Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-320-10

Income Provisions

Notice of Proposed Rule

(Amendment)

DAR File No.: 36563
Filed: 07/31/2012 09:08:20 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to increase the income limit for eligibility under Utah's Premium Partnership for Health Insurance (UPP) program.

Summary of the rule or change:

This amendment increases the income limit from 150% of the federal poverty level to 200% of the federal poverty level to qualify for UPP assistance.

State statutory or constitutional authorization for this rule:

• Section 26-18-3
• Section 26-1-5

Anticipated cost or savings to:

the state budget:

The Department anticipates an increase of about 200 enrollees in UPP as a result of this change. Nevertheless, the cost to the state budget as a result of this new enrollment is offset by the reduction of that same number of enrollees from the Primary Care Network (PCN) program.

local governments:

There is no impact to local governments because they do not provide UPP services or determine eligibility for the UPP program.

small businesses:

The Department anticipates an increase of about 200 enrollees in UPP as a result of this change. Nevertheless, any increase in revenue to small businesses as a result of this change is offset by the reduction of that same number of enrollees from the PCN program.

persons other than small businesses, businesses, or local governmental entities:

The Department anticipates an increase of about 200 enrollees in UPP as a result of this change. Some health plans will see an increase in revenue with the increase in UPP enrollment while PCN providers will see a decrease in total revenue. Additionally, there is an increase in savings to UPP enrollees as UPP helps pay for their health insurance premiums, and a loss in savings to potential PCN recipients due to the decrease in PCN enrollment. There is no data at this time to estimate these increases and decreases in revenue and savings to these affected providers and applicants.

Compliance costs for affected persons:

There is a potential loss in revenue to a single PCN provider due to the expected decrease in PCN enrollment, and a loss in potential savings to a single PCN applicant due to the decrease in PCN enrollment. Nevertheless, there is no data at this time to estimate the decrease in revenue or the decrease in savings to a single PCN provider or PCN applicant.

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

Growth in the population served by the UPP program is good policy and supported by this rule with no negative fiscal impact.

David Patton, PhD, 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 [email protected]

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:

09/14/2012

This rule may become effective on:

10/01/2012

Authorized by:

David Patton, Executive Director

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

R414-320. Medicaid Health Insurance Flexibility and Accountability Demonstration Waiver.

R414-320-10. Income Provisions.

(1) For an [adult]individual to be eligible to enroll, gross countable household income must be equal to or less than [150]200% of the federal non-farm poverty guideline for a household of the same size.

(2) [For children to be eligible to enroll, gross countable household income must be equal to or less than 200% of the federal non-farm poverty guideline for a household of the same size.

(3)] 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. The eligibility agency shall use the countable gross income of parents who live with a child to determine the child's eligibility. The agency may not count any income that it excludes under Section R414-320-10.

([4]3) Any income in a trust that a household member receives becomes the income of the individual for whom it is received. The income is countable if the eligibility agency [uses it]counts that individual's income to determine eligibility.

([5]4) The eligibility agency shall count as income [P]payments that a household member receives from the Family Employment program, Working Toward Employment program, or from refugee cash assistance or adoption support services as authorized under Title 35A, Chapter 3, Employment Support Act[ are countable income].

([6]5) The eligibility agency shall count [R]rental income[ is countable income]. The eligibility agency may deduct the following expenses:

(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.

([7]6) The eligibility agency shall count as income cash contributions from non-household members unless the parties sign a written agreement to repay the funds.

([8]7) The eligibility agency shall count as income the interest earned from payments under a sales contract or a loan agreement to the extent that the [agency]individual continues to receive these payments during the certification period.

([9]8) The eligibility agency shall count as income needs-based veteran's pensions. Nevertheless, the agency counts only the portion of a Veteran's Administration check to which the individual is legally entitled. Any portion of the payment for another family member counts solely as that family member's income.

([10]9) The eligibility agency shall count solely as the child's income the child support payments that a parent receives for a dependent child when that child lives in the home.

(1[1]0) The eligibility agency may only count in-kind income when a non-household member provides goods or services to an individual in exchange for services that the individual performs.

(1[2]1) The eligibility agency shall count as income supplemental security income and state supplemental payments.

(1[3]2) The eligibility agency may not count income that is excluded under 20 CFR 416 Subpart K, Appendix, 2010 edition, which is incorporated by reference.

(1[4]3) The eligibility agency may not count as income payments that are prohibited under other federal laws from being counted to determine eligibility for federally-funded medical assistance programs.

(1[5]4) The eligibility agency may not count as income death benefits to the extent that the funds are spent on the deceased person's burial or last illness.

(1[6]5) The eligibility agency may not count as income a bona fide loan that an individual contracts in good faith and endorses in writing to repay.

(1[7]6) The eligibility agency may not count as income child care assistance under Title XX.

(1[8]7) The eligibility agency may not count as income reimbursements of Medicare premiums that an individual receives from the Social Security Administration[ or the Department].

(1[9]8) The eligibility agency may only count earned and unearned income of an eligible child who is under 19 years of age when the child is the head of the household. When the applicant or enrollee's spouse is under the age of 19, the agency may only count the spouse's earned and unearned income when the spouse [is ]under the age of 19 [and ]is the head of the household. The eligibility agency shall count income of a spouse over age 19.

([20]19) The eligibility agency may not count as income educational income, such as educational loans, grants, scholarships, and work-study programs. The individual must verify enrollment in an educational program.

(2[1]0) The eligibility agency may not count reimbursements for employee work expenses incurred by an individual.

(2[2]1) The eligibility agency may not count the value of food stamp assistance.

(2[3]2) The eligibility agency may not count income paid by the U.S. Census Bureau to a temporary census taker to prepare for and conduct the census.

[ (24) The eligibility agency may not count 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.

(25) The eligibility agency may not count 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.

(26) The eligibility agency may not count a COBRA premium subsidy provided under Section 3001 of the American Recovery and Reinvestment Act of 2009, Pub. L No. 111 5, 123 Stat. 115.

]

KEY: CHIP, Medicaid, PCN, UPP

Date of Enactment or Last Substantive Amendment: [December 23, 2011]2012

Notice of Continuation: October 13, 2011

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