431-1.2 Health Insurance Premiums and Medicaid Work Incentive

Effective Date: June 1, 2020

No Previous Policy

Introduction

Health insurance premiums are handled differently for the Medicaid Work Incentive (MWI) program. The premiums do not meet a member's MWI premium. Instead, we deduct the premiums a member pays from the countable income during the premium calculation process.

A. Deducting Premiums

1. Deduct from the member's income health insurance premiums a member pays before calculating the MWI premium a member must pay to become eligible. Follow policy in 462-1

a. Deduct premiums for insurance covering the member, the spouse or dependents of the member or spouse.

b. The MWI premiums a member pays to DWS are not health insurance premiums. Do not enter the MWI premium as an expense.

c. The MWI premium paid by a household member for coverage under the MWI program will reduce the Medicaid spenddown owed by other household members. 462-2

[NOTE: The member needs to pay the MWI premium first, before meeting another family member's spenddown.]

2. For application and ongoing months, the following applies:

a. Deduct the whole premium amount from income only in the MWI premium calculation process for the month payment is due. Do not pro-rate the premium. Do not deduct premiums due in any other months. (462-1)

b. When the member pays a premium for an employer sponsored health insurance plan through a payroll deduction, deduct the actual amount paid each month. (In 3rd and 5th paycheck months, decide if the member pays a premium on those checks and adjust the amount of the deduction accordingly.)

c. If a member pays a Medicare Part D premium, deduct the premium in the month due.

d. If the member pays a Medicare Part A premium, deduct that amount before determining the MWI premium.

3. Retroactive months

a. Deduct health insurance premiums paid in retroactive months only in the month paid.

b. Do not deduct Part B Medicare premiums the member pays.