Current through Register Vol. 51, No. 19, September 20, 2024
A.
A recipient whose family income exceeds 175 percent of the poverty income
guidelines or whose family liquid assets exceed 200 percent of the poverty
income guidelines, or both, at the time of initial application or reapplication
is required to pay an annual Program participation fee.
B. Family income for purposes of this
regulation includes the adjusted gross income, as defined in the Internal
Revenue Code for federal income tax purposes, plus Social Security benefits,
all pension or retirement benefits, or both, and all interest income not
otherwise included in the adjusted gross income for federal income tax
purposes, of the recipient and each person in the recipient's family.
C. The Program shall establish a recipient's
annual Program payment fee equal to the sum of:
(1) 5 percent of the amount by which the
family income exceeds 175 percent of the poverty income guidelines adjusted for
family size; plus
(2) 5 percent of
the family's liquid assets above 200 percent of the poverty income guidelines
adjusted for family size.
D. For purposes of §C(2) of this
regulation, the Program shall:
(1) Include
assets which are available as of the date of application for initial enrollment
or certification of continuing enrollment, as applicable, in the family's
liquid assets;
(2) Include the
following in the family's liquid assets:
(a)
Cash,
(b) Savings and checking
accounts,
(c) Certificates of
deposit,
(d) Stocks,
(e) Bonds,
(f) Life insurance cash value exceeding
$1,500,
(g) Mutual funds,
(h) Money market certificates, and
(i) Other financial instruments or
investments that can readily be converted to cash; and
(3) Exclude the following from the family's
liquid assets:
(a) Items of real property,
and
(b) Items of personal
property.
E.
Collection of Fees.
(1) The Department shall
collect the annual Program participation fee in quarterly
installments.
(2) The Program shall
notify the recipient of the amount of the annual Program participation fee, the
quarterly amount to be paid, the payment due date, and payment
procedures.
(3) The Program may
revise the amount of the Program participation fee during a certification
period if the Program determines that a revision should be made because of a
change in:
(a) Family income;
(b) Family liquid assets; or
(c) Composition of the family unit.
(4) The recipient shall have a
grace period lasting from the first day of the quarter until 30 days before the
end of the quarter in which to pay the quarterly amount.
(5) The recipient's enrollment in the Program
shall be terminated on the last day of the quarter if a fee amount is not paid
by the end of the grace period.
(6)
The recipient is responsible for the assessed quarterly amount if the Program
receives claims and makes payment for services provided for the recipient
within the quarterly billing period.
(7) The Program shall extend the grace period
for up to 6 months when the Program determines that, due to extraordinary
medical expenses paid by the recipient, a change in family income, or frequent
or extended hospitalizations, payment within the grace period will cause
substantial hardship to the recipient.
(9) Before the Program will recertify an
applicant whose prior Program enrollment was terminated for failure to pay the
Program participation fee in accordance with this regulation, the applicant
shall:
(a) Pay any unpaid fees owing for all
prior enrollment periods during which the applicant was enrolled in the
Program; and
(b) Make advance
payment of the first quarterly installment of the Program participation fee
established for the subsequent enrollment period.
