SUBJECT:
CHANGES TO MC+ CHILDREN'S HEALTH INSURANCE PROGRAM (CHIP) - LEVEL OF CARE 2, REDUCED PREMIUM GROUP
FAMILY HEALTHCARE MANUAL REVISION #35: SECTIONS 0920.020.00, 0920.020.05.20, 0920.020.15, 0920.020.15.05, 0920.030.05 and 0920.030.10
DISCUSSION:
The Division of Medical Services (DMS) has determined that the state statute, as written, does not require the thirty-day waiting period or the six-month penalty period for non-payment of a premium for CHIP children in families whose income does not exceed 225% of the Federal Poverty Level (FPL). Effective immediately, CHIP LOC 2 (Reduced Premium Group whose gross income is above 150% and at or below 225% of the FPL) children are no longer subject to a 30-day waiting period or a penalty period for non-payment of premium.
TXIX start dates for the No-Cost and Premium groups are as follows:
- LOC 1 - Start date in IMU5 for eligibility is the date of application or the date first eligible, whichever is later. Coverage begins this date.
- LOC 2 (Reduced Premium Group) - Start date in IMU5 for eligibility is the date of application or the date first eligible, whichever is later. Coverage begins the date the premium payment is received or eligibility begins, whichever is later.
- LOC 3 (Full Premium Group) - Start date in IMU5 for eligibility is 30 days from the date of application or the date first eligible, whichever is later. Coverage begins the date the premium payment is received or eligibility begins, whichever is later.
PENALTY PERIOD FOR NON-PAYMENT OF PREMIUM
Families who fail to pay a premium any time after coverage begins will lose coverage for children active in a Premium Group LOC (2 or 3). If the assistance group contains only children active in the Premium Group (LOC 2 or 3) the whole case will be closed by the system. If the assistance group includes a child(ren) active as LOC Q, only the Premium Group child(ren) will close. Workers will receive notification when a case or a child(ren) is closed for non-payment of a premium. DO NOT send an IM-80 or other closing notice, as DMS sends the appropriate notices for closure.
NOTE: Children with “G” LOC (newborns) are not to be on MC+ cases with Premium Group children. Active “G” babies on cases with children going from non-premium to premium levels of care need to be transferred to their own newborn case. They may remain on a premium case as a “Z” LOC (included) if it helps reduce the premium payment.
Cases or children closed due to non-payment of premium are subject to penalty rules dependent on the LOC of the child(ren) on the date of closure.
- Child(ren) active LOC 2 closed for non-payment of premium are not subject to a six-month penalty period. The family may re-apply and be approved at any level of care after the case or child is closed.
- Child(ren) active LOC 3 closed for non-payment of premium continue to be subject to a six-month penalty period. The enrollment stop date on the child(ren)'s MCII screen may be viewed to determine the last date of coverage. The family may re-apply for coverage, but any child(ren) eligible at LOC 3 will not be eligible for benefits until the penalty period has expired. Re-applicants with children eligible for benefits in a non-CHIP group, No-Cost (LOC1) group, Reduced Premium (LOC 2) group, or for another program will not have the penalty period applied.
Families must re-apply for a child(ren) who is removed from an active case with an active child(ren) LOC Q. An IM-1UA must be filled out and signed for a family wishing to establish eligibility for a child(ren) closed for non-payment of premium.
LOC 2 CASES WITH APPLICATION DATES FROM SEPTEMBER 1, 2005 THROUGH NOVEMBER 4th, 2005
LOC 2 children who were approved with application dates from September 1, 2005 through November 4th, 2005 will be reviewed by DMS and FSD to determine if the initial coverage dates need to be adjusted. Families with adjusted dates of coverage for their children will be notified.
INVOICE CHANGES
DMS is changing their invoice notices to reflect the difference in premium payment penalties for LOC 2 and LOC 3 recipients. Caseworkers are to continue making budget adjustments and Premium Group changes from LOC 2 to LOC 3, or vice versa, effective on the date of action. Adverse Action Notices are not sent by the caseworker when going from a lower premium amount to a higher one, or going from LOC 2 to LOC 3.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
LH