Section He-M 520.05 - Financial Eligibility Requirements(a) To be eligible for financial assistance, a recipient shall: (1) Meet the program eligibility requirements in He-M 520.03;(2) Have a documented chronic medical condition; and(3) Meet the financial eligibility requirements in (b) through (h) below.(b) A recipient shall be eligible for financial assistance for health-related services related to the recipient's chronic medical condition if: (1) The recipient resides in a household with a net income less than or equal to 185% of that household's federal poverty guideline amount and with resources of $10,000 or less; or(2) The recipient resides in a household with a net income greater than 185% of that household's federal poverty guideline amount and the household's medical liability is enough to reduce the household's spend down amount by 100% prior to receiving financial assistance.(c) The following shall apply to a household's medical liability and spend down amount: (1) SMS shall determine a household's medical liability each time eligibility for financial assistance is reviewed;(2) A household's medical liability shall be used to reduce the spend down amount;(3) A household's medical liability that is used to reduce the spend down amount in one year shall not be used to reduce the spend down amount in any subsequent year;(4) Medical liability used to reduce the spend down amount shall not be eligible for payment through financial assistance; and(5) SMS shall notify recipients in writing of current spend down amounts.(d) If a household requests payment for services that would otherwise be covered under Medicaid and the household's income would allow it to be eligible for Medicaid, the household shall be encouraged to apply for such Medicaid services within 3 months of requesting financial assistance.(e) Households that do not apply for Medicaid eligibility for the applicant pursuant to (d) above, shall not be eligible for financial assistance under He-M 520.05 and He-M 520.06.(f) For purposes of determining financial eligibility, a recipient who meets any of the following criteria shall be considered to be the only individual in the household: (1) The recipient is an emancipated minor;(2) The recipient is aged 18 to 21;(3) The recipient is a foster child; or(4) The recipient has a court appointed guardian.(g) A recipient's adult siblings who are 18 or older and share the recipient's residence shall be excluded as household members when the siblings: (3) Have their own children.(h) For a child residing with a parent and one or more unrelated adults, the income of the unrelated adult shall be included in the household income if the unrelated adult is a parent of an applicant's sibling.(i) When a household member reports to SMS and supplies supporting documentation of a change in household net income, SMS shall then reassess financial eligibility.N.H. Admin. Code § He-M 520.05
#9748-A, eff 7-1-10; amd by #10138, eff 7-1-12
Amended by Volume XXXVIII Number 28, Filed July 12, 2018, Proposed by #12557, Effective 6/26/2018, Expires 12/24/2018.The amended version of this section by New Hampshire Register Volume 39, Number 02, eff.12/28/2018 is not yet available.