Indiana Administrative Code › Title 405 - OFFICE OF THE SECRETARY OF FAMILY AND SOCIAL SERVICES › Article 2 - MEDICAID MEMBERS; ELIGIBILITY › Rule 9 - Medicaid for Employees with Disabilities › Section 9-8 - Premiums

Current through July 10, 2024
Authority: IC 12-15-1-10; IC 12-15-21-2; IC
				  12-15-41-15
Affected: IC 12-14-15-1; IC 12-15-2-6.5; IC 12-15-41
Sec. 8.
(a) To be
				eligible for Medicaid for employees with disabilities, an individual must pay
				monthly premiums in accordance with the requirements specified in this section,
				unless the gross income of the individual and the individual's spouse is less
				than one hundred fifty percent (150%) of the federal poverty level. The amount
				of the premium is based on the gross income of the member and the member's
				spouse as a percentage of the federal poverty level for the applicable family
				size as determined in subsection (b) or (c). The amount of the premium will be
				adjusted by the premium amount of other creditable private health insurance as
				defined in 42 U.S.C. § 300gg-91 that covers the applicant or member and is
				paid by the applicant or member or his or her spouse or parent. The amount of
				the premium is calculated as described in the following Table:
Income as a Percent of the Federal
							 Poverty Level
Amount of Premium
Individual
Married Couple
Less than 150%
No premium required
No premium required
150% to 175%
$48
$65
More than 175% to 200%
$69
$93
More than 200% to 250%
$107
$145
More than 250% to 300%
$134
$182
More than 300% to 350%
$161
$218
More than 350%
$187
$254
(b)
				The individual premium amount is used when the individual, regardless of age,
				is not married or not living with his or her spouse. When the individual
				premium amount is used, only the individual's income is considered in
				calculating the premium, and the income is compared to the federal poverty
				level for a family size of one (1).
(c) The married couple premium amount is used
				when the individual is legally married and living with his or her spouse. When
				the couple premium amount is used, the income of both spouses is considered in
				calculating the premium, and the income is compared to the federal poverty
				level for a family size of two (2).
(d) When an applicant is determined eligible,
				the applicant will be conditionally approved pending payment of the premium.
				The first month for which a premium is required is the month following the
				month in which an applicant is approved as conditional. After the premium is
				received, coverage will be retroactive to the first day of the third month
				prior to the month of application if all eligibility requirements were met in
				the prior months.
(e) The
				individual must pay the first premium in order to receive coverage. If payment
				is not received by the due date specified in the second premium notice, the
				Medicaid application will be denied. A payment of less than the full amount due
				will be considered nonpayment.
(f)
				If any premium after the first premium is not paid by the due date, coverage
				will continue for a maximum of sixty (60) days before being discontinued. When
				an individual or couple have been discontinued from the program due to
				nonpayment of premiums, an application must be filed in order to be considered
				for eligibility. To be reenrolled based on an application filed after such a
				discontinuance, the individual must pay all past due premiums in addition to
				premiums owed for the current application. Past due premiums remain the
				obligation of the individual as a condition of eligibility for two (2) years
				after the date of discontinuance.
(g) When both spouses are members of Medicaid
				for employees with disabilities, the enrollment and continued eligibility of
				the couple is based on the payment of the married couple premium amount.
				Failure to pay the required premium amount in accordance with this section will
				result in the discontinuance of Medicaid coverage for both spouses.
(h) When a member reports a change in income
				or marital status as required by section 1(d) of this rule, and the change
				results in a lower premium, the new premium amount will be effective the first
				month following the date in which verification of the change is
				received.
(i) When a member who is
				eligible for Medicaid in the blind or disabled categories obtains employment,
				the change must be reported within ten (10) days as required by
				470
				IAC 2.1-1-2. An additional ten (10) days is allowed to
				provide verification of the employment. If the member is eligible for Medicaid
				for employees with disabilities, eligibility begins the first month following
				the date on which verification is received, subject to the timely notice
				requirements in
				42 CFR 431.211.