Section R9-31-1404. Hardship Exemption for a Member who is a Child Determined Eligible Under Article 3 of This Chapter

A.      Definitions. The following definitions apply to this Section:

1.        “Major expense” means the expense is more than 10 per- cent of the household’s countable income under R9-31- 304.

2.        “Medically necessary” has the same meaning as defined in A.A.C. R9-22-101.

B.       Hardship exemption. The Administration shall provide infor- mation to the head of household regarding the request for a hardship exemption. The Administration shall grant a hardship exemption from the disenrollment requirements under A.R.S.

§ 36-2982 for a household who:

1.        Is no longer able to pay the premium due to one of the hardship criteria in subsection (C), and

2.        Submits a written request for a hardship exemption and provides all necessary written information at the time of request.

C.      Hardship criteria. To be eligible for a hardship exemption, a household shall have:

1.        Medically necessary expenses or health insurance premi- ums that:

a.         Are not covered under Medicaid or other insurance, and

b.        Exceed  10  percent  of  the  household’s   countable income under R9-31-304;

2.        Unanticipated major expense, related to maintaining a residence for the household or transportation for work;

3.        A combination of medically necessary expenses under subsection (C)(1) and unanticipated major expenses under subsection (C)(2) that exceed 10 percent of the household’s countable income under R9-31-304; or

4.        Experienced the death of a household member during the month the premium was not paid.

D.      Written hardship exemption request. The Administration shall not consider a hardship exemption unless the Administration receives the written request and information under subsection

(C) by the due date specified in the Administration’s notice that explains the undue hardship exemption requirements.

E.       Notification. The Administration shall notify the head of household of the approval or denial of the request for exemp- tion and discontinuance under R9-31-310, no later than 10 days from the date the Administration received the request.

F.       Appeal and Request for hearing. The head of household may appeal and request a hearing concerning the discontinuance and denial of the hardship exemption.

Historical Note

New Section adopted by exempt rulemaking at 5 A.A.R. 3670, effective September 10, 1999 (Supp. 99-3). Former Section R9-31-1404 renumbered to R9-31-1405; new Section R9-31-1404 made by final rulemaking at 7

A.A.R. 5846, effective December 7, 2001 (Supp. 01-4). Amended by exempt rulemaking at 8 A.A.R. 5007, effec- tive January 1, 2003 (Supp. 02-4). Amended by exempt rulemaking at 11 A.A.R. 477, effective January 1, 2005

(Supp. 04-4).