All Medicaid Programs |
Obsolete Policy |
The Utah Department of Health may limit the number of adults covered by UPP and will accept applications for adults only during certain open enrollment periods. Children are not subject to the open enrollment requirement. References to open enrollment requirements in this section are only applicable to adults.
UPP Applications
An individual must complete and submit an application during the open enrollment period to be considered for enrollment. This includes individuals residing in households with open Medicaid cases, who are not included in the Medicaid coverage because they do not qualify for a Medicaid program.
Any Department approved application form submitted during the open enrollment period will be accepted. This includes an UPP, PCN, Medicaid, CHIP, DWS application form, online application etc. See section 703-2. Accept applications for children at any time.
UPP coverage can begin no earlier than the first day of the month the application is received.
Exceptions to Open Enrollment for UPP Reviews
If a UPP recipient submits their review by the last day of the review month and the review process cannot be completed in the review month or there is no time to send 10 day notice of an adverse action, extend eligibility to the next month. This is called the due process month.
Waive the UPP open enrollment requirement if all requested verification are received by the “due date” or the end of the due process month and the adult remains UPP eligible. The new certification period begins the first day of the month after the due process month.
If the client does not complete the review process by the end of the due process month, the case closes.
If an UPP recipient fails to complete the review process during the review month, the case closes at the end of the review month, and the client has three months to complete the review. UPP remains closed while the eligibility agency determines eligibility.
Waive the UPP open enrollment requirement if the review is completed or a new application is received in the three months immediately following the review month.
Waive the ‘already insured’ rule for UPP recipients during the three month reconsideration period.
The application processing time period applies. The client must provide requested verifications within the application processing time period.
If eligible the effective date of the new certification period is the first day of the month that the review was completed. There is no retroactive eligibility.
Exceptions to Open Enrollment for UPP Reported Changes
If an UPP recipient submits requested verification for a reported change after the case was closed but by effective date of the closure, and there is not time to send 10 day notice of an adverse action, reopen UPP and extend benefits to the next month while eligibility is being determined.
Waive the UPP open enrollment requirement.
If an UPP recipient submits all requested verification for a reported change after the effective closure date, treat the verification as a new application.
Waive the UPP open enrollment requirement in the month immediately following the closure.
The new application date is the date all requested verification is received.
The client must provide any additional verification within the application processing time period.
The effective date of the new certification period is the first day of the month after the case closure month.
Transitions between UPP and CHIP, and PCN
The following criteria must be met when opening UPP for someone who has had CHIP or PCN without a break in coverage. See Section 1009-5 for further details.
Do not require a new application.
Waive the open enrollment requirement.
All eligibility factors must be met.
Do a new income determination.
Complete a new access to insurance test.
If eligible, open UPP and create a new certification period.
Pending Medical Applications
Consider UPP for any individual who is included in the household for a Medicaid, RMA or CHIP application that is pending when the open enrollment begins.
The UPP effective date for an adult is the first day of the month of the open enrollment.
A new application is not required.
The UPP effective date for a child is the first day of the month of application.
Medicaid and RMA Closures and Denials
Consider UPP eligibility for adults in the following situations. A new application is not required.
A Medicaid or RMA recipient reports a change during an open enrollment period, returns requested verifications by the due date, and you determine that the client is no longer eligible and the Medicaid or RMA case will be closed the last day of the open enrollment month or the month immediately following the open enrollment period. The effective date of coverage for UPP is the first day of the month immediately following the Medicaid or RMA closure.
An individual applies for Medicaid or RMA before the open enrollment period and returns all requested verification by the due date during the open enrollment period and you determine that the applicant is not eligible for Medicaid or RMA. The UPP effective date is the first day of the month of open enrollment.
Medicaid and RMA Reviews
Consider UPP eligibility for adults in the following situations. A new application is not required.
A Medicaid or RMA recipient turns in a review form during an open enrollment period and you determine that the recipient is no longer eligible for Medicaid or RMA and Medicaid or RMA will be closed by the last day of the open enrollment month or the month immediately following the open enrollment period. The effective date of coverage for UPP begins the 1st day of the month immediately following the Medicaid or RMA closure.
A Medicaid or RMA recipient turns in a review form before an open enrollment period and the recipient returns requested verifications by the due date and you determine during the open enrollment period that the client is no longer eligible for Medicaid or RMA and Medicaid or RMA will end by the last day of the open enrollment month or the month immediately following the open enrollment period. The effective date of coverage for UPP is the first day of the month immediately following the Medicaid or RMA closure.