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Effective Date: April 1, 2009

Approval Date: ____________ 51

8.7 Please provide a description of the consequences for an enrollee or applicant who does not pay a charge. (42CFR 457.570 and 457.505(c))

The consequences for an enrollee or applicant who does not pay a charge, (42 CFR 457.570 and 457.505(c)), are as follows: No services are denied due to lack of a copayment. However, if required premiums are not paid, the coverage will not be continued. The state has established a process that gives beneficiaries reasonable notice of and an opportunity to pay past due cost sharing amounts (premiums, copayments, coinsurance, deductibles and similar fees) prior to disenrollment. If disenrollment occurs, the State will facilitate enrolling the child in Medicaid, or adjust the child’s cost-sharing category, as appropriate. Enrollees are notified of premiums they must pay two months in advance of the due date. If they do not pay on the date due, a disenrollment process is activated two months after the due date. There is no lock-out period for disenrollees before they can re-enroll. They can re-enroll at any time after disenrollment, if they are still eligible, but must pay what is owed for past due premiums.

8.7.1 Please provide an assurance that the following disenrollment protections are being applied:

State has established a process that gives enrollees reasonable notice of and an opportunity to pay past due premiums, copayments, coinsurance, deductibles or similar fees prior to disenrollment. (42CFR 457.570(a))

The disenrollment process affords the enrollee an opportunity to show that the enrollee's family income has declined prior to disenrollment for non payment of cost- sharing charges. (42CFR 457.570(b))

In the instance mentioned above, that the state will facilitate enrolling the child in Medicaid or adjust the child's cost-sharing category as appropriate. (42CFR 457.570(b))

The state provides the enrollee with an opportunity for an impartial review to address disenrollment from the program. (42CFR 457.570(c))

8.8 The state assures that it has made the following findings with respect to the payment aspects of its plan: (Section 2103(e))

8.8.1.

No Federal funds will be used toward state matching requirements. (Section 2105(c)(4)) (42CFR 457.220)

8.8.2.

No cost-sharing (including premiums, deductibles, copays, coinsurance and all other types) will be used toward state matching requirements. (Section 2105(c)(5)