Current through Bulletin 2024-06, March 15, 2024
(1) Subject to the limitations in Sections
R414-306-4
and
R414-310-6,
the effective date of PCN enrollment is the first day of the application month
with the following exceptions:
(a) An
applicant may be eligible for PCN if the applicant applies during an open
enrollment period and will turn 19 before the end of the month in which open
enrollment ends.
(i) Enrollment in PCN may
not begin before an individual turns 19 years of age.
(ii) If an applicant qualifies for Medicaid
or CHIP in the application month, enrollment in PCN begins the month after
eligibility for Medicaid or CHIP ends.
(b) If the individual is moving from UPP, the
effective date of enrollment is the first day after the health insurance
coverage ends.
(c) If the
individual is moving from Medicaid, or is eligible for Medicaid in the
application month or the month following the application month, the effective
date of enrollment is the first day of the month after Medicaid coverage ends.
To enroll in PCN, Medicaid eligibility must end by the end of the month
following the application month.
(2) The effective date of reenrollment for
PCN after the eligibility agency completes the periodic review is the first day
after either the review month or due process month. Subsection
R414-310-11(5)
defines the effective date of reenrollment when the enrollee completes the
review process in the three calendar months after the case is closed for
incomplete review.
(3) The
eligibility agency shall end eligibility for any of the following reasons:
(a) the individual turns 65 years of
age;
(b) the individual enrolls in
a health coverage plan as defined in Subsection 414-310-6(2);
(c) the individual gains access to an
employer-sponsored health plan that meets the requirements of Subsection
R414-310-6(2);
(d) a change in income or household
composition results in the individual exceeding the income limit;
(e) the individual dies;
(f) the individual moves out of state or
cannot be located; or
(g) the
individual enters a public institution or an Institution for Mental
Disease.
(4) An enrollee
who gains access to or enrolls in an employer-sponsored health plan may switch
to the UPP program if the enrollee meets UPP eligibility
requirements.
