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Enrollment: Co-payments and Deductibles
Q: Will the deductible still be allowed/applied to families that can spend
down to the old AFDC levels?
A: The only reason that children will not qualify for the new deductible policy,
other than a non-financial reason, is that their family has access to
employer-sponsored health insurance where the employer will pay 80% or more of
the premium, however to provide safety net for children with high deductible
plans, caps on services or other limitations on coverage, we have provided a
higher deductible limit of 150% of the FPL. Children in this situation may
qualify for BC+ by meeting this deductible, not the lower AFDC Medicaid
deductible we’ve had in the past. A deductible is met when a family’s
qualifying medical expenses exceed the difference between the family’s income
and 150% of the poverty level over a six-month period.
Q: What does it mean to “request” a deductible? How does a family do
this, and what is the earliest date they can make the request? Can they request
it upon application? How is the family supposed to know to ask for it in the
first place? (According to the BC+ Handbook, there is no backdating for the
deductible for children under age 19. The earliest a period of deductible
eligibility can start is the first day of the month during which the household
requests a deductible.)
A: Once a child has been terminated or denied enrollment in BC+ due to employer
insurance access, a Notice of Decision will be sent to the family. The notice
will include information about the option to request a deductible. At that time,
the family would be able to contact the IM agency to request that a deductible
period be started for the child or children. The six-month deductible period
will start with the month that the request was received by the IM agency. A
family may not request a deductible until BC+ eligibility for a child has been
denied. They may not request it upon application.
Q: Is there a Maximum Out-of-Pocket (MOOP) amount for recipients on the
Benchmark Plan?
A: No, although premiums for children and adults will not exceed 5% of the total
income of the family if the family's income is below 300% of the Federal Poverty
Level.
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Last Revised: October 24, 2008 | 
