*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
Effective: March 1, 2014 |
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25.10.25 - MA-EPD Good Cause for Late Payment |
Archived: June 1, 2016 (Previous Versions) |
The Special Recovery Unit (SRU) and Health Care Policy at DHS are responsible for good cause determinations involving late MA-EPD premium payments.
Good cause is defined as circumstances beyond an enrollee's control or that the enrollee could not reasonably foresee resulting in the enrollee being unable or failing to pay the premium or requesting voluntary cancellation.
Good cause circumstances include but are not limited to:
l Serious physical or mental illness.
l Lack of timely premium notices.
l MA-EPD coverage was dropped due to belief that other health coverage was available, and the other coverage does not materialize.
l A regular source of income on which the enrollee depended to pay the premium is not received.
Good cause does not include choosing to pay other household expenses instead of the premium.
A client cannot request good cause for the late payment of an initial premium. Good cause can only be requested for the late payment of subsequent premiums.
Good cause determinations are made on a case-by-case basis based on the evidence the enrollee submits.
To request good cause, the client or the person acting on the client’s behalf (financial worker, authorized representative, or case manager) may submit a written request to:
DHS MA-EPD Good Cause,
P.O. Box 64967,
St. Paul, MN 55164-0967.
Fax: (651) 431-7563.
The written request should include the client's:
l Legal name.
l PMI number.
l Mailing address.
l Phone number.
l Reason for requesting good cause.
DHS will provide the client with written notice of the decision within 30 days. Clients may appeal a finding that good cause does not exist.
SRU contacts the worker by sending either or both of the following:
l A copy of the approval or denial letter.
l A SIR webmail message to dhs.made@state.mn.us.
SRU will notify the worker of whether the premium payment is made or not.
A finding of good cause does not relieve the client's obligation to pay the premium. Good cause payment plans are generally set up so all past-due premiums are paid within six months. SRU will notify the worker when a good cause request is approved and if a client does not adhere to a good cause payment plan.
Enrollees who have been granted good cause and set up a payment plan will continue to appear on the MA-EPD Overdue Premiums Report.
l Do not close these enrollees for late payment unless instructed to do so by DHS.
l If the client later pays the premium in full and is otherwise eligible, reinstate coverage back to the date of closure.