No. 32626 (Amendment): R414-310. Medicaid Primary Care Network Demonstration Waiver

DAR File No.: 32626
Filed: 04/30/2009, 04:30
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

In accordance with the American Recovery and Reinvestment Act (ARRA) of 2009, the purpose of this change is to exclude certain types of income to determine Primary Care Network (PCN) eligibility.

Summary of the rule or change:

This change excludes certain types of income, recovery payments, and Consolidated Omnibus Reconciliation Act (COBRA) health insurance premium subsidies to determine PCN eligibility.

State statutory or constitutional authorization for this rule:

Sections 26-1-5 and 26-18-3

Anticipated cost or savings to:

the state budget:

There is a nominal cost to the state budget based on the "making work pay credit" for which some working individuals will qualify. Nevertheless, there is insufficient data to determine how many individuals will qualify for this credit and what the total cost will be. Otherwise, there is no budget impact because the income that is excluded to determine PCN eligibility was not available to individuals before Congress enacted ARRA.

local governments:

This change does not impact local governments because they do not determine PCN eligibility and do not fund or provide PCN services.

small businesses and persons other than businesses:

There are nominal savings to working individuals who will qualify for the "making work pay credit." under ARRA. Nevertheless, there is insufficient data to determine how many individuals will qualify for this credit and what the total cost will be. Otherwise, there is no budget impact because the income that is excluded to determine PCN eligibility was not available to individuals before Congress enacted ARRA.

Compliance costs for affected persons:

There are no compliance costs because this change does not require anyone to pay more for PCN coverage and it does not change the eligibility status of an individual recipient. Further, this change will only provide savings to an individual who qualifies for "making work pay credit."

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

These changes are necessary to comply with federal law and to stay within appropriations. 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
Health Care Financing, Coverage and Reimbursement Policy
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:

06/15/2009

This rule may become effective on:

07/01/2009

Authorized by:

David N. Sundwall, Executive Director

RULE TEXT

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

R414-310. Medicaid Primary Care Network Demonstration Waiver.

R414-310-9. Age Requirement.

(1) An individual must be at least 19 and not yet 65 years of age to enroll in the Primary Care Network program.

(2) The month in which an individual's 19th birthday occurs is the first month the person can be eligible for enrollment in the Primary Care Network program.

(a) If the individual could qualify for Medicaid in that month without paying a spenddown or premium, the individual cannot enroll in the Primary Care Network program until the following month.

(b) If the individual could enroll in the Children's Health Insurance Program[ and it is an open enrollment period for CHIP for that month], the individual cannot enroll in the Primary Care Network program until the following month.

(3) The benefit effective date for the Primary Care Network program cannot be earlier than the date of the 19th birthday.

(4) The individual's 65th birthday month is the last month the person can be eligible for enrollment in the Primary Care Network program.

 

R414-310-10. Income Provisions.

(1) To be eligible to enroll in the Primary Care Network program, a household's countable gross income must be equal to or less than 150% of the federal non-farm poverty guideline for a household of the same size. An individual with income above 150% of the federal poverty guideline is not allowed to spend down income to be eligible under the Primary Care Network program. All gross income, earned and unearned, received by the individual and the individual's spouse is counted toward household income, unless this section specifically describes a different treatment of the income.

(2) The Department does not count as income any payments from sources that federal laws specifically prohibit from being counted as income to determine eligibility for the Primary Care Network.

([2]3) Any income in a trust that is available to, or is received by a household member, is countable income.

([3]4) Payments received from the Family Employment Program, Working Toward Employment program, refugee cash assistance or adoption support services as authorized under Title 35A, Chapter 3 are countable income.

([4]5) 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]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.

([6]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 certification period.

([7]8) Needs-based Veteran's pensions are counted as income. Only the portion of a Veteran's Administration check to which the individual is legally entitled is countable income.

([8]9) Child support payments received for a dependent child living in the home are counted as that child's income.

([9]10) 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 which 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.

([10]11) Supplemental Security Income and State Supplemental payments are countable income.

([11]12) Income, unearned and earned, shall be deemed from an alien's sponsor, and the sponsor's spouse, if any, when the sponsor has signed an Affidavit of Support pursuant to Section 213A of the Immigration and Nationality Act on or after December 19, 1997. Sponsor deeming will end when the alien becomes a naturalized U.S. citizen, or has worked 40 qualifying quarters as defined under Title II of the Social Security Act or can be credited with 40 qualifying work quarters. Beginning after December 31, 1996, a creditable qualifying work quarter is one during which the alien did not receive any federal means-tested public assistance.

([12]13) Income that is defined in 20 CFR 416 Subpart K, Appendix, 2004 edition, which is incorporated by reference, is not countable.

([13]14) Payments that are prohibited under other federal laws from being counted as income to determine eligibility for federally-funded medical assistance programs are not countable.

([14]15) Death benefits are not countable income to the extent that the funds are spent on the deceased person's burial or last illness.

([15]16) 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.

([16]17) Child Care Assistance under Title XX is not countable income.

([17]18) Reimbursements of Medicare premiums received by an individual from Social Security Administration or the State Department of Health are not countable income.

([18]19) Earned and unearned income of a child who is under age 19 is not counted if the child is not the head of a household.

([19]20) 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.

([20]21) Reimbursements for employee work expenses incurred by an individual are not countable income.

([21]22) The value of food stamp assistance is not countable income.

([22]23) Income paid by the U.S. Census Bureau to a temporary census taker to prepare for and conduct the census is not countable income.

(24) The additional $25 a week payment to unemployment insurance recipients provided under Section 2002 of the American Recovery and Reinvestment Act of 2009, Pub. L. No. 111-5, which an individual may receive from March 2009 through June 2010 is not countable income.

(25) The one-time economic recovery payments received by individuals receiving social security, supplemental security income, railroad retirement, or veteran's benefits under the provisions of Section 2201 of the American Recovery and Reinvestment Act of 2009, Pub. L. No. 111-5, 123 Stat. 115, and refunds received under the provisions of Section 2202 of the American Recovery and Reinvestment Act of 2009, Pub. L .No. 111-5, 123 Stat. 115, for certain government retirees are not countable income.

(26) The Consolidated Omnibus Reconciliation Act (COBRA) premium subsidy provided under Section 3001 of the American Recovery and Reinvestment Act of 2009, Pub. L No.111-5, 123 Stat. 115, is not countable income.

(27) The making work pay credit provided under Section 1001 of the American Recovery and Reinvestment Act of 2009, Pub. L. No. 111-5, 123 Stat. 115, is not countable income.

 

KEY: Medicaid, primary care, covered-at-work, demonstration

Date of Enactment or Last Substantive Amendment: [January 22], 2009

Notice of Continuation: June 13, 2007

Authorizing, and Implemented or Interpreted Law: 26-18-1; 26-1-5; 26-18-3