Medicaid Policy                                                                 

348-3.4 Disenrollment Period For Adult Expansion

Effective Date: December 1, 2021

 

Previous Policy (348-3.4 was previously found in 348-3.3 until December 1, 2021) 

 

 

Introduction

An individual who fails to meet the ESI enrollment requirements may lose eligibility for Adult Expansion Medicaid. If the individual was receiving a premium reimbursement, the individual will no longer receive an ESI premium reimbursement.   

A.   Ineligibility Period

1.    The ineligibility period is 12 months and begins the month following the closure of Adult Expansion. 

2.    The following are reasons an individual will lose Adult Expansion Medicaid coverage and the ESI premium reimbursement. The individual was required to participate and:

·       Voluntarily terminated their qualified employer-sponsored health plan coverage; or

·       Refused to enroll in their qualified employer-sponsored health plan within 30 days.

B.   Exceptions to Ineligibility Period

The ineligibility period does not apply to the following individuals. They remain eligible for Adult Expansion Medicaid:

·       Verified American Indians/Alaskan Natives

·       Individuals who are not required to participate, but choose to do so.

·       Individuals who no longer have access to a qualified employer-sponsored health plan..

·       Individuals who have been terminated from a job, or have quit a job, and lose health insurance coverage as a result.

·       Individuals who were already enrolled in their employer’s insurance prior to approval for Adult Expansion and do not verify the premium deduction.

 

·       Individuals who change from a qualified employer-sponsored health plan to a non-qualified plan at open enrollment, the ESI reimbursement will end.

 

 

C.   Ending the Ineligibility Period

     The ineligibility period can end before the end of the 12 months under the following circumstances:

·       Individual enrolls in an employer-sponsored health plan; or

·       Individual loses access to coverage due to employer no longer offering a qualified health insurance plan; or

·       Individual loses access to coverage due to termination or loss of job.

If the case has been closed for more than 30 days, the individual needs to reapply and verify the change in circumstances. If the case has not been closed more than 30 days, do not require a new application just verify the change.