Section He-C 5003.01 - Premium Schedule for Medicaid for Employed Adults with Disabilities (MEAD)(a) Monthly premium calculation shall be determined by combining monthly net income for initial eligibility, based on current treatment, disregards and exclusions from income for aid to the permanently and totally disabled (APTD) and aid to the needy blind (ANB) recipients pursuant to He-W 654, with monthly Supplemental Security Income (SSI) and shall include deduction of private health insurance premiums pursuant to He-C 5003.02(b) . (b) As a condition of eligibility for MEAD, recipients shall pay a monthly premium. (c) The amount of a premium charged to a recipient shall not exceed 7.5 % of the recipient's net income, and spouse's net income if residing together, with combined net income of less than or equal to 450% of the federal poverty level (FPL) . (d) Premium payment shall be based on the recipient's net income, and spouse's net income if residing together, relative to the percent of FPL, rounded up to the next dollar amount, as follows: (1) Recipients with net income of less than 150% FPL shall not pay a premium; (2) Recipients with net income of 150% up to and including 200% FPL shall pay not more than 7.5% of 150% FPL; (3) Recipients with net income of more than 200% up to and including 250% FPL shall pay not more than 7.5% of 200% FPL; (4) Recipients with net income of more than 250% up to and including 300% FPL shall pay not more than 7.5% of 250% FPL;(5) Recipients with net income of more than 300% up to and including 350% FPL shall pay not more than 7.5% of 300% FPL;(6) Recipients with net income of more than 350% up to and including 400% FPL shall pay not more than 7.5% of 350% FPL; and(7) Recipients with net income of more than 400% up to and including 450% FPL shall pay not more than 7.5% of 400% FPL.(e) Notwithstanding (c) and (d) above, when a recipient's annual adjusted gross income as defined by the IRS exceeds $75,000, that recipient shall pay the full premium identified in (f) below. (f) The full premium shall be calculated annually as 7.5% of the recipient's adjusted gross income. (g) A choice to accept retroactive medicaid coverage for the month(s) prior to the date of application shall result in a premium payment due for all retroactive months covered. (h) The retroactive premium payment shall be included in the first premium payment as specified in (i) below. (i) The first premium payment shall be billed on the first day of the month following the month eligibility was determined and applied to the month(s) following the month non-retroactive eligibility was determined effective. (j) Subsequent payments for all months, which shall follow retroactive and first premium payment month(s), shall be due on the first day of the month and applied to the current month. (k) Premium payments are due by the recipient for every month except for the first month of non-retroactive coverage. (l) A recipient shall be terminated from MEAD for non-payment of premiums for 2 consecutive months without good cause.(m) A recipient who has been terminated from MEAD for non-payment of premium in accordance with (l) above shall be reinstated if the recipient meets all other MEAD eligibility criteria in accordance with He-W 641.03 and: (1) The recipient has paid the past due premiums in full; or(2) It has been determined by the premium collection agency that the recipient has exhausted all available liquid resources and income with which to pay past due premiums, in accordance with (n) (3) below. (n) Non-payment of premiums for good cause shall: (2) Be available once every 2 years from the date the last month's premium was paid; and (3) Exist only after the recipient has exhausted all available resources and income with which to pay his or her premium, due to one of the following: a. A temporary or unexpected loss of income lasting for a minimum of 3 months; b. An uncovered medical expense that prevents payment of the premium; or c. A hardship due to: 1.Loss of home;
2.Costs associated with fire/flood;
3.Unexpected high heating bills resulting in a 25% increase over annual cost;
4.Significant car repairs totaling 25% of current gross monthly income; or
5.Replacement of a refrigerator or stove.
(o) A good cause determination for non-payment of premium shall be verified and made by the premium collection agency. (p) A 3-month payment plan option shall be available once every 2 years, from the date of the last month a premium was paid, to ease a financial burden due to good cause.(q) Termination from MEAD shall result from failure to pay in full the balance owed at the end of the 3-month plan in accordance with (p) above.N.H. Admin. Code § He-C 5003.01
#7637, eff 2-1-02; ss by #8237, eff 12-31-04; ss by #10261, eff 1-25-13