N.H. Admin. Code § He-W 606.75

Current through Register No. 50, December 12, 2024

Section He-W 606.75 - Allocated Income

(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 He-W 601.05, 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.

(c) Acceptable verification of (b)(1) through (7) above, shall include the documentation listed below:

(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 606.59;

(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 which indicate the amount and frequency of payment;

b. A bill or receipt for the mortgage payment;

c. Property taxes;

d. Homeowner 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.

N.H. Admin. Code § He-W 606.75

(See Revision Note at Chapter Heading He-W 600) #5171, eff 6-26-91; ss by #6531, INTERIM, eff 6-27-97, EXPIRED: 10-25-97; ss by #6614, eff 10-24-97; ss by #8452, eff 10-22-05

Ss by #10471, eff 11/26/2013.

Amended by Number 10, Filed March 7, 2024, Proposed by #13875, Effective 2/21/2024, Expires 2/21/2034.