All Medicaid Programs |
Obsolete Policy |
The certification period begins on the effective date of the UPP coverage. (See Section 1007) The last month of enrollment is the review month. (See Section 1008-1) The certification period for UPP is 12 months. With few exceptions, once an applicant is determined to be eligible for UPP, he or she remains eligible for the entire certification period.
Exceptions to the 12 Months of Eligibility - An UPP recipient may lose eligibility before the end of the 12-month certification period in the following situations:
The recipient moves out of state or cannot be located.
The recipient enters a public institution or an institution for mental disease.
The recipient dies.
The recipient becomes eligible to enroll in Medicare.
The recipient turns 19. Eligibility ends the last day of the month the person turns age 19.
The recipient becomes covered by the Veteran's Administration Health Care System.
The recipient gains access to VA benefits but does not follow through with the VA application process.
The recipient becomes eligible for another medical program without a spenddown, or MWI premium.
A child enrollee discontinues employer-sponsored health insurance or COBRA and enrolls in CHIP.
Create a new CHIP certification period.
A recipient of Utah’s Premium Partnership enrolls in, or there is a change in, an employer-sponsored insurance and the cost of coverage does not exceed 5% of the individual's countable income after any applicable 5% disregard is applied. (See 1003-4 C for how to determine cost of coverage)
A recipient of Utah’s Premium Partnership enrolls in a new employer-sponsored insurance and does not report it within 10 days from either the day the recipient signs up or the health insurance coverage begins, whichever is later.
A recipient's employer-sponsored insurance no longer meets the definition of an “UPP Qualified Health Plan”. (See 1003-1, M).
An UPP recipient enrolls in any other type of creditable health insurance coverage other than the employer-sponsored coverage or COBRA.
Health insurance coverage is not confirmed during the quarterly review by DOH (see 1009-1).
An UPP recipient is no longer covered for employer-sponsored or COBRA coverage.
A due process month (see Glossary) may be allowed at review. A due process month initiated at review is not part of a 12 month certification.
When you cannot give a 10-day notice before deciding eligibility, extend benefits to the following month. (See Section 811, and 1008-1)
Changes discovered or reported during the 12 month certification period
Only act on the information when the individual requests a Medicaid determination, requests a new income determination, or the reported change is an exception to the 12 month certification period. (For exceptions, see A above and Section 1009 for more information on changes.)
Requesting Medicaid or a New Income Determination: If the client submits a new application or asks for Medicaid in person, or via phone, fax, email, or in writing, or requests a new income determination, complete a Medicaid determination.
If the change makes any UPP recipient in the household eligible for Medicaid without a spenddown, or MWI premium, remove the individual from UPP and open Medicaid.
If the change makes the individual ineligible for Medicaid, continue UPP until the end of the certification period unless the change is an exception to the 12 month certification period. (See A above.)
No Request for Medicaid or Income Determination: Only make a change at application or review.
If the client does not turn in a new application, ask for Medicaid, or ask for a new income determination, do not determine eligibility for Medicaid.
If the change becomes known through interface matches or tasks; continue the certification period and take action at application and review.
When to Establish a New 12-Month Certification Period
The certification period for UPP must be redetermined at 12 months. A new 12-month certification period will be established when a recipient completes the review process at the end of a certification period and continued eligibility for UPP is established.
Create a new 12-month certification period when a client moves from CHIP, PCN, or Medicaid to UPP.
Transferring an Electronic Account to the FFM
The electronic client information will be transferred to the FFM when UPP is closed.