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MAABD MAABD MAABD MAABD MAABD MAABD MAABD MAABD MAABD MAABD MAABD No Insurance Penalty Insurance Penalty 5% $ 5,000 $ 7,500 1,300 1,800 2,400 3,150 + 1,805 + 2,280 $10,505/12 $14,730/12 = $875.42 = $1,227.50 From either of these two (2) monthly reimbursement amounts, the home care credit, medical expenses and/or health insurance premium would be deducted to reach the net monthly reimbursement amount. D-385.6 Investigations and Recovery (I&R) Staff Responsibilities • Create a case file for each referred case. • Send the initial notice of monthly reimbursement letter along with a copy of the worksheet, Form 2028-EE. A monthly reimbursement will be calculated for each month the disabled child is Medicaid eligible. • Control and receive the monthly reimbursement funds. • Send delinquent letters, file small claims court actions and make referrals to the Deputy Attorney General, as appropriate. • Evaluate and negotiate undue hardship requests. • On an annual basis, review the child's medical costs in comparison to paid reimbursement amounts and provide a credit against future month reimbursement amounts for any funds in excess of the child's medical costs. Medicaid-paid Provider 60 amounts are not included in the “child’s medical costs” for these purposes. D-385.5 MAABD APPLICATION PROCESSING Responsibilities of Eligibility Staff Division of Social Services Medical Assistance Manual 14 Aug 25 MTL 11/25