All Medicaid Programs |
Obsolete Policy |
Special Rules for Reviews in January-March 2014
Initially, use MAGI rules to determine eligibility. If individuals are eligible, re-certify the UPP for 12 months. If the individuals are eligible under another MAGI program using the MAGI methodology, close the UPP and open the other MAGI program.
If the individuals fail both eligibility for UPP and other MAGI programs using the MAGI methodology, use 2013 eligibility policy to determine medical eligibility.
If the individual passes eligibility for other medical assistance programs using 2013 eligibility policy, continue eligibility through March 2014 and re-determine medical assistance eligibility for April 1, 2014 using MAGI rules. If the individual passes eligibility for UPP using 2013 rules, continue UPP under 2013 rules for another 12-month certification period.
The eligibility agency must re-determine eligibility for UPP every 12 months.
Send a pre-populated review form, including the 116M form, to the client. (See 1008-2 for details of the review process)
The review form must include the most current electronic information available and a list of verification needed to complete the review.
The client must submit a new form 116M at all reviews.
The client has 30 days from the date the form is mailed to respond.
The review form must be signed to be considered complete.
If the case closes because the client does not complete the review request, there is a three month reconsideration period after the review month for the client to contact the eligibility agency to complete the review.
The benefit effective date is the first day of the month in which the client responds.
No interview or application form is required.
Waive the ‘already insured rule’.
If the client does not complete the review within the three month reconsideration period, the client must re-apply during the next open enrollment period.
All eligibility factors apply, including enrollment in employer-sponsored health insurance.
Referrals for the Advanced Premium Tax Credit.
The electronic client information will be transferred to the FFM when UPP is closed.
When the agency completes a review for financial, food stamp or other medical programs during the UPP certification period, an UPP review can be completed if all factors of eligibility are reviewed.