Section 16.03.18.205 - PREMIUMS FOR PARTICIPATION UNDER HOME CARE FOR CERTAIN DISABLED CHILDREN (HCCDC)01.Household Income Above 150% and Equal to or Less Than 185% of FPG. Participants with household income above one hundred fifty percent (150%) and equal to or less than one hundred eighty-five percent (185%) of the current FPG pay a monthly premium of fifteen dollars ($15). The maximum monthly premium is limited to thirty dollars ($30).02.Household Income Above 185% of FPG. Participants with income above one hundred eighty-five percent (185%) of the current FPG pay a monthly premium. The monthly premium is a fixed percentage of household income as provided in the table below. TABLE 205.02 SLIDING FEE SCHEDULE FOR MONTHLY PREMIUMS FOR HCCDC PARTICIPATION |
Household Income Above 185% of Current FPG | Premium Based on% of Household Income |
ABOVE | LESS THAN OR EQUAL TO | |
185% | 250% | 1.0% |
250% | 300% | 1.5% |
300% | 400% | 2.0% |
400% | 500% | 2.5% |
500% | 600% | 3.0% |
600% | 700% | 3.5% |
700% | 800% | 4.0% |
800% | 900% | 4.5% |
900% | No Upper Limit | 5.0% |
03.Failure to Provide Information. Failure to provide the Department with information to determine eligibility may subject the participant to a monthly premium equal to the average monthly cost of coverage for participants receiving Medicaid Enhanced Plan Benefits through HCCDC.04.Failure to Pay Premium. Failure to pay the premium will not cause the participant to lose coverage or eligibility for services.05.Waiver of Premium. The premium is waived if the Department determines payment of the premium would cause undue hardship. Undue hardship exists when an unexpected expense would cause the household to forgo basic food or shelter to make a premium payment. Detailed documentation of the household's living expenses demonstrating such hardship must be provided to the Department.06.Premium Recalculation. Premiums are recalculated at each annual eligibility determination. If the Department receives verification of a reduction in household income prior to annual redetermination, the premium is recalculated.Idaho Admin. Code r. 16.03.18.205