medical Assistance Due to New or Increased Spousal Support. Pursuant to 42 CFR 435.115, as amended, and 42 USC 1396u-1(c)(1), medical assistance shall be extended for 4 additional months when the primary reason for the termination of categorically needy medical assistance is increased income which was caused in whole or in part by new or increased spousal support income.

Source. (See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; ss by #6614, eff 10-24-97; ss by #7328, eff 8-1-00; ss by #9207, eff 7-19-08; ss by #11169, eff 8-26-16 (See Revision Note at Part heading for He-W 882)

He-W 882.05 Twelve Month Extended Medical Assistance.

(a) Assistance groups receiving a category of financial assistance to needy families (FANF) financial assistance, as defined in He-W 601.04(g), shall be eligible to receive up to 12 months of extended medical assistance when termination of FANF financial assistance was due solely to:

(1) Increased hours of employment; or

(2) Increased income from employment.

(b) If one of the conditions in (a)(1)-(2) above are met, the requirement that the household has received financial assistance in at least 3 of the last 6 months shall not apply, pursuant to 42 USC 1396r-6(a)(1)(B).

(c) Good cause for failure to return a complete quarterly report timely, as required by 42 USC 1396r-6(b)(2)(B), shall be limited to the following circumstances:

(1) Mail delay;

(2) Illness of the parent or caretaker relative, or other family member; or

(3) Emergencies such as floods, fires, loss of shelter, or similar events which prevent the family from returning the quarterly report on time.

Source. (See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91; amd by #6446, eff 2-1-97; amd by #6531, INTERIM, eff 6-27-97, EXPIRES: 10-25-97; amd by #6614, eff 10-24-97; ss by #7328, eff 8-1-00; ss by #9207, eff 7-19-08; ss by #11169, eff 8-26-16 (See Revision Note at Part heading for He-W 882)

PARTS He-W 883 RESERVED

He-W 884.01 Redeterminations - General.

(a) A redetermination of eligibility shall be required under the following conditions:

(1) At regularly scheduled intervals as prescribed by federal regulations;

(2) Prior to the expiration of extended medical assistance coverage periods, if the individual requests a redetermination of eligibility for benefits;

(3) When requested by the individual;

(4) When the department of health and human services (DHHS) discovers conflicting information regarding eligibility factors; or

(5) When a change in case circumstances affects other eligibility factors.

Source. #13524, eff 1-24-23

He-W 884.02 Regularly Scheduled Redeterminations.

(a) For modified adjusted gross income (MAGI) based medical assistance, redeterminations shall be scheduled no more than once every 12 months.

(b) For non-MAGI based medical assistance, redeterminations shall be scheduled at least every 12 months.

Source. #13524, eff 1-24-23

PARTS He-W 885 through He-W 889

PART He-W 890 REIMBURSEMENT

He-W 890.01 Reimbursement.

(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:

(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.

He-W 895.01 Purpose. The purpose of these rules is to establish criteria for:

(a) The determination of undue hardship pursuant to 42 USC 1396p(b)(3); and

(b) The waiver of the state's claim for recovery of medical assistance granted against a deceased Medicaid recipient's estate where estate recovery would result in an undue hardship.

Source. (See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91, EXPIRED: 6-26-97

New. #7311, eff 6-22-00; ss by #7667, eff 3-27-02; ss by #9225, eff 8-1-08; ss by #11170, eff 8-26-16 (See Revision Note at Part heading for He-W 895)

He-W 895.02 Definitions.

(a) “Applicant” means the individual who submits the written request that the department waive its right to recover for medical assistance provided to the deceased Medicaid recipient.

(b) "Cost effective" means the amount of public assistance recovered exceeds the total cost to the department of pursuing the recovery by $500.00 or more.

(d) "Estate" means all assets and liabilities of a Medicaid recipient subject to the jurisdiction of the probate court, including but not limited to all property, real or personal, in a revocable trust as contemplated by RSA 167:14-a, V and property held by the recipient during his or her lifetime in either joint tenancy, tenancy in common, or life estate as contemplated at RSA 167:14-a, VI.

(e) "Heir" means those persons, including the surviving spouse, who might be entitled to some or all of the estate of the Medicaid recipient under the statutes of succession.

(f) "Income producing property" means real property, either residential, commercial or industrial upon which money is made, such as rental property.

(g) "Medicaid recipient" means an individual who receives or received Medicaid benefits.

(h) “Medical institution” means any nursing facility as defined at 42 USC §1396r(a), long term care facility for the mentally retarded as defined at 42 USC §1396d(d), or medical institution as defined at 42 CFR §435.1010.

(i) “Medical professional” means any doctor, physician’s assistant, nurse, nurse practitioner, licensed nursing assistant or certified nursing assistant who regularly provided treatment to the deceased Medicaid recipient prior to the deceased Medicaid recipient’s admission to the medical institution.

(j) "Primary residence" means the applicant’s or heir's domicile.

(k) "Probate court" means the court having jurisdiction over the administration of estates as provided by RSA 547:3.

(l) “Uncompensated care” means care provided to the deceased Medicaid recipient gratuitously, without compensation from the department or any other person, organization, or agency and for which the applicant has not filed a claim against the estate for reimbursement under any theory of law or equity.

