Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 477 - MEDICAID ELIGIBILITY
Chapter 3 - APPLICATION PROCESS
Section 477-3-008 - CONTINUOUS ELIGIBILITY

Universal Citation: 477 NE Admin Rules and Regs ch 3 ยง 008

Current through September 17, 2024

008.01 CONTINUOUS ELIGIBILITY FOR PREGNANT WOMEN. Once a pregnant woman is determined Medicaid eligible, she remains continuously eligible through the post-partum period, regardless of her category of eligibility at the time the pregnancy began. Continuous eligibility does not apply to pregnant women covered during a period of presumptive eligibility.

008.02 CONTINUOUS ELIGIBILITY FOR A NEWBORN. Children born to Medicaid-eligible mothers are deemed eligible for Medicaid and remain Medicaid eligible for one year after birth. For 599 Children's Health Insurance Program (CHIP), see 477 Nebraska Administrative Code (NAC) 19.

008.03 CONTINUOUS ELIGIBILITY FOR CHILDREN. Children from birth through age 18 are eligible for six months of continuous Medicaid from the date of initial eligibility. Retroactive months do not count in the six months of continuous eligibility unless there is no prospective eligibility. For 599 Children's Health Insurance Program (CHIP), see 477 NAC 19.

008.03(A) CONTINUOUS ELIGIBILITY FOR CHILDREN (EFFECTIVE JANUARY 1, 2024). Children from birth through age 18 are eligible for one year of continuous Medicaid from the date of initial eligibility. Retroactive months do not count in the one year of continuous eligibility unless there is no prospective eligibility. For 599 Children's Health Insurance Program (CHIP), see 477 NAC 19.

008.04 CONTINUOUS ELIGIBILITY FOR HOSPITALIZED CHILDREN. Children who are eligible and enrolled in Medicaid and are receiving inpatient services covered by Medicaid on the date they lose eligibility due to age are continuously eligible until the end of their inpatient stay if the child would remain eligible but for attaining such age.

008.05 EXCEPTIONS TO CONTINUOUS ELIGIBILITY. Exceptions to continuous eligibility are:

(A) A child attaining age 19 who does not meet another level of continuous eligibility, such as pregnancy or hospitalization;

(B) The individual requests voluntary termination;

(C) The individual ceases to be a state resident;

(D) The agency determines that eligibility was determined incorrectly at the most recent determination or redetermination of eligibility because of agency error or fraud, abuse, or perjury attributed to the individual; or

(E) The individual dies.

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