Utah Administrative Code
Topic - Health
Title R414 - Integrated Healthcare
Rule R414-310 - Medicaid Primary Care Network Demonstration Waiver
Section R414-310-13 - Change Reporting and Benefit Changes
Universal Citation: UT Admin Code R 414-310-13
Current through Bulletin 2024-06, March 15, 2024
(1) Unless otherwise stated, the provisions in Section R414-308-7 apply to the PCN program.
(2) Reportable changes are defined in Subsection R414-310-3(2).
(3) For a decrease in income, the following provisions apply:
(a) If a change is already
anticipated in a best estimate of income, the eligibility agency may only
re-determine eligibility if the enrollee requests a redetermination of
benefits.
(b) If a change is not
anticipated, the agency shall re-determine eligibility.
(c) If a change makes the enrollee eligible
for Medicaid, the effective date of the change is the first day of the month of
report, if the change is verified timely.
(d) If a change is not verified timely, the
change is effective on the first day of the month the change is
verified.
(4) If an enrollee requests enrollment for a spouse, the application date for the spouse is the date of the request, and the following provisions apply:
(a) The eligibility agency does not require a
new application;
(b) Eligibility is
determined in accordance with Section
R414-310-11;
(c) The effective date of enrollment is
determined in accordance with Section
R414-310-12;
and
(d) The applicant must meet all
other eligibility requirements.
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