(m) "Undue hardship" for purposes of He-W 695, means circumstances described in these rules that would make application of the department's right to recovery unfair and which, if verified as provided in these rules, would result in the department's waiving its right to recover for medical assistance correctly paid on behalf of the deceased Medicaid recipient.

Source. (See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91, EXPIRED: 6-26-97

New. #7311, eff 6-22-00; ss by #7667, eff 3-27-02; ss by #9225, eff 8-1-08; ss by #11170, eff 8-26-16 (See Revision Note at Part heading for He-W 895)

He-W 895.03 Waiver of Recovery.

(a) The administrator or executor of the estate, the surviving joint tenant or remainderman of a life estate shall receive written notice of the right to request a waiver of recovery under these rules, including criteria for determining undue hardship and the procedure for requesting such a waiver concurrent with the notification of the department’s claim.

(b) Recovery of medical assistance pursuant to RSA 167:14 shall be waived if recovery will result in undue hardship to the heir as determined under He-W 895.04 or if the department determines that it is not cost effective to recover the assistance paid.

Source. (See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91, EXPIRED: 6-26-97

New. #7311, eff 6-22-00; ss by #7667, eff 3-27-02; ss by #9225, eff 8-1-08; ss by #11170, eff 8-26-16 (See Revision Note at Part heading for He-W 895)

He-W 895.04 Criteria for Determination of Undue Hardship. The department shall waive recovery on the basis of undue hardship as provided in (a), (b), (c), (d), (e) or (f) below:

(a) Where the estate includes real property on which a business or farm is located and:

(1) The business or farm has been in operation at the primary residence of the heir for at least 12 months preceding the death of the decedent;

(2) The business or farm produces more than 50% of the heir's livelihood; and

(3) The recovery of the claim would directly result in the loss of the livelihood of the heir;

(b) Where the estate includes income-producing property and:

(1) The heir has used his/her own personal resources for the past 12 months to maintain the income-producing property;

(2) The property produces more than 50% of the heir's livelihood; and

(3) The recovery of the claim would directly result in the loss of the livelihood of the heir;

(c) Where the estate includes only personal property and recovery by the department would directly result in the heir becoming eligible for public assistance;

(d) Where the estate includes the home of the Medicaid recipient upon which the department placed a lien or upon which the department had authority to place a lien but didn’t due to insufficient time, and:

(1) The applicant is an adult child of the deceased Medicaid recipient;

(2) The applicant is the grandchild of a deceased Medicaid recipient who died on or after January 1, 2008 and who can establish that the deceased Medicaid recipient had guardianship over the applicant while the applicant was a minor or that the deceased Medicaid recipient served as in-loco parentis to the applicant while he or she was a minor;

(3) The applicant resided in the home of the deceased Medicaid recipient for a period of at least 2 years immediately before the date of the deceased Medicaid recipient's admission to the medical institution;

(4) The applicant establishes that he or she provided uncompensated care daily to the deceased Medicaid recipient for at least 2 years immediately before the date of the deceased Medicaid recipient’s admission to the medical institution which permitted the deceased Medicaid recipient to reside at home rather than in a medical institution, including but not limited to any or all of the following activities:

a. Bathing;

b. Dressing;

c. Administering medication;

d. Shopping;

e. Cooking;

f. Feeding;

g. House cleaning;

h. Money management;

i. Driving; or

j. Other care specific to the condition of the deceased Medicaid recipient; and

(5) The applicant is lawfully residing in the home of the deceased Medicaid recipient and has lawfully resided in such home on a continuous basis since the date of the deceased Medicaid recipient's admission to the medical institution;

(e) Where the estate includes the home of the Medicaid recipient, and:

(1) The applicant is a sibling of the deceased Medicaid recipient;

(2) The applicant resided in the home of the deceased Medicaid recipient for a period of at least one year immediately before the date of the deceased Medicaid recipient's admission to the medical institution; and

(3) The applicant is lawfully residing in the home of the deceased Medicaid recipient and has lawfully resided in such home on a continuous basis since the date of the deceased Medicaid recipient's admission to the medical institution; or

(f) Where the estate includes the home of the Medicaid recipient which she or he held either in life estate or in joint tenancy, and:

(1) The applicant can demonstrate that he or she is either the remainderman under the life estate or the surviving joint tenant; and

(2) The applicant can demonstrate that he or she paid value for the remainder interest or joint interest either when the interest was created or to cure a transfer of asset penalty contemplated at He-W 820.01(s)(3).

Source. (See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91, EXPIRED: 6-26-97

New. #7311, eff 6-22-00; ss by #7667, eff 3-27-02; ss by #9225, eff 8-1-08; ss by #11170, eff 8-26-16 (See Revision Note at Part heading for He-W 895)

He-W 895.05 Request for Undue Hardship.

(a) A request for an undue hardship waiver shall be in writing and include the following information:

(1) The deceased Medicaid recipient's name;

(2) The deceased Medicaid recipient's last street address;

(3) The applicant’s name;

(4) The applicant’s relationship to the deceased Medicaid recipient; and

(5) The reason(s) for the undue hardship waiver request as described in He-W 895.04.

