Page 206

UPDATED: JANUARY 2012

303

INCOME EXCESS

PAY-IN

Policy: Local social services districts are required to offer individuals with excess income the opportunity to reduce their excess income by pre- paying to the district the amount by which their income exceeds the Medically Needy Income level or Medicaid Standard, whichever is higher. Participation in the Pay-In program is optional on the part of the A/R. The A/R may elect to pay-in for periods of one to six months. When the pay-in period is longer than one month, the individual may pay the full excess income amount at the beginning of the period or may pay in monthly installments.

References: SSL. Sect.

366(2)(b)

Dept. Reg.

360-4.8

ADMs

96 ADM-15 94 ADM-17

Interpretation: In order to obtain coverage, the participant pays to the local social services district the amount by which his or her net available income exceeds the Medically Needy Income level or Medicaid Standard, whichever is higher, for the appropriate period. In determining this amount, the district deducts from income any necessary medical expenses incurred during the period which are not payable by the Medicaid program. The A/R may elect to pay-in for periods of one to six months.

For pay-in periods of less than six months, inpatient coverage will not be authorized; instead outpatient coverage will be authorized. When the A/R pays the full excess income liability for a six-month period, inpatient and outpatient coverage will be authorized for that period.

If the individual has paid his/her liability to the local district and subsequently incurs expenses during the covered period for services not covered by the Medicaid program, the local district either refunds to the recipient the amount of the medical expense from the recipient’s account, or may credit the amount to the recipient’s account in a subsequent excess income period.

(MRG)