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78 of the month. He or she is also questioned regarding whether he or she received the notification. A last billing statement is also mailed to the applicant on the 20th day of the month, and if the payment has still not been received by the last day of the second month, a disenrollment with appeal information letter is sent to the applicant.
Guidance: Section 8.7.1 is based on Section 2101(a) of the Act provides that the purpose of title XXI is to provide funds to States to enable them to initiate and expand the provision of child health assistance to uninsured, low-income children in an effective and efficient manner that is coordinated with other sources of health benefits coverage for children.
8.7.1. Provide an assurance that the following disenrollment protections are being applied:
Guidance: Provide a description below of the State’s premium grace period process and how the State notifies families of their rights and responsibilities with respect to payment of premiums. (Section 2103(e)(3)(C))
8.7.1.1.
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))
8.7.1.2.
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))
8.7.1.3.
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))
8.7.1.4
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, copayments, coinsurance
and all other types) will be used toward State matching requirements.
(Section 2105(c)(5) (42CFR 457.224) (Previously 8.4.5) 8.8.3.
No funds under this title will be used for coverage if a private insurer would have been obligated to provide such assistance except for a provision limiting this obligation because the child is eligible under the this title. (Section 2105(c)(6)(A)) (42CFR 457.626(a)(1))