(b) Relevant documentation shall be attached to support the undue hardship waiver request including, but not limited to, the following:

(1) Mortgage note;

(2) Real property deed;

(3) IRS forms, including business, personal or farm deduction forms;

(4) Proof of residency such as a copy of the heir's driver's license or W-2;

(5) Canceled checks relating to the income producing property or business;

(6) City or town tax assessor bills;

(7) A copy of the deceased Medicaid recipients' death certificate;

(8) Estate paperwork filed with probate court;

(9) An affidavit from the applicant describing the kind and quality of care provided the deceased Medicaid recipient including dates the care was provided, if applicable; and

(10) Affidavits from at least 2 medical professionals who cared for the deceased Medicaid recipient prior to admission to the medical institution stating that the applicant provided the kind and quality of care necessary to maintain the Medicaid recipient at home rather than in a medical institution for at least 2 years immediately before the Medicaid recipient’s admission to the medical institution.

Source. (See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91, EXPIRED: 6-26-97

New. #7311, eff 6-22-00; ss by #7667, eff 3-27-02; ss by #9225, eff 8-1-08; ss by #11170, eff 8-26-16 (See Revision Note at Part heading for He-W 895)

He-W 895.06 Undue Hardship Request Review.

(a) A request for a hardship waiver shall be filed with the department within 30 calendar days from the Medicaid recipient's death or within 30 calendar days from the date of the filing of the department's claim with the probate court, whichever is later.

(b) The request shall contain a written statement of the circumstances constituting the hardship and supporting documentation as described in He-W 895.05.

(c) Determinations of the existence of undue hardship shall be made within 90 calendar days from the date of the hardship waiver request.

(d) A written notice of decision shall be sent to the person making the request.

(e) All denial notices shall include a statement informing the applicant that he/she may appeal the department's decision and instructions for how to request an administrative appeal.

Source. (See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91, EXPIRED: 6-26-97

New. #7311, eff 6-22-00; ss by #7667, eff 3-27-02; ss by #9225, eff 8-1-08; ss by #11170, eff 8-26-16 (See Revision Note at Part heading for He-W 895)

He-W 895.07 Reduction from Claim Against Non-Probate Assets.

(a) Surviving joint tenants or remainderman of life estates shall be eligible for a dollar-for-dollar reduction in the amount of the department’s claim for medical assistance correctly paid on behalf of a deceased Medicaid recipient when he or she can demonstrate that he or she advanced their personal funds to provide for a shortfall in the deceased Medicaid recipient’s expenses reasonable and necessary for burial as contemplated at RSA 554:19, I(b).

(b) Satisfactory documentation of personal funds advanced shall be cancelled checks and billing statements from the entity providing the disposition services such as a funeral home, crematory or monument company.

(c) No reduction shall be granted for expenses that are not necessary for burial as contemplated at RSA 554:19, II including but not limited to flowers, music, post-prandial meals, travel expenses to or from funeral services, telephone or postage expenses.

Source. (See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91, EXPIRED: 6-26-97

New. #7311, eff 6-22-00; ss by #7667, eff 3-27-02; ss by #9225, eff 8-1-08; ss by #11170, eff 8-26-16 (See Revision Note at Part heading for He-W 895)

He-W 895.08 Administrative Hearings.

(a) A decision pursuant to He-W 895.06 shall be final unless within 30 calendar days of the date of the decision, a request is submitted for an administrative appeal pursuant to He-C 200.

(b) If the department's administrative appeal process finds in favor of the applicant, then the department shall withdraw its claim for recovery from probate court.

Source. (See Revision Note #1 at Chapter Heading He-W 600) #5171, eff 6-26-91, EXPIRED: 6-26-97

New. #7311, eff 6-22-00; ss by #7667, eff 3-27-02; ss by #9225, eff 8-1-08; ss by #11170, eff 8-26-16 (See Revision Note at Part heading for He-W 895)

PARTS He-W 896 through He-W 897 RESERVED

PART He-W 898 MEDICARE AND MEDICARE SAVINGS PROGRAMS

He-W 898.01 Buy In of Medicare Part B.

(a) The department shall buy Medicare Part B coverage, as described in 42 USC 1395j, for individuals who are determined to be eligible for Medicare Part B by the Social Security Administration and:

(1) Determined to be categorically needy pursuant to He-W 802.04; or

(2) Recipients of financial assistance to needy families or adult category financial assistance, Supplemental Security Income, or medical assistance under the provisions of 42 CFR 435.135.

(b) The effective date of the buy-in of Medicare Part B coverage shall be the first day of the month in which the individual meets the criteria in (a) above.

Source. #13906, eff 3-19-24

PART He-W 899 RESERVED

APPENDIX A: Incorporation by Reference Information

Rule	Title	Publisher; How to Obtain; and Cost
He-W 837.04(a)(1)	ASAM Criteria: Treatment Criteria for Substance-Related, Addictive, and Co-Occurring Conditions, 3^rd edition (2013)	Publisher: American Society of Addiction Medicine (ASAM). The ASAM Criteria (2013) can be purchased online through the ASAM website at: http://www.asamcriteria.org/. Cost = $95 (non-members) or $85 (members). Discounts are available for large purchases.

Rule

Title

Publisher; How to Obtain; and Cost

He-W 837.04(a)(1)

ASAM Criteria: Treatment Criteria for Substance-Related, Addictive, and Co-Occurring Conditions, 3^rd edition (2013)

Publisher: American Society of Addiction Medicine (ASAM).

