Medicaid Policy
Medicaid Policy
Effective Date: December 1, 2021
General Requirements
1. Any individual eligible for Adult Expansion Medicaid program who has access to or is enrolled in an Employer-Sponsored Insurance plan (ESI), must meet the enrollment requirements or be exempt from enrollment.
2. An Employer-Sponsored Health Plan is health insurance offered by an employer to an employee and/or their dependents.
3. The ESI requirement provides a premium reimbursement for the cost of the employee’s portion of the monthly insurance premium when the plan is a Qualified Health Plan (QHP).
4. Individuals who are not eligible for the ESI reimbursement include:
· Adult Expansion – Presumptive Eligibility
· Adult Expansion – Emergency only recipients
· Individuals who do not have access to a qualified ESI plan
5. Individuals eligible for ESI premium reimbursement will also receive Medicaid benefits.
6. The ESI medical insurance information must be reviewed at application, review and changes to access to health insurance for the Adult Expansion program.
7. We will not reimburse any other type of health insurance plan that is not their employer-sponsored health plan including:
· Those who have a plan through the Federal Marketplace, along with those who are receiving an Advanced Premium Tax Credit (APTC).
348-3.1 ESI Enrollment Requirements
348-3.2 Health Insurance Coverage
348-3.3 How to calculate an ESI premium reimbursement
348-3.4 Disenrollment Period for Adult Expansion