All Medicaid Programs |
Obsolete Policy |
Effective Date: February 1, 2021 - November 30, 2021
General Requirements
1. Any individual eligible for Adult Expansion Medicaid program who has access to or is enrolled in an Employer-Sponsored Insurance plan (ESI), must meet the enrollment requirements or be exempt from enrollment.
2. An Employer-Sponsored Health Plan is health insurance offered by an employer to an employee and/or their dependents.
3. The ESI requirement provides a premium reimbursement for the cost of the employee’s portion of the monthly insurance premium when the plan is a Qualified Health Plan (QHP).
o Do not reimburse contributions made by the individual or their employer to an HSA or FSA account.
4. Individuals who are not eligible for the ESI reimbursement include:
o Individuals who are already enrolled in any other type of health insurance plan that is not their employer-sponsored health plan.
o Adult Expansion – Presumptive Eligibility
o Adult Expansion – Emergency only recipients
o Individuals who do not have access to a qualified ESI plan.
5. Individuals eligible for ESI premium reimbursement will also receive Medicaid benefits.
6. The ESI medical insurance information must be reviewed at application, review and changes to access to health insurance for the Adult Expansion program.
348-3.1 ESI Enrollment Requirements
348-3.2 Health Insurance Coverage
348-3.3 Disenrollment Period for Adult Expansion