All Medicaid Programs |
Obsolete Policy |
The Eligibility Period
The eligibility period includes all days and months an individual is eligible for assistance based on an approved application or an approved eligibility review.
The recipient must complete an eligibility review in the last month of the assigned eligibility period.
The client must also report changes during the eligibility period that may affect the client's eligibility. (See section 721 on reviews and 107-4 on reporting changes.)
The first day of the eligibility period is the first day for which assistance is approved.
It may include retroactive months, the three months immediately before the application month.
The benefit effective date is usually the first day of the month, either the application month or one of the retroactive months.
In a few cases, the benefit effective date will not be the first day of a month. (See Sec. 711 for exceptions to beginning benefits on the first day of a month.)
For an approved review, the eligibility period begins on the first day of the month after the review month.
The eligibility period ends at the end of the review month, unless information about a change causes the client to be ineligible before the end of the prospective eligibility period. (See #4)
The review month is the last month the household can receive medical assistance unless a review is completed and eligibility is renewed.
Clients must report changes during the eligibility period as required by section 107-4.
Eligibility may end before the review month based on changes in the client's circumstances that make the client ineligible.
Take action on any information reported by the household or changes received from other sources such as computer matches during the eligibility period.
If a change occurs that causes the client to no longer be eligible, eligibility ends at the end of the month in which the worker can send proper notice of the closure.
Always provide 10-day notice to the household of any adverse action, including nursing home cases. For nursing home specific policy, see sections 811 and 833.
Length of the eligibility period
The length of the eligibility period is the amount of time the agency determines the client will likely continue to be eligible for medical assistance based on current information. The eligibility period will end whenever the agency determines that the client no longer qualifies for medical assistance.
The eligibility period cannot be longer than 12 months for any Medicaid or CHIP program.
All MAGI and Medicare Cost-Sharing programs have a mandatory 12 month eligibility period.
Assign 12 month eligibility periods for all other medical assistance programs unless there is evidence that circumstances are likely to change (i.e. fluctuating income).