Medicaid Policy
Medicaid Policy
A. Transitions Between UPP and Other Medical Programs
1. Allow individuals to return to the UPP program from Medicaid, Refugee Medical Assistance (RMA) or CHIP. They can currently be enrolled in their health insurance plan. This does not require an UPP open enrollment period, provided that:
a. They were on UPP initially before being on Medicaid, RMA, CHIP; and
b. There is not a break in coverage.
2. Allow individuals and their spouse to transition to the UPP program from the Adult Expansion program with ESI premium reimbursement. The spouse may or may not be on Adult Expansion, and may or may not be enrolled in the ESI. Waive the "already enrolled rule" (1003-2) for individuals who are transitioning from Adult Expansion to UPP when there is no break in coverage.
3. Children of an individual transitioning from Adult Expansion to UPP may qualify for CHIP or UPP. Waive the “already enrolled rule” for children of an individual who meets the criteria in number 2 if the parent wants to enroll the children in UPP.
4. UPP reimbursement may begin the month following the closure of Medicaid, RMA, CHIP or Adult Expansion with ESI premium reimbursement.
B. Requirements for Transitioning Between Programs
1. When the following transitions occur, requirements in #2 apply.
a. CHIP to UPP (within the CHIP certification period);
b. CHIP to UPP (when the CHIP certification period has ended);
c. CHIP to UPP to CHIP (within the CHIP certification period);
d. CHIP to UPP to CHIP (when the CHIP certification period has ended);
e. UPP to Medicaid to UPP;
f. UPP to RMA to UPP; or
g. Adult Expansion with ESI premium reimbursement to UPP.
2. Criteria:
a. Do not require a new application.
b. Determine the health insurance plan is an “UPP Qualified Health Plan”.
c. If eligible for UPP, create a new certification period.
d. All eligibility factors must be met.
· Exception: the individual may currently be enrolled in their health insurance plan as long as they were initially on UPP before being on Medicaid or RMA, or on Adult Expansion with ESI premium reimbursement even without previous UPP coverage and there is not a break in coverage. The spouse and children of an Adult Expansion adult are included in this exception.
e. Complete a new access to insurance test (1003-4) and re-determine income. See section 1004 to determine countable income.
f. Waive the open enrollment requirement (1000-3) for adults if there has not been a break in coverage. Children are always exempt from the UPP open enrollment requirement.
g. If married adults were both UPP recipients and only one of them changed to a Medicaid or RMA program, follow the policy in section 1009-3 to add the spouse back to UPP.