New Hampshire Medicaid is a federal and state funded insurance program that serves individuals and families who meet financial and other eligibility requirements. Medicaid for children, ages 0-19 provides a full range of health and dental services to eligible children at no cost to the family. A child will receive care from doctors, dentists and health care providers who are contracted as Medicaid Providers.
The Division of Family Assistance (DFA) determines Medicaid financial eligibility and all non-financial eligibility, with the exception of medical necessity determinations, for the following groups: children under the age of 19, pregnant women, low-income families with children, blind individuals, refugees, non-citizens, seniors, and disabled adults.
In order to be eligible a family must meet income and resource limits (see Income Guidelines on sidebar).
Children’s Medicaid (CM): provides free health and dental coverage for children up to age 19 with family income no higher than 300% of the federal poverty income limits (i.e. family of four with a gross monthly income of $5,888.)
Home Care for Children with Severe Disabilities (HCCSD): (Often called “Katie Beckett”) is for children with severe disabilities up to age 19 whose medical/behavioral disability is so severe that they qualify under a medical determination for Social Security Supplemental Income eligibility and for institutional care, but who are being cared for at home. Only the income and resources of the child are counted towards eligibility for this program.
Medicaid for Adults ages 19-21 yrs.: Children with special challenges may be eligible to continue coverage through the Aid to the Permanently and Totally Disabled (APTD) or Aid to the Needy Blind (ANB) eligibilities with the same benefits until the age of 21. After turning 21 yrs, benefits change.
Aid to the Needy Blind (ANB): a category of eligibility that requires an individual (child or adult) to be diagnosed as legally blind. The visual acuity in the better eye can be no greater than 20/200.
Aid To The Permanently Disabled (APTD): When a person turns 18 years old, Medicaid considers them an adult. Eligibility for Medicaid is based on income and assets as well as medical condition. An adult applying for Medicaid must have a severe, impairing health condition that has lasted and is expected to last for a minimum of 48 months (4 years) and have income levels at or below poverty level with assets (savings account, trust, etc) below $1,500. This Medicaid eligibility is called Aid to the Totally and Permanently Disabled (APTD). If a person is working and their income is too high for this program, but they still qualify medically, they may qualify for Medicaid for Employed Adults with Disabilities or MEAD.
Medicaid for Employed Adults with Disabilities (MEAD): provides Medicaid coverage to adults with disabilities who are working and who would not otherwise be financially eligible for Medicaid. MEAD was designed to allow individuals with disabilities to increase their working income and have higher resource limits.
The Division of Family Assistance now offers NH EASY, New Hampshire’s Electronic Application System. You can apply or reapply for assistance, check eligibility, report changes, track your application status and more by visiting the NH EASY web page. Applications can also be done at field offices called DHHS – District Offices (DO’S).
When You Receive NH Medicaid
The Medicaid Care Management (MCM) program uses two Health Plans. Each Health Plan has its own network of doctors, nurses and other providers. These health plans cover the same services that NH Medicaid does and they also offer optional services, programs, and other extras including wellness and prevention programs.
You will be asked to pick from these three Health Plans:
New Hampshire Healthy Families – Member Services: 1-866-769-3085
Well Sense Health Plan – Member Services: 1-877-957-1300
For more information about NH’s Medicaid Care Management click on MCM logo at right.
A suggested process for making an informed decision
Picking a Medicaid Care Management Health Plan can be a bit overwhelming when your child has special needs. NH Family Voices and Special Medical Services collaborated on this tool in hopes it will help families look at the providers they are currently using and how they would fit into one of MCO networks.
In 2011 the NH legislature signed into law (SB147), a requirement for the NH Department of Health and Human Services (DHHS) to transition all of NH Medicaid to a managed care type of service. That legislation has led to many changes for families who use NH Medicaid as a way to pay for health care for themselves and their children. This document was developed to educate families about managed care in the Medicaid world. It helps you to understand how managed care works, what may be asked of you and what you can ask of others.
You can develop partnerships with your child’s doctors and other providers. These partnerships will help your child receive the best healthcare. Start with clear communication between you and providers. Be sure to share your cultural differences so that they do not become barriers to access and service. The following tips will help you prepare for an office visit, talk with your child’s provider, and learn more after the visit.
Health plans can benefit from learning more about CYSHCN from families who have been there, done that. Look for opportunities to share your experiences with your health plan through Family Advisory Councils or other committees. Join with other families to share information. Help others learn about cultural differences so that they do not become barriers to good care. Use this tip sheet to begin a dialogue with your child’s health care plan. Help them examine and improve their programs, policies and resources for CYSHCN.
Resources on Medicaid
In July 2014 the Centers for Medicare and Medicaid Services issued a Clarification of Medicaid Coverage of Services to Children with Autism (ASD CMS Guidance), which made clear that states must provide evidence-based treatments for children with ASD in Medicaid.
Health Advocate: EPSDT Coverage for Children with Autism – 2015
Health Advocate reviews the advocacy history that led up to guidance from the Centers for Medicare & Medicaid Services (CMS) to ensure that state EPSDT programs keep up with the evolving standard of care for children. In July 2014, CMS issued a Clarification of Medicaid Coverage of Services to Children with Autism, which made clear that states must provide evidence-based treatments for children with ASD in Medicaid.
A Guide to the Medicaid Appeals Process by Kaiser
This background brief provides a comprehensive look at the appeals process for the Medicaid program, which differs significantly from those available through the Medicare program and private health insurance. The Medicaid appeals process provides redress for individual applicants and beneficiaries the process is multi-layered and can be complex to navigate. The guide describes Medicaid’s appeals system, including the fair hearing process and coverage expands under health reform and efforts proceed to integrate services for dual eligible, who are enrolled in both Medicare and Medicaid, protections through the appeals process will be increasingly important.
Medicaid Tutorial by the Catalyst Center
The Catalyst Center has a new tutorial about Medicaid and the Children’s Health Insurance Program (CHIP). Learn about public health programs, why they are important for children and youth with special health care needs, eligibility changes under health reform, and partnerships to improve services in this new tutorial on Medicaid/CHIP