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B. The provisions governing non-payment of LTSS cost of care are set forth in the LTSS post-eligibility treatment of income rule contained in Part 50-00-8 of this Title. 1.9.3 Hardship Exemption A. If circumstances arise that prevent a beneficiary eligible through the Sherlock pathway from paying their premium in a given month, the beneficiary may apply for a hardship exemption.

1. An individual is eligible for a hardship exemption if they meet any of the following criteria in the month for which they are applying: a. They were unhoused b. They were evicted in the past six (6) months or were facing eviction or foreclosure c. They received a shut-off notice from a utility company d. They recently experienced domestic violence e. They recently experienced the death of a close family member f. They experienced a fire, flood, or other natural or human-caused disaster that caused substantial damage to their property g. They filed for bankruptcy in the last six (6) months h. They had medical expenses they could not pay in the last 24 months that resulted in substantial debt i. They experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member j. They expect to claim a child as a tax dependent who has been denied coverage in Medicaid and Children’s Health Insurance Program (CHIP), and another person is required by court order to provide medical support to the child and that person does not do so k. They experienced other extenuating circumstances that inhibited their ability to pay their premium

2. If the hardship exemption request is approved the beneficiary will not be required to pay the premium amount that was due on the invoice to which the individual responded with the hardship request. Invoices will reflect the amount due for the current month as well as any past-due amounts for the previous unpaid premiums.