ACWDL 14-29: Interim Non-Payment of Premium (NPP) Processes for the Optional Targeted Low-Income Children Program (August 8, 2014)

DHCS issued guidelines for counties to proceed on discontinuing Optional Targeted Low-Income Children Program cases on the basis of non-payment of premiums (NPP).  The counties have experienced a backlog of NPPs that should have been terminated.  DHCS has determined that premium payment status is an eligibility condition, so there are no redetermination requirements unless there’s a reported change in circumstances.

For those on aid codes H3 and H5, NPPs will be sent a timely NOA and terminated accordingly.  Beneficiaries must pay past-due premiums before termination to preserve eligibility.  If a beneficiary pays past-due premiums after discontinuance but within 30 days, coverage can be reinstated without a break in coverage.  After 30 days, the beneficiary will need to reapply.  Those on aid code 5D will proceed similarly.

The letter includes sample discontinuance language for NOAs.