The CAO must not require an individual to pay past overdue premiums before they reopen the individual’s MAWD benefits.
If the individual is eligible for MAWD, the CAO will:
Review the MAWD Payments Due/Payment History Search website at http://dhhsintra.dpw.state.pa.us/MAWD/ to determine if there are any past overdue premiums.
· Contact the individual to explain the MAWD program and monthly premium requirement.
If there are any past overdue premiums, discuss them with the individual and determine if there is good cause.
If there is not good cause for the overdue premiums, explain that they are still owed and let the individual know that if they do not pay the premium in full, it will be considered overdue again and that non-payment of the premium without good cause will result in the closure of MAWD.
· Obtain the individual’s consent to be reviewed for MAWD prior to authorizing MAWD.
NOTE: If there are no overdue premiums and the individual specifically applies for MAWD, then the individual is aware of the program and its premium requirement and the CAO does not need to contact the individual prior to authorizing MAWD. See 316.1 for more information.
Once MAWD has been reopened, if the CAO receives an alert that the individual has not paid their premium in full, the CAO will:
Contact the individual to determine if there is good cause for not paying the premium.
If there is not good cause and the individual does not pay the premium, close MAWD if the individual is not eligible for another category of Medical Assistance (MA) and send an advance notice.
If the individual is eligible in another MA category, authorize medical benefits in the new category without a break in coverage and send the appropriate notice.
See 316.66 Failure to Pay Premium for more information.
EXAMPLE: Martha’s MAWD benefits were closed on July 31, 2019 after Martha did not pay her MAWD premium and the CAO contacted her and determined that good cause did not exist. In March 2021, Martha applies for MAWD without having paid the overdue premiums of $50.00 per month for May, June, and July 2019. Martha is determined eligible for MAWD effective March 1, 2021 with a monthly premium amount of $25.00. Prior to authorizing MAWD, the CAO will contact Martha to discuss whether there is good cause for the overdue premiums totaling $150.00 and her current monthly premium of $25.00. If there is not good cause, the CAO will explain that past overdue premiums are still owed and will show on her premium statement. Once Martha understands the program and consents to the premium requirement, the CAO will authorize MAWD. If the CAO must send an Initial Premium Statement (PA 1755) based on scenarios discussed in Appendix D, then the CAO will enter the monthly premium amount and include the past due amount with the initial monthly amount and any retroactive months in the total amount due.
Updated March 10, 2021, Replacing February 14, 2012