The ASAM Criteria (2013) can be purchased online through the ASAM website at: http://www.asamcriteria.org/.

Cost = $95 (non-members) or $85 (members). Discounts are available for large purchases.

APPENDIX B

Rule	Specific State Statute the Rule Implements
He-W 801.01	RSA 161:2,I; RSA 161-B:2, XIII & XIV; RSA 161-C:22; RSA 167:3-c,I & XII; RSA 167:4,I,IV(b) & (e), RSA 167:6,I,IV,V,VI,VIII & IX; RSA 167:7,IV; RSA 167:8; RSA 167:14-a; RSA 170-B:2,I & XII; RSA 167:78,II; 8 CFR 215.1(a); 38 CFR 3.352; 42 CFR 435.4; 42 CFR 435.908; 45 CFR 206.10(a)(1)(iii), (a)(4),(b)(1)-(2) & (b)(5); 45 CFR 234.11; 45 CFR 233.20(a); 45 CFR 260.31; Section 407 of PRWORA (PL 104-193); Section 419 of PRWORA (PL 104-193); 8 USC 1158; 42 U.S.C § 619(1); 42 USC 608(b); 42 USC 601; 42 USC 608(a)(3); 42 USC 659(i)(3); 42 USC 1206; 42 USC 1320b-7(d); 42 USC 1355; Section 1605 of the SSA [42 USC 1385 note]; 42 USC 1382b; 42 USC 1382c(b); 42 USC 1396p(c)
He-W 801.02	RSA 126-A:19; RSA 126-A:20; RSA 161:2,I; RSA 161-B:2; RSA 167:3-c,I & II; RSA 167:4,I; RSA 167:6,IV; RSA 167:7,II-III;RSA 167:78,III & VI; RSA 167:82,VII;42 CFR 435.406; 42 CFR 435.407; 45 CFR 260.30; 45 CFR 206.10(a)(1)(vii),(a)(8) & (b)(5); 45 CFR 233.20(a)(2)-(3)(i),(a)(12); 42 USC 619(2); 42 USC 1320b-7; 42 USC 1382a(a)(2)(g); 42 USC 1382b;42 USC 1396u
He-W 801.03	RSA 161-B:2,II & IV; RSA 161:2,I; RSA 167:3-c,I & & IX; RSA 167:4,I; RSA 167:6,V; RSA 167:7,IV; RSA 167:13; RSA 167:14-14-a; RSA 167:28; 24 CFR 5.100; 45 CFR 206.10(a)(9)(iii)-(iv) & (b)(3); 45 CFR 233.20(a)(2)-(a)(3)& (a)(6)-(a)(11); 45 CFR 261.10; 45 CFR 263.2(b)(2); 42 C.F.R § 435.4; 42 USC 619(2); 42 USC 1437f; Section 404(g) of PRWORA (P.L. 104-193); 42 USC 1382b
He-W 801.04	RSA 161-B:2,XIII; RSA 167:4,I(b); RSA 161:4-a,V & IX; RSA 167:78,VI & X; 24 CFR 5.100; 42 CFR 435.4; 42 USC 608(a)(1); 45 CFR 233.20(a)(2)-(3), (a)(6) & (a)(15)(i); 45 CFR 260.30; 45 CFR 263.2(b)(2); 42 USC 608(a)(1); 42 USC 602;42 USC 1382b; 42 USC 1396a(a)(10)(A)(i)(IX); 42 USC 1396p(d)(2)(A); 42 USC 1396t; 42 USC 9902(2)
He-W 801.05	RSA 151; RSA 161-B:1- B:2,XI & XIII-XIV;RSA 167:3; RSA 167:3-a; RSA 167:3-b; RSA 167:3-c,I; RSA 167:3-i;RSA 161:4-a,IX; RSA 167:6,V & VII; RSA 167:7,I-a(a); RSA 167:8,I; RSA 167:68; RSA 167:78, II,VI, XI, XVI & XVII;8 CFR 1.2; 8 CFR 101.1; 8 CFR 215.1(a), 42 CFR 435.121(e)(4); 42 CFR 435.123;42 CFR 435.124;42 CFR 435.125;42 CFR 435.126; 42 CFR 435.301(a)(1)(ii); 42 CFR 435.602; 42 CFR 435.603(e);42 CFR 435.1009; 45 CFR 206.10(a)(4);45 CFR 233.20(a)(2)-(3); 45 CFR 233.107;42 USC 604(f); 42 USC 608(a)(1); 42 USC 608; 42 USC 1382(e); 42 U.S.C § 1382b; 42 USC 1320b-7; 42 USC 1396a(a)(10); 42 USC 1396a(a)(10)(A)(ii)(XV); 42 USC 1396a(a)(10)(A)(i)(VIII); 42 USC 1396d(a); 42 USC 1396p(d)-(e); 42 USC 1396r(a); 42 USC 1396u(d); 42 USC 1397d(a)(5); 42 USC 1397jj
He-W 801.06	RSA 161-B:2,XIII-XIV; RSA 161:2,I; RSA 167:3; RSA 167:3-c,I-II; RSA 167:4,I(b),III-a & IV; RSA 167:6,V & VI; RSA 167:7,II & III; RSA 167:8,I; RSA 167:26; RSA 167:28; RSA 167:77-e; RSA 170-B:2,XII; 20 CFR 416.1180-.1182; 45 CFR 206.10; 45 CFR 233.20(a)(3) & (a)(12)(i); 45 CFR 234.60(a)(7)(i); 42 USC 1385; 42 USC 1382(e); 42 USC 1382a(a)(2)(G); 42 USC 1382b; 42 USC 1382c(a)(3); 42 USC 1396a; 42 U.S.C. 1396p(d); 42 USC 1396u-1
