No. 29873 (Amendment): R382-10. Eligibility

DAR File No.: 29873
Filed: 04/26/2007, 04:26
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

This amendment is necessary to increase quarterly premiums for coverage under the Children's Health Insurance Program (CHIP) and to exempt taxable interest and dividend income if a household expects to receive less than $500 per year.

Summary of the rule or change:

This amendment increases quarterly premium amounts approved during the 2007 General Session of the Utah Legislature (H.B. 150). It also exempts taxable interest and dividend income if a household expects to receive less than $500 per year. (DAR NOTE: H.B. 150 (2007) is found at Chapter 371, Laws of Utah 2007, and will be effective 07/01/2007.)

State statutory or constitutional authorization for this rule:

Sections 26-1-5 and 26-40-103

Anticipated cost or savings to:

the state budget:

This amendment allows the Department to collect an additional $1,084,540 in quarterly premiums. By increasing the enrollee's share of the cost, CHIP can use existing budget to cover rising health care costs.

local governments:

There is no budget impact because local governments do not fund or provide CHIP benefits.

other persons:

CHIP families with income above 100% of the federal poverty level (FPL) pay an additional $1,084,540 in quarterly premiums, which allows CHIP to use existing budget to cover rising health care costs.

Compliance costs for affected persons:

A single family with income between 100% and 150% of the FPL pays $68 more per year in quarterly premiums. A single family with income from 151% to 200% of the FPL pays $140 more per year.

Comments by the department head on the fiscal impact the rule may have on businesses:

Rising health care costs necessitate this increase in cost sharing by the recipients of this service. Fiscal impact on business is not anticipated. David N. Sundwall, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Children's Health Insurance Program
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY UT 84116-3231

Direct questions regarding this rule to:

Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at [e-mail]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

06/14/2007

Interested persons may attend a public hearing regarding this rule:

5/24/2007 at 5:00 PM, Cannon Health Building, 288 N 1460 W, Room 114, Salt Lake City, UT

This rule may become effective on:

06/22/2007

Authorized by:

David N. Sundwall, Executive Director

RULE TEXT

R382. Health, Children's Health Insurance Program.

R382-10. Eligibility.

R382-10-13. Income Provisions.

To be eligible to enroll in the Children's Health Insurance Program, gross household income must be equal to or less than 200% of the federal non-farm poverty guideline for a household of equal size. All gross income, earned and unearned, received by the parents and stepparents of any child who is included in the household size, is counted toward household income, unless this section specifically describes a different treatment of the income.

(1) The Department does not count income that is defined in 20 CFR 416(K) Appendix, 2006 edition, which is adopted and incorporated by reference.

(2) Any income in a trust that is available to, or is received by a household member, is countable income.

(3) Payments received from the Family Employment Program, General Assistance, or refugee cash assistance or adoption support services as authorized under Title 35A, Chapter 3 is countable income.

(4) Rental income is countable income. The following expenses can be deducted:

(a) taxes and attorney fees needed to make the income available;

(b) upkeep and repair costs necessary to maintain the current value of the property;

(c) utility costs only if they are paid by the owner; and

(d) interest only on a loan or mortgage secured by the rental property.

(5) Deposits to joint checking or savings accounts are countable income, even if the deposits are made by a non-household member. An applicant or enrollee who disputes household ownership of deposits to joint checking or savings accounts shall be given an opportunity to prove that the deposits do not represent income to the household. Funds that are successfully disputed are not countable income.

(6) Cash contributions made by non-household members are counted as income unless the parties have a signed written agreement for repayment of the funds.

(7) The interest earned from payments made under a sales contract or a loan agreement is countable income to the extent that these payments will continue to be received during the eligibility period.

(8) In-kind income, which is goods or services provided to the individual from a non-household member and which is not in the form of cash, for which the individual performed a service or is provided as part of the individual's wages is counted as income. In-kind income for which the individual did not perform a service or did not work to receive is not counted as income.

(9) SSI and State Supplemental Payments are countable income.

(10) Death benefits are not countable income to the extent that the funds are spent on the deceased person's burial or last illness.

(11) A bona fide loan that an individual must repay and that the individual has contracted in good faith without fraud or deceit, and genuinely endorsed in writing for repayment is not countable income.

(12) Child Care Assistance under Title XX is not countable income.

(13) Reimbursements of Medicare premiums received by an individual from Social Security Administration or the Department are not countable income.

(14) Needs-based Veteran's pensions are not counted as income. If the income is not needs-based, only the portion of a Veteran's Administration check to which the individual is legally entitled is countable income.

(15) Income of a child is excluded if the child is not the head of a household.

(16) Educational income such as educational loans, grants, scholarships, and work-study programs are not countable income. The individual must verify enrollment in an educational program.

(17) Reimbursements for expenses incurred by an individual are not countable income.

(18) Any payments made to an individual because of his status as a victim of Nazi persecution as defined in Pub. L. No. 103-286 are not countable income, including payments made by the Federal Republic of Germany, Austrian Social Insurance payments, and Netherlands WUV payments.

(19) Victim's Compensation payments as defined in Pub. L. No. 101-508 are not countable income.

(20) Disaster relief funds received if a catastrophe has been declared a major disaster by the President of the United States as defined in Pub. L. No. 103-286 are not countable income.

(21) Income of an alien's sponsor or the sponsor's spouse, is not countable income.

(22) If the household expects to receive less than $500 per year, taxable interest and dividend income are not countable income.

 

R382-10-21. Quarterly Premiums.

(1) Each family with children enrolled in the CHIP program must pay a quarterly premium based on the countable income of the family during the first month of the quarter.

(a) A family whose countable income is equal to or less than 100% of the federal poverty level or who are American Indian pays no premium.

(b) A family with countable income greater than 100% and up to 150% of the federal poverty level must pay a quarterly premium of $[13]30.

(c) A family with countable income greater than 150% and up to 200% of the federal poverty level must pay a quarterly premium of $[25]60.

(2) A family who does not pay its quarterly premium by the premium due date will be terminated from CHIP. Coverage may be reinstated when any of the following events occur:

(a) The family pays the premium by the last day of the month immediately following the termination;

(b) The family's countable income decreased to below 100% of the federal poverty level prior to the first month of the quarter.

(c) The family's countable income decreases prior to the first month of the quarter and the family owes a lower premium amount. The new premium must be paid within 30 days.

(3) A family who was terminated from CHIP who reapplies within one year of the termination date, must pay any outstanding premiums before the children can be re-enrolled.

 

KEY: children's health benefits

Date of Enactment or Last Substantive Amendment: 2007

Notice of Continuation: June 10, 2003

Authorizing, and Implemented or Interpreted Law: 26-1-5; 26-40