Current through Register No. 40, October 3, 2024
(a) In
accordance with RSA
167:3-i,
RSA
167:3-c, XII,
RSA
167:6, IX, and
42 USC
1396 a(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 APTD or ANB as specified in
He-W 600;
(2) Is age 18 through 64,
inclusive;
(3) Meets the medical
criteria for MEAD pursuant to
He-W
504.02;
(4) Is employed for pay pursuant to
He-W
641.03(b) , or self-employed for pay
pursuant to He-W 641.03(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 his or her gross income, and if
applicable, to the spouse's gross income pursuant to He-W 654, 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;
(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; and
(7) Pays
the monthly premium, established pursuant to He-C 5003.
(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.
(c) To be
considered self-employed for pay, an individual shall:
(1) Meet the requirements of (b) (2) above;
and
(2) Provide documentation that
he or she makes regular payments based on earnings as required pursuant to
FICA.
(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
656; or
4. Already allowed as a
deduction pursuant to He-W 654.
(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
641.03(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
641.03(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 recipi ent who has completed the
6-month extension may obtain one additional 6-month extension if the recipient
provides either:
(1) A doctor's written
statement 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, and/or
employment agencies such as One-Stops, Vocational Rehabilitation, or Employment
Networks.
(i) The
division of family assistance shall determine that 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.
(See Revision Note at Chapter Heading He-W 600) #5171,
eff 6-26-91; ss by #5895, eff 9-15-94; rpld by #6446, eff 2-1-97
New. #7644, eff 2-8-02; ss by
#8292, eff 2-24-05; ss by #9402, eff
3-5-09
