Eligibility begins on the date the qualified provider signs the MA 332. 55 Pa. Code § 140.142
Eligibility ends at either of the following times, whichever comes first: 55 Pa. Code § 140.142
The earliest date that action can be taken after a notice is sent and the individual no longer is eligible for Healthy Beginnings.
NOTE: This applies only if the CAO decides that the woman is not eligible for continuing Healthy Beginnings.
45 days from the date when the qualified provider signs the MA 332.
NOTE: The CAO must decide whether the woman can get continuing MA benefits during the 45-day period.
Eligibility begins at one of the following times: 55 Pa. Code § 140.124
The date the application is date-stamped by the CAO.
The date the application is signed, if it is submitted by a provider.
The date the application was submitted through Commonwealth of Pennsylvania Access to Social Services (COMPASS).
Eligibility ends at the following times: 55 Pa. Code § 140.125
For a pregnant woman—the last day of the month in which the 60-day postpartum period ends (See Chapter 338, MA Benefits, for information about eligibility during this period.)
At the end of the 60 day postpartum eligibility period a SAR or a complete renewal for ongoing MA and SelectPlan eligibility is required to be completed.
MA:
A SAR is required if the last application for MA was less than 11 months prior to the end of the woman’s postpartum eligibility period. The caseworker will use the information provided on the last application. The renewal date will be reset based on the last application date.
A complete renewal is required if the woman’s last MA application was 11 months or more prior to the end of the postpartum eligibility period. A renewal packet is to be sent to the individual. MA is to be closed for the woman as scheduled if the renewal form and required proof are not returned.
SelectPlan:
A SAR is required to be completed based on the information already in the record. If a woman is eligible for SelectPlan, eligibility starts the first day of the calendar month following her 60 days postpartum coverage. The woman is automatically entitled to 12 months of continued SelectPlan eligibility with the renewal date as the last day of the 12th month.
For a qualified child, the date the child meets the age limit, unless the child is hospitalized on that date.
The CAO will process a renewal to determine whether the child can remain eligible for MA no later than the first work day of the week after the qualified child’s birthday. An Advance Notice is issued notifying the recipient that benefits will be discontinued if the child does not qualify for any other MA Program.
For a change in income or other circumstances an Advance Notice is processed.
Exception: A pregnant woman who has been receiving benefits continues to be eligible for MA coverage through the 60-day postpartum period following birth. Her newborn is automatically eligible for MA for one year, even if the family income is above the income limit in Appendix D.
NOTE: In cases where there are multiple budgets open with a Healthy Beginnings budget, the CAO will take the necessary steps to align all budget renewal dates to the same date. The Healthy Beginnings renewal is processed at the same time the other renewals are due.
Retroactive coverage begins at the following times: 55 Pa. Code § 181.12
For the mother, as early as the first day of the third month before the month when she applies. The woman must have been pregnant during the retroactive months to get Healthy Beginnings coverage for those months.
For children, as early as the first day of the third month before the month when the application was submitted.
For newborns, as early as the day they were born.
NOTE: If the child is approved for retroactive Healthy Beginnings benefits as of the date of birth and the mother is eligible for retroactive coverage on the date of birth, the child is eligible for one year.
For retroactive coverage for the mother only, eligibility ends on the last day of the month when the 60-day postpartum period ends.
Reminder: Before Healthy Beginnings is stopped, the CAO must decide whether the individual can get MA under any MA category to include SelectPlan. If so, the CAO must approve MA in the right category without interruption in MA coverage.
In cases where there are multiple budgets open , the CAO will take the necessary steps to align all budget renewal dates to the same date. Healthy Beginnings budgets are processed at the same time the other renewals are due.
Updated February 14, 2012, Replacing October 13, 2009