DHCS MEDIL I 14-35: Interim Non-Payment of Premium (NPP) Processes (6/18/14)

This letter updates counties about the process they should use for terminating TLICP beneficiaries for non-payment of premiums.  For clients in non-payment of premium status, there are no redetermination requirements prior to sending a NOA to discontinue the client unless there’s a change in circumstances.  The letter also provides a sample discontinuance notice.

For clients in aid codes H3 and H5, counties will provide a timely notice and terminate eligibility through MEDS.  For clients in aid code 5D (Healthy Families Program transition), counties would need to submit a remedy ticket to DHCS after providing timely notice.

To cure the situation and prevent termination, clients must pay past premiums prior to date of discontinuance.  If client misses that date but pays within 30 days of date of discontinuance to cure, county must verify payment and reinstate or submit a remedy ticket.  After the 30 day cure period, the client would need to reapply; any owed amounts would be charged as part of the first month’s premium.