N-7000, Premiums


Revision 16-4; Effective December 1, 2016

Medicaid Buy-In for Children (MBIC) correspondence refers to a premium as a monthly payment.

A family may have to pay a monthly premium as a condition of eligibility. The premium amounts are based on a sliding scale, dependent upon family income and whether the applicant/recipient is covered under a parent's employer-sponsored health insurance (ESI) plan. If a parent's insurance qualifies, the Health Insurance Premium Payment Program (HIPP) can reimburse the family for the ESI premium (see D-7700, Health Insurance Premium Payment Reimbursement Program). HIPP eligibility is also a determining factor in the MBIC premium amount.

Note: The 50% rule for ESI only applies to eligibility and not to premium calculations.

Premium amounts are calculated using the gross countable family income. In the budgeting examples in Section N-6351, Examples of Budgeting Steps, the amount of gross family income used for premium calculation is the "balance of budget group income." Since the premium amount is calculated before the substantial MBIC exclusion of $85 + one-half of the remainder, 300 percent of the federal poverty level is used for the premium calculations.

Note: In TIERS, list the parent/guardian of the MBIC child as the head of household. The parent/guardian also needs to be listed as the alternate payee as well as the EDG name. This is primarily for any premium reimbursements and managed care purposes.