Ma eligibility begins:
The date when the CAO gets and stamps a signed application form.
The earliest date the application is signed by the applicant if it is submitted by an MA provider or at any site chosen by the Department of Public Welfare (DPW).
The date a COMPASS application is submitted online.
The date of first treatment or admission if the COMPASS application is submitted by an MA provider.
The date the application was submitted to the FFM if the application is forwarded to the CAO from the FFM.
Eligibility ends on the date the individual no longer meets the eligibility requirements.
A child born to a woman who is receiving MA or CHIP on the date of the child's birth automatically receives MA coverage for one year. (See Section 309.32.)
A woman who is determined eligible and authorized for SelectPlan at the end of her post-partum coverage is entitled up to 12 months of SelectPlan eligibility. If a woman is eligible for SelectPlan, her eligibility begins the first day of the calendar month following her 60 day post-partum coverage. (See Section 311.3.)
An individual can apply for benefits for medical services in the past if he or she has an unpaid medical expense from before the application date. Benefits for past medical services may be approved for the period starting with the first day of the third month before the date of application. The individual may choose to apply for either (a) retroactive-only, (b) continuing-only, or (c) combined retroactive and continuing MA benefits.
Eligibility ends on the date the individual no longer meets the eligibility requirements.
Individuals may be eligible for a 4 month extension of MA under TMA if all of the following criteria are met:
The individual was eligible in a PC/PU 27, MG 27 or C/U budget for 3 out of the last 6 months (not including the closing month).
The individual meets the target criteria to be eligible for MAGI-related MA (requesting MA as a parent/caretaker or child, with the dependent child still in the household).
The individual is ineligible for MG 27 or C/U due to an increase in earned income, alimony or spousal support.
TMA is authorized as MG 71, effective the processing date of the income change. A renewal is due at the end of the 4th month (not including the month of change).
[42 CFR 435.170, 42 CFR 435.117(a)]
Example: On January 6th, an income increase is processed on an MG 27 case and causes net income for the household to increase above the MG 27 limit. The household members have been eligible for MG 27 for 3 or more of the past 6 months and still meet MAGI target criteria, TMA is explored and MG 71 is opened effective January 6th. The renewal date is set to May 31st.
At renewal, a TMA recipient will be reviewed for other MA eligibility besides TMA. An individual can have multiple periods of TMA in a lifetime depending on changes in income, but there are no consecutive TMA periods.
Renewals for MAGI MA budgets are completed once every 12 months. There is no semiannual reporting (SAR) for MAGI MA.
At application, the renewal date is the last day of the 11th month from the earliest authorized MAGI budget (this applies to retroactive eligibility also).
Example: Application date of 06/15/2014, the renewal date is set for 05/31/2015.
At renewal, the renewal date is the last day of the 12th month from the renewal processing.
Example: Renewal date is 05/31/2015, the next renewal date is set for 05/31/2016.
MAGI and Non-MAGI MA renewals for cases with MAGI and Non-MAGI MA budgets must be processed at the same time.
A renewal packet must be sent to the recipient. The recipient must be allowed at least 30 days to complete and return the packet to the CAO. When processing a renewal, the CAO must complete an ex-parte review of the case. MAGI renewals must be processed without requiring additional information from the individual, if the CAO is able to obtain eligibility information via electronic sources.
If the CAO is unable to verify reported information via electronic sources a PA 253 must be generated to the individual requesting the information required for eligibility determination.
The CAO will send a notice informing the recipient of the outcome of the renewal, regardless of whether there is a change in MA or not.
If MAGI renewal is not received timely, and MA is closed, the reconsideration time frame is 90 days.
Issued September 19, 2014