He-W 801.07	RSA 21:6;RSA 161-B:2,XIV; RSA 167:3; RSA 167:3-c,I; RSA 167:4,I; RSA 167:6,V; RSA 167:7,I-III; RSA 167:14-a; RSA 167:78,XXIII; RSA 170-B:2,XII; 42 CFR 435.403(d); 42 USC 607(e); 45 CFR 206.10(a)(1)(vii)(A); 45 CFR 233.10(b)(2); 45 CFR 233.20(a); 42 USC 409(a)(4); 42 USC 1396a(a)(34);42 USC 1382b; 42 USC 1396p
He-W 801.08	RSA 161-B:1, RSA 161-C:22; RSA 161:2,XVI; RSA 167:3-c,I; RSA 167:7,IV; RSA 167:14-a,V; RSA 167-77-e; RSA 167:78; 45 CFR 303.0 et. Seq; 42 USC 422; 42 USC 404(a)(1); 42 USC 608(a)(2)-(3); 42 USC 1382a(a)(2); 42 USC 1396p(c)-(d); 42 USC 1397
He-W 802.03	RSA 161:4-a, IV; RSA 167:3-c, I; RSA 167:4; RSA 167:8; 42 CFR 435.907
He-W 802.04	RSA 161:4-a; RSA 167:3-c; RSA 167:3-e; RSA 167:3-f; RSA 167:3-g; RSA 167:6, VII; RSA 167:68; 42 CFR 435.117; 42 CFR 435.210; 42 CFR 435.211; 42 CFR 435.217; 42 CFR 435:225; 42 CFR 435.236; 42 CFR 441.101; 42 USC 1396a; 42 USC 1396d
He-W 803.01	42 CFR 435.908(b), 42 CFR 435.923
He-W 803.02	RSA 167:17-b, RSA 641:3
He-W 803.03	RSA 167:17, 42 CFR 435.916(c)
He-W 804.01	RSA 167:6, VII; RSA 167:10
He-W 804.02	42 CFR 435.912; 42 CFR 435.917
He-W 804.03	42 USC 1396r-6; 42 CFR 431.213; 42 CFR 431.214; 42 USC 1396r-6(b)
He-W 804.04	RSA 167:3-c, I; RSA 167:83, II(b); 45 CFR 206.10(a)(4)
He-W 804.05	RSA 167:3-c, I; RSA 167:31; RSA 167: 32; RSA 167:83, II(b); 45 CFR 206.10(a)(4); 42 CFR 431.300-42 CFR 431.307
He-W 806.01	RSA 161:4-a; 42 CFR 435.913
He-W 806.10	RSA 161:4-a; 42 CFR 435.913
He-W 806.19	RSA 161:4-a; 42 CFR 435.913
He-W 806.20	RSA 161:4-a; 42 CFR 435.4
He-W 806.21	RSA 161:4-a; 42 CFR 435.4
He-W 806.23	RSA 161:4-a; 42 CFR 435.4
He-W 806.24	RSA 161:4-a; 42 CFR 435.4
He-W 806.37 (reserved)
He-W 806.41	RSA 161:4-a; 42 CFR 435.116; 42 CFR 435.913
He-W 806.42	RSA 161:4-a; 42 CFR 435.913; 42 USC 306(a)
He-W 806.59	RSA 161:4-a; 42 CFR 435.913
He-W 806.18	42 CFR 435.1009, 42 CFR 435.1010
He-W 806.37	RSA 167:3-c,I; 42 CFR 435.608; 42 CFR 435.914
He-W 806.55	RSA 167:3-b; RSA 167:3-c,I; RSA 167:79,V(b); RSA 167:80;
He-W 806.60	RSA 161:4-a,II; RSA161:4-a,X(g); RSA 167:3-c,I; RSA 167:7,IV; RSA 167:17,III; RSA 167:17-b,I(a); RSA 167:17-b,I(d); 42 CFR 435.601(b)
He-W 806.65	RSA 161:4-a; 42 CFR 435.913
He-W 806.68	RSA 167:4,I(a); 42 CFR 435.914
He-W 806.69	RSA 167:6,VI; 20 CFR 416.905; 20 CFR 416.976; 20 CFR 416.1112(c)(6); 42 CFR 435.914; 42 USC 1382c
He-W 806.73	RSA 161:4-a; 42 CFR 435.913
He-W 806.74	RSA 167:4,I(a); 42 CFR 435.733(c)(4)(ii); 42 CFR 435.832(c)(4)(ii)
He-W 806.75	RSA 161:4-a; 42 CFR 435.913
He-W 806.76	RSA 161:4-a; 42 CFR 435.913
He-W 806.78	RSA 167:4; RSA 167:7, IV; 42 CFR 435.601(b), 42 CFR 435.914
He-W 806.83	RSA 167:83, II(c); 42 CFR 435.913
He-W 806.84	RSA 161:4-a; 42 CFR 435.913
He-W 806.89	RSA 161:4-a,X; RSA 167:3-c,I; 42 CFR 435.4; 42 CFR 435.300; 42 CFR 435.301; 42 CFR 435.330; 42 CFR 435.831; 42 USC 1396a(a)(10); 42 USC 1396d(a)
He-W 806.90	RSA 161:4-a; 42 CFR 435.913; 42 USC 1396a(a)(34)
He-W 806.92	RSA 161:4-a, IX; RSA 167:3-c, I; 42 CFR 435.908
He-W 806.98	RSA 161:4-a; 42 CFR 435.913; 42 USC 1396r-6
He-W 806.100	RSA 161:4-a; 42 CFR 435.913; 42 CFR 435.916
