DHHS - Medicaid Policy Manual
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  Medicaid Policy                                                                 

 

827 Eligibility For Other Programs

Effective Date: January 1, 2025

Previous Policy

 

All Medical Programs

When a member is no longer eligible for their current Medicaid program, their eligibility for other medical assistance programs must be addressed before terminating their coverage.

  1. Do not require a new application.

  1. Determine eligibility for other programs until the member:

    1. no longer qualifies for any other medical program,

    1. fails to provide requested verification,

    1. states they no longer want medical coverage,

    1. has moved out of state,

    1. cannot be located, or

    1. is deceased.

  1. If possible, determine eligibility without contacting the member. If you need information or verification from the member, follow the verification policy found in 731.

  1. Terminate coverage when the member no longer qualifies for any medical program or requests closure of their coverage. Follow advance notice requirements found in policy 811.

  1. See section 721-4 for rules to follow when addressing eligibility for any member who is losing benefits on a time-limited or age-limited program.

  1. A due process month may be necessary if proper notice cannot be given. See section 811-1

  1. If an SSI recipient stops receiving SSI payments, see 329, 303-6 and 330.