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The first premium month is the month after authorization. The months of application and months through the month of authorization are premium-free. The children will be enrolled when the premium has been paid. When processing the MA 10 application, the DFR worker must complete an off-line calculation to determine if the child would be eligible for retro Medicaid coverage in another category. Refer to Chapter 3405.00.00 on how to process retro benefits for a MAGI case.

It is not necessary to request retro income unless there is a significant change in income, however income should be entered for each retro month. If the child is found to be eligible for retro coverage, then the worker should open the category for those retro months and fully document what was completed in the case notes. The billing process allows for an overdue billing, which gives the payer a subsequent opportunity to pay the premium before the application will be closed. If a payment is not received by the final due date, the conditional approval will be system denied. Once the first premium has been paid and MA 10 is authorized, coverage can only be discontinued for non-payment at renewal.24 Outstanding premiums must be paid by renewal month. If the premium payments are not received by renewal month, benefits will be terminated. If the individual is discontinued for nonpayment of premiums, that individual will need to submit a new application. Individuals who reapply are not required to pay the previously owed premiums.

Note: For MAGI applications, if the applicant does not state/verify the income was different in the retro months, the verified income for the application month must be copied/entered for each retro month to avoid incorrectly determining eligibility for those months based on zero income.

2035.33.00 DESIGNATION OF MED WORKS PREMIUM PAYER ENROLLMENT PROCESS

MADW/I premium payer is set in the following default order: • Applicant/recipient aged 18 and older • Mother of applicant/recipient under age 18 • Father of applicant/recipient under age 18

The caseworker can change the payer of a child under age 18 from mother to father as requested by the parent. In the case of a married couple when both are applicants/recipients of