N.H. Admin. Code § He-W 511.09

Current through Register No. 36, September 5, 2024
Section He-W 511.09 - Loss of Eligibility and Discontinuation of Premium Payments
(a) Except as provided in (b) below, when the newly eligible adult loses medicaid eligibility, premium payments shall be discontinued as of the month of medicaid ineligibility.
(b) Premium payments shall continue for 6 months from the date the department determines that the group health plan is cost effective, even if the newly eligible adult loses medicaid eligibility within that 6-month period.
(c) Coverage of any medicaid benefits provided outside the group health plan, including any wrap around services, shall end on the date the newly eligible adult loses medicaid eligibility.
(d) If the department determines that the health plan is no longer cost effective, HIPP premium payment shall be discontinued pending timely and adequate notice, made in accordance with 42 CFR 431.211.
(e) If the newly eligible adult fails to provide the information necessary to determine the availability and cost effectiveness of group health insurance in accordance with the timeframes set forth in He-W 511.04(e) or (f) above, he or she shall be terminated from the medicaid program within 15 days following the failure to comply.
(f) If the newly eligible adult fails to provide the information necessary to establish ongoing eligibility in accordance with the timeframes set forth in He-W 11.06(b), he or she shall be terminated from the medicaid program within 15 days for failure to comply.
(g) If the newly eligible adult provides the necessary documentation within the 15 day advance notice period stipulated in (e) or (f) above, his or her termination from the medicaid program shall be voided and a HIPP cost effective calculation shall be performed.
(h) If the newly eligible adult disenrolls from their cost effective group health plan, the newly eligible adult shall lose eligibility for medicaid until such time as the newly eligible adult recipient re-enrolls in the cost effective group health plan and reapplies for medicaid.
(i) If the health plan is no longer available or the policy has lapsed, premium payments shall be discontinued as of the effective date of the termination of the coverage.

N.H. Admin. Code § He-W 511.09

#10632, eff 7-1-14