Medicaid Policy
Medicaid Policy
A recipient may request to add his or her legally married spouse or dependent child to UPP during the certification period. A new application form is not required. Determine the effective date of enrollment in UPP for each individual as described below. (See 1004 to determine countable income.)
Do not apply a 90-day sanction period for individuals terminating a FFM plan to enroll in UPP (See 1003-7).
Adding a Spouse During the Certification Period
If the spouse was previously included on UPP and removed from the UPP program because they became eligible for Medicaid, or the Refugee Medical Assistance (RMA), the effective date to add the spouse back to the UPP program is the day after the Medicaid, or RMA ends. Open enrollment does not apply if there has been no break in coverage (See 1009-5).
If the spouse was previously included on UPP and removed from the UPP program because the spouse became enrolled in a FFM plan, the effective date to add the spouse back to the UPP program is the day after the FFM plan ends. Open enrollment does not apply if there is no break in coverage between the termination of the FFM plan and the effective date of UPP.
If the spouse was not previously included on UPP, the spouse may be added only during UPP open enrollment periods. The spouse must meet all eligibility factors before they can be added to UPP. The effective date to add the spouse is the first day of the application month.
Adding a Child During the Certification Period
Children are not subject to the open enrollment requirements.
A newborn child, newly adopted child, child placed for adoption or a child placed for foster care that are not already insured may be added to the UPP program the date of the event if the child is enrolled in the employer sponsored insurance and the report to the FFM or the application is filed within 60 days of the event.
If the report to the FFM or the application is filed more than 60 days after the event, the effective date of UPP enrollment is the first day of the month in which the request is made.
For all other children in the household:
Children 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 effective date is the first day of the application month for children who are not enrolled in a health plan at the time of application (See 703-2).
Reasons for Adding a Person to the UPP Case:
The member gets married during the certification period.
The individual who was not in the home at the time of application returns to the home.
The individual was included in UPP at the time of application but lost eligibility and then again becomes eligible during the certification period.
At the time of the UPP application the individual was not eligible for UPP because of enrollment in or access to other health insurance or was sanctioned for voluntary termination of health insurance but would now be eligible.
At the time of the UPP application, the person had access to employer-sponsored coverage or COBRA and would have been eligible for UPP but they could not enroll in the coverage until the following month or until an open enrollment period for employer-sponsored insurance.
The individual had had a FFM plan that is ending.
Determining Eligibility for the Spouse or Dependent Child
Determine if the spouse or child is eligible for Medicaid. If the spouse of child are eligible for Medicaid, they are not eligible to be added to the UPP household.
A new income calculation and access to insurance test are required to determine if the individual is eligible for UPP.
All other eligibility requirements must be met.
If adding a spouse or child child does not adversely affect the current UPP member's eligibility and all other eligibility requirements have been met, treat the change as a review and establish a new 12-month certification period.
If all factors have not been determined for the current UPP members, add the new household member to the remainder of the certification period.
If the change adversely affects the eligibility, don not act on the change until the next review.