He-W 816.01	RSA 167:3-c, I; 8 USC 1631
He-W 816.02	RSA 167:3-c, I; 8 USC 1641(b); 42 USC 602(a)(1)(B)(ii); 42 CFR 435.406
He-W 816.03	RSA 167:3-c, I; RSA 126-A:4-i; 8 USC 1641(b); 42 USC 1396b(v)(4); 42 USC 602(a)(1)(B)(ii); 42 CFR 435.406
He-W 820.01	RSA 126-A:4-b,(a); RSA 161:4-a, II; RSA 167:3-c, I; RSA 167:4, I(b), III-a, & IV; 42 USC 1396p(c); 42 USC 1382a
He-W 821.01	RSA 126-A:4-b,(a); RSA 167:3-c, I; RSA 167:4, III-a & IV; 42 USC 1396p(c)(2)(D)
He-W 821.02	RSA 126-A:4-b,(a); RSA 167:3-c, I; RSA 167:4, III-a & IV; 42 USC 1396p(f)
He-W 821.03	RSA 126-A:4-b,(a); RSA 126-A:5, VIII; 42 USC 1396p(c)(2)(D)
He-W 824.01	42 CFR 435.1009, 42 CFR 435.1010
He-W 825.01	42 CFR 435.117; 42 CFR 435.910; 42 USC 1320b-7
He-W 828.01	42 CFR 435.4; RSA 167:6,V; RSA 167:3-c,I
He-W 828.02	42 CFR 435.4; RSA 167:6,V; RSA 167:3-c,I
He-W 828.03	42 CFR 435.4; RSA 167:6,V; RSA 167:3-c,I; 42 CFR 431.211; RSA 282-A:36
He-W 830.01	RSA 169-C:3,XIV; RSA 167:6; RSA 167:78; RSA 167:79,II & V(b)
He-W 832.01	42 CFR 435.4; 42 CFR 435.110; 42 CFR 435.310
He-W 837.01	RSA 126-AA; 42 U.S.C. 12101 et seq.; Pub. L. No. 93-112; Pub. L. 111-148; 42 CFR 435.916
He-W 837.02	42 CFR 435.603(a)-(h)
He-W 837.03	RSA 126-AA
He-W 837.04	RSA 126-AA; RSA 167:82,II(g); 42 CFR 435.4; 42 CFR 440.315(f)
He-W 837.05	RSA 126-AA; RSA 167:3-i; RSA 167:6, IV-VI; RSA 167:3-e; RSA 167:3-f; 42 U.S.C.1396a(a)(10)(A)(ii)(XV); 42 CFR 435.4; 42 CFR 435.121; 42 U.S.C. 1396a(e)-(f); 42 U.S.C. 1396n; 42 U.S.C. Chapter 7; 42 U.S.C. 1381 et seq.
He-W 837.06	RSA 126-AA
He-W 837.07	RSA 126-AA; RSA 641:3; RSA 167:82,II(g)
He-W 837.08	RSA 126-AA; 45 CFR 475
He-W 837.09	RSA 126-AA; 45 CFR 400.75
He-W 837.10	RSA 126-AA; 42 U.S.C. 12101 et seq.
He-W 837.11	RSA 126-AA
He-W 837.12	RSA 126-AA; 24 CFR 5.2005; 24 CFR 5.2009
He-W 837.13	RSA 126-AA
He-W 837.14	RSA 126-AA; 24 CFR 5.2005; 24 CFR 5.2009
He-W 837.15	RSA 126-AA
He-W 837.16	RSA 126-AA; 42 CFR 435.916(f)
He-W 837.17	RSA 126-AA
He-W 837.18	RSA 126-AA
He-W 841.03	RSA 167:3-I; RSA 167:3-c, XII; RSA 167:6,IX; 42 USC 1396a(a)(10)(A)(ii)(XV) [Section 1902(a)(10)(A)(ii)(XV) of the Social Security Act]
He-W 842.02	RSA 167:6; 42 CFR 435.4
He-W 842.03	RSA 167:6; RSA 167:6, VI; 20 CFR 416.920; 42 CFR 435.4
He-W 842.04	RSA 167:6; RSA 161:4-a, II; 42 CFR 435.4
He-W 844.01	RSA 161:4-a, IX; RSA 167:3-c, I;
He-W 845.01	42 USC 1396a (l)(1)(2)(A)(i); RSA 167:68; 42 CFR 435.916(f)
He-W 845.02	RSA 167:3-c, I; 42 CFR 435.915; 42 CFR 435.916(f); 42 CFR 435.926; Section 5112 of the CAA, 2023
He-W 845.03	RSA 167:3-c, I; 42 CFR 435.117(b)(1); 42 CFR 435.915; 42 CFR 435.916(a)(1); 42 CFR 435.916(f); 42 CFR 435.926(c); sections 1902(e)(4) and 2112(e) of the Social Security Act
He-W 848.03	RSA 167:3-c, II-b; RSA 167:7, I-a; RSA 167:27-c; 42 USC 1382g
He-W 852.02	RSA 167:3-c, I; RSA 167:4; RSA 167:7; 42 CFR 435.602; 42 CFR 435.603
He-W 852.05	RSA 167:3-c, I; RSA 167:4; RSA 167:7
He-W 852.06	RSA 161:4-a, IX; RSA 167:3-c, I
He-W 852.07 (repeal)
He-W 854.01	RSA 167:3-c,I; RSA 167:4,I(a)
He-W 854.02	RSA 167: 3-c, IX, RSA 167:4, I(a); RSA 167:6, VII; Section 1902(f) of the Social Security Act (SSA) [42 USC 1396a(f)]; 42 CFR 435.401(c)(2); 42 CFR 435.601(b);
