All Medicaid Programs |
Obsolete Policy |
Allow a person to come back on the UPP program from Medicaid or Refugee Medical Assistance (RMA), even if they are currently enrolled in their health insurance plan, as long as they were on UPP initially when they went to Medicaid, RMA or CHIP and there was not a break in coverage. It does not have to be an UPP open enrollment period.
Clients returning to UPP are not sanctioned if they maintain their insurance. The person may be currently enrolled in their health insurance plan as long as they were on UPP prior to being on Medicaid, RMA or CHIP and there was no break in coverage. UPP reimbursement may begin the month following the closure of Medicaid, RMA or CHIP.
Transitions between UPP and Other Medical Programs
When the following transitions occur, requirements in #2 apply.
CHIP to UPP (within the CHIP certification period)
CHIP to UPP (when the CHIP certification period has ended)
CHIP to UPP to CHIP (within the CHIP certification period)
CHIP to UPP to CHIP (when the CHIP certification period has ended)
UPP to Medicaid to UPP
UPP to RMA to UPP
Criteria:
Do not require a new application.
Determine the health insurance plan is an “UPP Qualified Health Plan”.
If eligible for UPP, create a new certification period.
All eligibility factors must be met.
Exception: the person may be currently enrolled in their health insurance plan as long as they were on UPP prior to Medicaid or RMA and there was not a break in coverage.
Complete a new access to insurance test and re-determine income. See section 1004 to determine countable income.
Waive the open enrollment requirement for adults if there has not been a break in coverage. Children are always exempt from the UPP open enrollment requirement.
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.