Idaho Administrative Code
Title IDAPA 16 - Health and Welfare, Department of
Rule 16.03.18 - MEDICAID COST-SHARING
Section 16.03.18.250 - DELINQUENT PREMIUM PAYMENTS

Universal Citation: ID Admin Code 16.03.18.250

Current through September 2, 2024

If the participant is sixty (60) days or more past due on premium payments, the participant is contacted to determine the reason for the delinquency. If the participant's income is less than the amount used for the most recent eligibility determination, the participant is offered a new eligibility determination. The change is effective the month after the participant becomes eligible for such benefits.

01. Delinquent Payments. A participant is not approved for or renewed for coverage that requires premium payments, if their premium payments are sixty (60) days or more delinquent.

02. Reestablishing Eligibility. A participant can reestablish eligibility by paying the premium debt in full, unless forgiven in this rule.

03. Premium Debt. Any premium debt assessed, but not paid, will be forgiven if one (1) of the following applies:

a. The participant reports and the Department determines that the participant's household income is below one hundred and thirty-three percent (133%) FPG. This may occur at any time during the eligibility period; or

b. A participant in the Medicaid Basic Plan has a medical condition that requires the participant to receive the benefits provided in IDAPA 16.03.10, "Medicaid Enhanced Plan Benefits."

Effective July 1, 2024

Disclaimer: These regulations may not be the most recent version. Idaho may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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