Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 5 - Program Integrity, Division of › Section 907 KAR 5:005 - Health Insurance Premium Payment (HIPP) Program

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				42 C.F.R.
				400.203,
				430.10,
				26
				U.S.C. 4980B,
				5000(b)(1),
				29
				U.S.C. 1161-1169,
				42 U.S.C.
				1396e(a)-(e)
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and
				Family Services, Department for Medicaid Services has responsibility to
				administer the Medicaid Program.
				KRS
				205.520(3) authorizes the
				cabinet, by administrative regulation, to comply with a requirement that may be
				imposed or opportunity presented by federal law for the provision of medical
				assistance to Kentucky's indigent citizenry.
				42 U.S.C.
				1396e(a) through (e)
				authorizes states to establish a health insurance premium payment, or HIPP,
				program to provide health insurance coverage outside of Medicaid to Medicaid
				enrollees, and any family member of Med-icaid enrollees, if the department
				determines that HIPP program participation would be cost effective for the
				department. This administrative regulation establishes the Kentucky integrated
				health insurance premium payment program requirements as authorized by
				42 U.S.C.
				1396e(a) through (e).
Section 1. Definitions.
(1) "Buying in" means purchasing benefits
			 from Medicare on behalf of an individual.
(2) "Department" means the Department for
			 Medicaid Services or its designee.
(3) "Federal financial participation" is
			 defined in
			 42 C.F.R.
			 400.203.
(4) "Group health insurance plan" means any
			 plan, including a self-insured plan, of, or contributed to by, an employer to
			 provide health care directly or otherwise to the employer's employees, former
			 employees, or the families of the employees or former employees, if the plan:
(a) Meets the criteria established in
			 26 U.S.C.
			 5000(b)(1); and
(b) Includes continuation coverage pursuant
			 to
			 26
			 U.S.C. 4980B or
			 29
			 U.S.C. 1161 to
			 1169.
(5) "Income" means:
(a) Wages, salary, or compensation for labor
			 or services;
(b) Money received
			 from a statutory benefit including Social Security, Veteran's Administration
			 pension, black lung benefit, or railroad retirement benefit; or
(c) Money received from any pension plan,
			 rental property, or an investment including interest or dividends.
(6) "Income deduction" means a
			 deduction from an individual's income for the purpose of obtaining or trying to
			 obtain Medicaid eligibility.
(7)
			 "Kentucky integrated health insurance premium payment program participant" or
			 "KI-HIPP program participant" means an individual receiving health insurance
			 benefits in accordance with this administrative regulation.
(8) "Medicaid" means the Kentucky Medicaid
			 program.
(9) "Medicaid enrollee"
			 means an individual eligible for and participating in Medicaid pursuant to
			 907 KAR
			 1:005,
			 907
			 KAR 20:010,
			 907
			 KAR 20:020, and
			 907
			 KAR 20:025.
(10) "Spend-down program" means a program by
			 which an individual becomes eligible for Medicaid benefits:
(a) By spending down income in excess of the
			 Medicaid income threshold; and
(b)
			 In accordance with
			 907
			 KAR 20:020.
(11) "State plan" is defined in
			 42 C.F.R.
			 430.10.
(12) "Wrap-around coverage" means coverage of
			 a benefit not covered by an individual's group health insurance plan.