Changes in the Copayment Assessment

The copayment shall be calculated at the time of application and when a redetermination is conducted at the end of an eligibility period.

If you receive new earned income information due to a change in a family income prior to redetermination: recalculate the income to ensure the case remains eligible by being below 85% SMI. Case note the date that you received the new information along with the new total monthly income amount. If the copayment has decreased due to a loss of income or increase in family size, the lower copayment goes into effect the month following the reassessment. Do not increase the copayment amount in the CCMS Families continue to be subject to the Combined Gross Monthly Base Income limit of 85% of SMI and shall report all increases in income within 10 calendar days even if the change does not immediately affect the copayment. If the family is determined to have income over 85% of SMI , cancel the case giving 10 calendar days' notice in accordance with Policy 02.07.01.

A decrease in the monthly copayment shall be implemented on the first of the month following the month in which the change is reported and documented. Parents who report a decrease in income must provide written documentation to support the reduction in copayment. This documentation must be maintained in CCMS.

Do not adjust the copayment for any month due to vacation, illness, center closure, or when care begins or ends mid-month, even at the time eligibility is established.

The State is responsible for the costs in excess of the assessed copayment up to the state maximum rates. See example in section IV. (C) of this part. The parent is responsible for additional costs charged by the provider that are not reimbursed by CCAP.

The only times a copayment amount can increase during an eligibility period is when it had been decreased during the eligibility period and is being re-assessed due to a change reported by the client. Copayments can only be re-assessed up to the amount originally assessed during eligibility determination. This could occur when: A client reported a temporary loss of employment and their copayment was lowered due to decreased family income. If the client returns to work, the copayment is to be reassessed based on the new income documentation. If the new income exceeds 85% SMI, cancel the case with a 10-day notice. If the new copayment is higher than the original amount assessed at the time of eligibility determination, increase the copayment to the same amount as established at the beginning of the eligibility period. If the copayment is higher than it was during the loss of employment, but lower than the original amount, change the copayment based on the new income amount. A family that qualifies for use of Co-payment Chart B per Procedure I. F. above can have their copayment increased to the Chart A level starting in September since the change was determined at the time eligibility was established.