Administrative Rules of Montana
Department 37 - PUBLIC HEALTH AND HUMAN SERVICES
Chapter 37.81 - PHARMACY ACCESS PRESCRIPTION DRUG BENEFIT PROGRAM
Subchapter 37.81.3 - Big Sky Rx Program
Rule 37.81.307 - ELIGIBILITY FOR BIG SKY RX

(1) An applicant must be eligible and enrolled in the program to receive premium assistance.

(2) To qualify the applicant must:

(3) An applicant who meets the eligibility requirements for Social Security Extra Help as outlined in 42 CFR 423.773 (2007), which is adopted and incorporated by reference, must provide a determination from Social Security Extra Help.

(4) An individual who is receiving benefits for Medicaid is not eligible for the Big Sky Rx Program.

(5) An individual in a LIS program with full premium subsidy is not eligible.

(6) Eligibility determinations shall be effective for 12 months from the date of determination regardless of change in income or household size. This also applies to an applicant on the waiting list as provided in ARM 37.81.326.

(7) Enrollees in the program must comply with procedures specified by the PDP, the department, Extra Help, and Social Security (if applicable) to receive premium assistance.

(8) Program enrollment and eligibility will terminate at the end of the month in which any of the following events occur:

(9) Termination of the benefit amount will be effective at the end of the month and a notice of termination will be mailed to the enrollee.

(10) Big Sky Rx eligibility and benefits are not an entitlement. If funding is insufficient, the department may reduce enrollment numbers or enrollment criteria to limit the number of individuals who are eligible to participate.