Medicaid Policy
Medicaid Policy
No Previous Policy
Coordination Requirement
The agency is required to coordinate enrollment for individuals between the FFM and UPP. Applications may be received from the FFM when an individual reports a change or directly from the family.
Evaluate all individuals in the home to determine their eligibility for UPP. If the only reason an individual would not qualify for UPP is because of enrollment in a FFM plan, the agency must offer the applicant the opportunity to terminate the FFM plan and enroll the individual in UPP. Notify the applicant of their eligibility and what actions must be taken.
Do not apply a 90-day sanction period for individuals terminating a FFM plan to enroll in UPP. (See Section 1003-7)
Effective Date of Enrollment in UPP
When the agency receives an application from individuals with health coverage through the FFM, determine the effective date of enrollment in UPP for each individual as described below.
A newborn child, newly adopted child, child placed for adoption or a child placed for foster care not already insured may be added to the UPP program the date of the event if the report to the FFM or application is filed within 60 days of the event.
If the report to the FFM or application is filed more than 60 days after the event, the effective date of UPP eligibility is the first day of the month in which the report or application was filed.
For all other Individual in the household:
Individuals who are enrolled in an FFM plan at the time of application, the effective date to enroll in UPP is the day following the termination date of the FFM plan.
The UPP effective date cannot be prior to the application date.
Individuals who are not enrolled in a health plan at the time of application, the effective date is the first day of the application month. (See Section 703-2)