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G. Financial Responsibility
Apply financial responsibility and budgeting rules in MA-2260, Financial Eligibility Regulations – PLA policy.
V. ENROLLMENT FEE AND PREMIUM PROCEDURES
A. Enrollment Fee
All individuals with total monthly countable income above 150% of the federal poverty level must pay a $50 enrollment fee for each twelve-month certification period. The enrollment fee is collected by the county and retained to offset administrative expenses. Do not charge an enrollment fee for the retroactive month(s) when an a/b receives retroactive coverage. If a premium is due the local agency must mail the enrollment fee notice with the premium invoice.
Note: Members of federally recognized Native American tribes and Alaska natives are exempt from cost sharing, including enrollment fees and premiums.
1. Determine if an Enrollment Fee is due
a. Calculate the amount of total countable net income for the individual.
b. If this amount exceeds 150% of FPL, an enrollment fee is due. Those in this income range must have unearned income at or below 150% of FPL.
2. Notification of Enrollment Fee
Upon determination that an a/b is eligible for HCWD and that his income exceeds 150% of FPL, notify the applicant in writing that an enrollment fee of $50 is due. Refer to the DHB-5149, HCWD Enrollment Fee Notice form.
a. Give the a/b at least 12 calendar days to pay the fee.
b. If 12 calendar days exceeds the 45/90-day processing standard, pend until you receive notice of payment, or until the first workday after the due date for payment.
Allow for the exclusion of days when necessary verifications are received and the only remaining item necessary to process the application is the enrollment fee (and premium when applicable). The exclusion of days begins on the day of the request for the fee and ends on the day the fee is received or on the 13th calendar day, whichever occurs first. Use HCWD code for this purpose. Refer to MA-2300, Application policy. Docusign Envelope ID: B8C63DC7-7367-4210-853E-B7B004802EE4