Medicaid Policy
Medicaid Policy
A. Paying the MWI Premium
1. The member must meet the MWI premium with cash, check, credit or debit card, or money order only.
a. Do not use incurred medical bills and medical deductions to pay the premium.
b. Follow the rules in section 460-3 for the time limits on paying the premium.
c. The MWI premium a member pays will reduce the spenddown of another household member. The deduction shows as a cash payment after the premium is paid.
i. Other family members can use cash or medical deductions to meet the rest of their spenddown. Sec. 461-5
d. DO NOT enter the MWI premium as a health insurance expense.
2. The individual is not required to pay the MWI premium for months when the member does not want Medicaid coverage.
a. Close the case in the second month after a member does not pay the MWI premium. Send proper notice of closure.
b. If the member never meets the MWI premium and has not been eligible for the MWI program in at least one previous month, the member is not eligible for the lifetime asset exclusion if they reapply for Disability Medicaid in the future.
c. If the individual contacts the worker requesting the case stay open or meets the current month’s premium before the closure date, keep the case open. However if the third month’s premium is not met, again schedule the case to close and send proper notice of the closure. Set alerts as needed to see if the member pays the premiums.
d. If the individual contacts the agency after the effective date of the closure, the individual needs to reapply for benefits. Sec. 703-1
3. Individuals eligible for the MWI program do not have the option of being on the Disability Medicaid spenddown program instead. However, an MWI member who lives with a disabled, blind or aged spouse who does not have earned income must be opened together on a spenddown program (if they fail the 100% FPL program limit) when both want to receive medical coverage. See section 314.
B. Refunds of MWI Premiums
An MWI premium is not the same as paying a spenddown to receive Medicaid. The member cannot receive a refund of the MWI premium paid even if the member does not receive any medical services in that month.
An MWI premium can only be refunded if the agency finds that the member should have paid a lower premium, or no premium at all. In this case, the agency will initiate a refund of the difference between the correct MWI premium, and the amount the member paid.