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Health Insurance Premium program
Revised date
Purpose statement
Provide information about the Premium Payment program that may reimburse premiums for private health insurance coverage for those receiving Apple Health (Medicaid), WAC 182-558.
Worker responsibilities
Premium Payment program and spenddown
Health insurance premiums being paid on an individual's behalf by the Premium Payment program at HCA are still considered an income deduction for the Medically Needy program. Indicate the amount of the health insurance premium on the MEDX screen in ACES. Medicare premiums and related coinsurance expenses are not indicated on the MEDX screen in ACES but may be applied toward spenddown as the expenses are incurred.
All Medicare premium expenses under Part A, Part B, Part C, and Part D are entered as a spenddown expense in ACES online as the expenses are incurred. For initial applications, allow the first 2 months of premiums as a deduction if the individual has incurred the expense and they do not have coverage under a Medicare Savings program that is paying the expense on their behalf.
After April 2009, Medicare Part C premiums were no longer allowed as a health insurance deduction on the MEDX screen.
Some public programs use non-federal dollars to purchase private health insurance on behalf of individuals. When a public program verifies payment of a health insurance premium on behalf of a Spenddown individual, the worker needs to redetermine eligibility under the MN program using the expense as an income deduction and not a spenddown expense. In some cases, individuals will become eligible for Medically Needy (MN) with no spenddown liability and should be approved for a 12-month certification. In other cases, the spenddown liability will be reduced by the health insurance premium amount. Make sure a new letter is generated to indicate this change.
Department of Health (DOH) HIV/AIDS early intervention program and the Evergreen Health Insurance program are considered public programs for spenddown. DOH will verify expenses incurred or paid by these programs on behalf of spenddown individuals. These expenses are to be used toward meeting the individual's spenddown liability.