Medicaid Policy
Medicaid Policy
The effective dates for the UPP certification, the UPP reimbursement payment and the health insurance plan may have different start dates. Applications for UPP will only be accepted during an UPP open enrollment periods (See 1000-3).
Certification Period
The effective date of the certification period is not based on when the health insurance will begin or when the member will begin to pay the premiums.
If the applicant meets the requirements for UPP, the effective date for the certification period is the first day of the month (See 1008).
Exceptions to benefits starting on the first day of a month (see 1000-3):
The individual is enrolled in health insurance coverage that will terminate involuntarily during the open enrollment period or by the end of the month immediately following the open enrollment period, in which case eligibility begins the day after the health insurance coverage ends. See 1003-11 if the individual will be terminating an FFM plan.
The individual is sanctioned for voluntarily termination of health insurance coverage and the ineligibility period ends during the open enrollment period or by the end of the month immediately following the open enrollment period, in which case eligibility begins the day after the ineligibility period ends.
The individual moved to Utah to take up residency during the application month, in which case eligibility cannot begin before the date the person arrived in Utah.
The individual is a qualified non-citizen who was subject to the five-year bar for UPP during the application month, in which case eligibility cannot begin before the date the five-year-bar ended.
The individual became a qualified non-citizen who was not subject to the five-year bar during the application month, in which case eligibility cannot begin before the date the individual became a qualified non-citizen.
The individual is released from a Utah jail or prison or discharged from the State Hospital or other IMD, in which case eligibility cannot be earlier than the date the person was released.
Premium Reimbursements
An UPP reimbursement is not a guaranteed for the entire certification period and does not impact when the certification period will begin.
The effective date for the premium reimbursement will begin once the member begins to pay the insurance premium.
A reimbursement will not be issues for a month prior to the certification period start date or before the applicant verifies that a premium has been paid.
If the employer deducts the health insurance premium in a month prior to the insurance effective date, the member is eligible to receive a reimbursement in the month the premium was paid.
If an applicant is already enrolled in COBRA coverage in the application month and has paid their COBRA premiums, the member is eligible to receive an UPP reimbursement in the month of application (See 1003-10).