Idaho Administrative Code
Title IDAPA 16 - Health and Welfare, Department of
Rule 16.03.18 - MEDICAID COST-SHARING
Section 16.03.18.205 - PREMIUMS FOR PARTICIPATION UNDER HOME CARE FOR CERTAIN DISABLED CHILDREN (HCCDC)
Current through August 31, 2023
01. Family Income Above 150% and Equal to or Less Than 185% of FPG. Each HCCDC participant with a family income above one hundred fifty percent (150%) and equal to or less than one hundred eighty-five percent (185%) of the current FPG must pay a monthly premium of fifteen dollars ($15) to the Department. The maximum monthly premium a family must pay is limited to thirty dollars ($30). (3-15-22)
02. Family Income Above 185% of FPG. Each HCCDC family with income above one hundred eighty-five percent (185%) of the current FPG must pay a monthly premium to the Department. The monthly premium is a fixed percent of the family's income as provided in the table below. (3-15-22)
|
TABLE 205.02 SLIDING FEE SCHEDULE FOR MONTHLY PREMIUMS FOR HCCDC PARTICIPATION |
||
|
Family Income Above 185% of Current FPG |
Premium Based on % of Family Income |
|
|
ABOVE |
LESS THAN OR EQUAL TO |
|
|
185% |
250% |
1.0% |
|
250% |
300% |
1.5% |
|
300% |
400% |
2.0% |
|
400% |
500% |
2.5% |
|
500% |
600% |
3.0% |
|
600% |
700% |
3.5% |
|
700% |
800% |
4.0% |
|
800% |
900% |
4.5% |
|
900% |
No Upper Limit |
5.0% |
(3-15-22)
03. Reduction of Premium for Creditable Health Insurance. A family who purchases creditable health insurance for the participant may receive a twenty-five percent (25%) reduction of the required monthly premium. (3-15-22)
04. Failure to Provide Information. Failure to provide the Department with information needed to determine family income and household size may subject the participant to a monthly premium equal to the average monthly cost of coverage for participants receiving Medicaid Enhanced Plan Benefits through HCCDC. (3-15-22)
05. Failure to Pay Premium. Failure to pay the premium for an HCCDC participant will not cause the participant to lose coverage or eligibility for services. A participant eligible through HCCDC is exempt from the provisions of Section 250 of these rules. (3-15-22)
06. Waiver of Premium. The premium may be waived if the Department determines that payment of the premium would cause undue hardship on the family. Undue hardship exists when an unexpected expense would cause the family to forgo basic food or shelter in order to make a premium payment. Detailed documentation of the family's living and insurance expenses demonstrating such hardship must be provided to the Department. (3-15-22)
07. Premium Recalculation. The premium amount is recalculated at each annual eligibility renewal. If a financially responsible adult reports a reduction in family income prior to renewal, the premium will be reduced to the appropriate level upon verification of the reduction to the family's income. When the family income is at a level that does not require premium payments, the premium will no longer be assessed. (3-15-22)