He-W 854.03	45 CFR 233.20(a)(3)(ii)(F)
He-W 854.05	42 USC 1396a
He-W 854.06	RSA 167:3-c,I; RSA 167:4,I(a); RSA 167:7,IV; RSA 167:17,III; 42 CFR 435.601(b); 42 USC 1396a
He-W 854.11	RSA 167:3-c,I; RSA 167:4,I(a);
He-W 854.16	RSA 167:4, I(a)
He-W 854.17	RSA 167:27-a,, 42 CFR 435.733, 42 CFR 435.832, 38 USC 5503, Section 1924(d) of the SSA [42 USC 1396r-5(d)]
He-W 854.18	RSA 167:3-c, IX ; RSA 167:4, I(a); Section 1902(a) of the SSA [42 USC 1396a(a)(17)(B),(C)]; 20 CFR 416.1112(c); 42 CFR 435.601(b)
He-W 854.19	RSA 167:3-c,I; RSA 167:4
He-W 854.20	RSA 167:4, I(a)
He-W 856.01	RSA 167:4, IV(d); 42 USC 1396r-5(d), (f), and (g); 42 USC 1396r-5(e)(2)(C)
He-W 856.02	RSA 161:4-a, III; 42 USC 604(h); 45 CFR 263.20-23; 45 CFR 260.31(b)(5)
He-W 856.03	RSA 167:4; RSA 641:3
He-W 856.04	RSA 167:3-c,I; RSA 167:4; RSA 167:17; RSA 167:81; RSA 167:83 II(m) 45 CFR 233.20(a)(3); Section 1612(a)(2)(G) of the Social Security Act (SSA) [42 USC 1382a(a)(2)(G)]; Section 1613 of the SSA [42 USC 1382b] Section 1902(a)(10)(A)(ii)(XIII) of the SSA [42 USC 1396a(a)(10(A)(ii)(XIII)] Section 1917(c)(1)(H)-(I) of the SSA [42 USC 1396p(c)(1)(H)-(I)] Section 1917(d) of the (SSA) [42 USC 1396p(d)]
He-W 856.05	RSA 161:4-a, II; RSA 167:3-c, I; 42 CFR 435.210
He-W 856.06	RSA 167: 4, IV(d); 42 CFR 435.10; 42 CFR 435.210; 42 CFR 435.601; 42 CFR 435.840; 42 CFR 435.843, 42 CFR 435.845
He-W 856.07	RSA 167:4-f
He-W 858.03	RSA 167:7,I & I-a; 42 USC 1382g
He-W 858.04	42 USC 1396b(f)(1)(A)-(C); 42 USC 1396u–1(b); RSA 167:3-c
He-W 858.05	RSA 151-E:3; RSA 167:4, I(a); 20 CFR 416.405; 20 CFR 416.410; 42 CFR 435.211; 42 CFR 435.236; 42 CFR 435.622
He-W 858.06	RSA 151-E:3; RSA 167:4, I(a); 42 CFR 435.217(a); 42 CFR 435.622; 42 CFR 435.831(b)-(c); 42 CFR 435.1005
He-W 864.02	RSA 167:6, VII; RSA 167:79, II; 42 CFR 435.310; 42 CFR 435.603(a)(2) & (j)(6); 42 CFR 435.831
He-W 876.01	RSA 167:3-c, I, RSA 167:6, VII; 42 CFR 435.211; 42 CFR 435.622; 42 CFR 435.831; 42 CFR 435.840
He-W 878.01	RSA 161:4-a,X; RSA 167:3-c,I; 42 CFR 435.4; 42 CFR 435.300; 42 CFR 435.301; 42 CFR 435.330; 42 CFR 435.831; 42 USC 1396a(a)(10); 42 USC 1396d(a)
He-W 880.01	42 CFR 435.911; 42 CFR 435.912; 42 CFR 435.915; RSA 167:3-c
He-W 880.02	42 CFR 435.911; 42 CFR 435.912; 42 CFR 435.915; RSA 167:3-c,I; RSA 167:10
He-W 882.01	42 CFR 435.911; 42 CFR 435.912; 42 CFR 435.915; 42 CFR 435.917; RSA 167:3-c; 42 CFR 435.916(a)(3)(iii)
He-W 882.02 – He-W 882.03	Reserved
He-W 882.04	42 CFR 435.115(f)-(h); 45 CFR 233.20(a)(15); 42 USC 1396u-1(C)(1)
He-W 882.05	RSA 167:82, VI; 42 USC 1396r-6; 42 USC 1396u-1(c)(2)
He-W 884.01	42 CFR 435.916; RSA 126-A:3,VIII as amended by Chapter 224:43, Laws of NH 2011
He-W 884.02	42 CFR 435.916; RSA 126-A:3,VIII as amended by Chapter 224:43, Laws of NH 2011; RSA 167:3-c,VIII; RSA 167:83,II(d)
He-W 890.01	RSA 167:13; RSA 167:14; RSA 167:14-a; RSA 167:16; RSA 167:16-a; RSA 167:28; 42 CFR 433.36; 42 USC 1396p
He-W 895.01-He-W 895.06	RSA 167:13-16; 42 USC 1396p
He-W 895.07	RSA 167:13-16; RSA 554:19; 42 USC 1396p
He-W 895.08	RSA 167:13-16; 42 USC 1396p
He-W 898	RSA 167:3-c, I; 42 CFR 435.135; 42 USC 1395v; 42 USC 1395j
He-W 899 (reserved)

