11126.1 Methods of Collection

Agency Error and Client Error claims shall be collected in one of the following ways:

If the household responds with a payment on the claim, the payment shall be accepted according to established procedures. If the claim is paid in full, no further collection action is required. If the claim is only partially paid, further action is necessary to collect the remaining amount of the claim.

If the household responds with a promise to make payments, the payments shall be accepted according to established procedures. If the payments continue or the claim is paid in full, no further collection action is required. If the household fails to begin making payments or to continue making payments, further action is necessary to collect the remaining amount of the claim.

If the household is unable or unwilling to make a voluntary repayment to the agency, a special spenddown shall be imposed. The special spenddown shall be created in an amount equal to the amount to be recovered and shall be considered in the current eligibility base period.

Medical expenses may be allowed against the special spenddown if the expense is verified, medically necessary and reported to the agency on at least a 6- month basis. Medical expenses shall be counted against the regular spenddown (if any) and then the special spenddown.

A special spenddown may be used for both automatic and determined eligible. There is no requirement that the client have a regular spenddown. However, a special spenddown shall not be used in the Medicaid poverty level or CHIP programs.

If a special spenddown is imposed on a regular spenddown, the amount of both spenddowns must be met before the overstated eligibility claim is considered satisfied. If unmet, the special spenddown may extend over more than one base period.