Obsolete 1120 - 1009-5 Transitions between UPP and Other Medical Programs

Effective Date: January 1, 2020 - October 31, 2020

Transitions Between UPP and Other Medical Programs

Allow individuals to return to the UPP program from Medicaid, Refugee Medical Assistance (RMA) or CHIP. They can currently be enrolled in their health insurance plan. This does not require an UPP open enrollment period, provided that:

They were on UPP initially before being on Medicaid, RMA, CHIP; and

There is not a break in coverage.

Waive the "already enrolled rule" (1003-2) for individuals who are transitioning from Adult Expansion to UPP when they:

Were receiving an ESI premium reimbursement;

They were on UPP initially before being on Adult Expansion; and

There is not a break in coverage.

Individuals returning to UPP may be currently enrolled in their health insurance plan. They will not be sanctioned if they maintain their insurance, provided that:

They were on UPP initially before 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.

Requirements for Transitioning Between 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; or

Moving from Adult Expansion with ESI 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 individual may currently be enrolled in their health insurance plan as long as they were initially on UPP before being on Medicaid or RMA and there was not a break in coverage.

Complete a new access to insurance test (1003-4) and re-determine income. See section 1004 to determine countable income.

Waive the open enrollment requirement (1000-3) 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.