RSA 167:3-c,I; 42 CFR 435.608; 42 CFR 435.914

RSA 161:4-a; 42 CFR 435.913

RSA 167:4,I(a); 42 CFR 435.914

RSA 167:6,VI; 20 CFR 416.905; 20 CFR 416.976; 20 CFR 416.1112(c)(6); 42 CFR 435.914; 42 USC 1382c

RSA 167:83, II(c); 42 CFR 435.913

RSA 161:4-a; 42 CFR 435.913

RSA 161:4-a,X; RSA 167:3-c,I; 42 CFR 435.4; 42 CFR 435.300; 42 CFR 435.301; 42 CFR 435.330; 42 CFR 435.831; 42 USC 1396a(a)(10); 42 USC 1396d(a)

RSA 161:4-a; 42 CFR 435.913; 42 USC 1396r-6

RSA 161:4-a; 42 CFR 435.913; 42 CFR 435.916

RSA 167:3-c, I; 8 USC 1641(b); 42 USC 602(a)(1)(B)(ii); 42 CFR 435.406

RSA 167:3-c, I; RSA 126-A:4-i; 8 USC 1641(b); 42 USC 1396b(v)(4); 42 USC 602(a)(1)(B)(ii); 42 CFR 435.406

RSA 126-A:4-b,(a); RSA 161:4-a, II; RSA 167:3-c, I; RSA 167:4, I(b), III-a, & IV; 42 USC 1396p(c); 42 USC 1382a

RSA 126-A:4-b,(a); RSA 167:3-c, I; RSA 167:4, III-a & IV; 42 USC 1396p(c)(2)(D)

RSA 126-A:4-b,(a); RSA 167:3-c, I; RSA 167:4, III-a & IV; 42 USC 1396p(f)

RSA 126-A:4-b,(a); RSA 126-A:5, VIII; 42 USC 1396p(c)(2)(D)

RSA 167:3-c, II-b; RSA 167:7, I-a; RSA 167:27-c; 42 USC 1382g

RSA 167:3-c,I; RSA 167:4; RSA 167:17; RSA 167:81; RSA 167:83 II(m)

45 CFR 233.20(a)(3); Section 1612(a)(2)(G) of the Social Security Act (SSA)

[42 USC 1382a(a)(2)(G)]; Section 1613 of the SSA [42 USC 1382b]

Section 1902(a)(10)(A)(ii)(XIII) of the SSA [42 USC 1396a(a)(10(A)(ii)(XIII)]

Section 1917(c)(1)(H)-(I) of the SSA [42 USC 1396p(c)(1)(H)-(I)]

Section 1917(d) of the (SSA) [42 USC 1396p(d)]

RSA 161:4-a, II; RSA 167:3-c, I; 42 CFR 435.210

RSA 167: 4, IV(d); 42 CFR 435.10; 42 CFR 435.210; 42 CFR 435.601; 42 CFR 435.840; 42 CFR 435.843, 42 CFR 435.845

RSA 167:6, VII; RSA 167:79, II; 42 CFR 435.310; 42 CFR 435.603(a)(2) & (j)(6); 42 CFR 435.831

RSA 161:4-a,X; RSA 167:3-c,I; 42 CFR 435.4; 42 CFR 435.300; 42 CFR 435.301; 42 CFR 435.330; 42 CFR 435.831; 42 USC 1396a(a)(10); 42 USC 1396d(a)

RSA 167:3-c, I; 42 CFR 435.135; 42 USC 1395v; 42 USC 1395j