All Medicaid Programs |
Obsolete Policy |
The following individuals may be eligible for UPP.
Individuals who have access to or who are covered by COBRA.
Individuals who have access to employer sponsored insurance but have not yet enrolled. (See Section 1003-1)
Individuals are enrolled if they have signed up for the plan and the plan provides medical care as defined in this section.
If the plan has a waiting period before benefits begin, they may still enroll and be eligible for coverage with UPP. However, they cannot receive a reimbursement until the month they pay a health insurance premium.
An individual enrolled in a FFM plan may be found eligible for UPP, if they now have access to employer sponsored insurance. Coordinate enrollment in UPP with the termination of the FFM plan. Individuals enrolled in an individual health insurance plan that is not through the FFM are not eligible unless they meet an exception. (See Section 1003-11)
The following individuals would not be eligible for UPP.
Individuals who are enrolled and currently receiving benefits in an employer-sponsored health plan through their employer, their spouse’s employer, or their parent's or legal guardian's employer
Individuals who are enrolled in Medicare Part A or Part B.
Individuals who are enrolled in health insurance coverage through the Veteran's Administration Health Care System.
Individuals who are eligible for a student health insurance plan. It does not matter if they are enrolled or not.
Individuals who are enrolled in any other type of group health insurance plan that is not considered limited coverage. (See Section 1003-1)
Exceptions:
For UPP clients moving to Medicaid and back to UPP, see Section 1009-5.
When individuals complete their review within 3 months of review closure, see Section 1008-2.