Sec. 10.20.01.04. Program Participation Fee

A. A recipient whose family income exceeds 175 percent of the poverty income guidelines or whose family liquid assets exceed 200 percent of the poverty income guidelines, or both, at the time of initial application or reapplication is required to pay an annual Program participation fee.

B. Family income for purposes of this regulation includes the adjusted gross income, as defined in the Internal Revenue Code for federal income tax purposes, plus Social Security benefits, all pension or retirement benefits, or both, and all interest income not otherwise included in the adjusted gross income for federal income tax purposes, of the recipient and each person in the recipient's family.

C. The Program shall establish a recipient's annual Program payment fee equal to the sum of:

(1) 5 percent of the amount by which the family income exceeds 175 percent of the poverty income guidelines adjusted for family size; plus

(2) 5 percent of the family's liquid assets above 200 percent of the poverty income guidelines adjusted for family size.

D. For purposes of §C(2) of this regulation, the Program shall:

(1) Include assets which are available as of the date of application for initial enrollment or certification of continuing enrollment, as applicable, in the family's liquid assets;

(2) Include the following in the family's liquid assets:

(a) Cash;

(b) Savings and checking accounts;

(c) Certificates of deposit;

(d) Stocks;

(e) Bonds;

(f) Life insurance cash value exceeding $1,500;

(g) Mutual funds;

(h) Money market certificates; and

(i) Other financial instruments or investments that can readily be converted to cash; and

(3) Exclude the following from the family's liquid assets:

(a) Items of real property; and

(b) Items of personal property.

E. Collection of Fees.

(1) The Department shall collect the annual Program participation fee in quarterly installments.

(2) The Program shall notify the recipient of the amount of the annual Program participation fee, the quarterly amount to be paid, the payment due date, and payment procedures.

(3) The Program may revise the amount of the Program participation fee during a certification period if the Program determines that a revision should be made because of a change in:

(a) Family income;

(b) Family liquid assets; or

(c) Composition of the family unit.

(4) The recipient shall have a grace period lasting from the first day of the quarter until 30 days before the end of the quarter in which to pay the quarterly amount.

(5) The recipient's enrollment in the Program shall be terminated on the last day of the quarter if a fee amount is not paid by the end of the grace period.

(6) The recipient is responsible for the assessed quarterly amount if the Program receives claims and makes payment for services provided for the recipient within the quarterly billing period.

(7) The Program shall extend the grace period for up to 6 months when the Program determines that, due to extraordinary medical expenses paid by the recipient, a change in family income, or frequent or extended hospitalizations, payment within the grace period will cause substantial hardship to the recipient.

(9) Before the Program will recertify an applicant whose prior Program enrollment was terminated for failure to pay the Program participation fee in accordance with this regulation, the applicant shall:

(a) Pay any unpaid fees owing for all prior enrollment periods during which the applicant was enrolled in the Program; and

(b) Make advance payment of the first quarterly installment of the Program participation fee established for the subsequent enrollment period.