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Title 8: Medicaid Page 37 Iowa Department of Health and Human Services Employees’ Manual Chapter G: Case Maintenance Additional Non-MAGI-Related Case Maintenance Revised November 4, 2022 MEPD Case Maintenance Procedure: When a premium is not received by the due date, a batch will run to discontinue the MEPD case for failure to pay the premium. Standard procedures are as follows: ▪ When payments are recorded after the due date, an alert is issued to notify the worker to: • Reinstate the MEPD case when a payment is received before the effective date of cancellation. • Reopen the MEPD case when a payment is received in the month following the month it was due. • Leave the MEPD case closed when a payment is received after the month following the month when it was due. The member must file a new application to determine eligibility for MEPD.

1. Mr. B applies for MEPD on January 30. Approval entries are made on March 10 (before system cutoff). Mr. B receives an MEPD Billing Statement showing that:: ▪ The premium for January is due by June 14. ▪ The premium for February is due by June 14. ▪ The premium for March is due by April 14.

Mr. B does not pay the March premium by April 14. The system cancels the case with timely notice.

Mr. B pays all three premiums on June 10. After the payments are posted in June, the worker receives an alert saying that the payments were received. Medicaid eligibility is granted for January, February, and March because: ▪ March premium was paid within three months of the billing month, and ▪ January and February premiums were paid before the due date of June 14.

It is too late to reopen the case for ongoing benefits because the March payment was received later than the month following the month it was due. Mr. B must reapply if he wants to get MEPD again. 2. Mr. Z applies for MEPD on January 5 and is approved on January 28 (after system cutoff). His first MEPD Billing Statement shows: ▪ The premium for January is due by February 14. ▪ The premium for February is due by February 14.

Mr. Z doesn’t pay the premiums by February 14. The system cancels the case with timely notice. Due to the MEPD reopening policy, the worker waits to complete the automatic redetermination to Medically Needy until the end of the month following the month the payment was to cover.

Mr. Z pays both premiums on March 27. An alert is issued to the worker stating that the premiums have been paid. Mr. Z is eligible for Medicaid in January and February because the premium payments were received during the three-month period to accept payments. The MEPD case is reopened because the premium payments were applied before the last day of the month following the month they were due.