The Automated process for determining MA eligibility reviews eligibility for MA applicants, MA recipients, and TANF recipients who are due to stop getting benefits in the following order:
1. Presumptive Eligibility for Pregnant Women (Chapter 312.9)
2. Foster Care/Adoption Subsidy (see Supplemental Handbook, Chapter 850)
3. Long-Term-Care Facility and Home and Community-Based Services (see Long-Term Care Handbook)
4. Extended NMP Special Circumstances (see Chapter 387.6)
5. Refugee Unaccompanied Minor (see Supplemental Handbook, Chapter 730)
6. Healthy Horizons (see Chapter 319)
7. SSI-related NMP (see Chapter 368)
8. NMP for the Family (see Chapter 368)
NOTE: When determining whether other family members are eligible for SSI-related NMP/Healthy Horizons, the CAO must include the following individuals in the NMP for the Family budget group:
Children under 18.
Full-time students who are age 18 or over.
Parent who is eligible for SSI-related NMP/HH.
Spouse who is eligible for SSI-related NMP/HH.
NOTE: Children between over age 18 and under age 21 who is eligible for SSI-related NMP/HH may be included.
The CAO must assign each eligible individual to the correct SSI-related NMP/Healthy Horizons category.
9. Automatic Medical Coverage Extensions ( Chapter 338)
The CAO will use one of the following Automatic Medical Coverage Extensions that best meets the family’s needs:
Newborn eligibility (Section 338.41)
Pregnancy and postpartum ( Section 338.42)
Payment of support (see Section 338.43)
TANF closure for a reason that does not affect MA eligibility (see Section 338.45)
Employment (EMC) (see Chapter 339)
NOTE: Determine eligibility for EMC for the entire family if the entire family is not eligible for NMP. Persons found eligible for EMC are identified as PC/PU 71.
10. RMA—Non-SSI/Non-pregnant (see Supplemental Handbook, Chapter 730)
11. TANF and GA-related NMP (see Chapter 369)
NOTE: Persons found eligible for NMP using this method are identified as PC/PU 00.
12. Special eligibles.
Breast and Cervical Cancer Prevention and Treatment (BCCPT) (see Chapter 317)
13. Income-ineligible pregnant women (see Chapter 312)
14. Special eligibles (SSI-Related).
Medical Assistance for Workers with Disabilities (MAWD) (see Chapter 316)
15. Home and Community-Based Services for individuals with AIDS or symptomatic HIV (see Long-Term Care Handbook)
16. SSI, TANF, and GA-related MNO (see Chapter 369)
NOTE: The CAO will determine eligibility for MNO for other family members.
17. Income-Ineligible Newborn (see Chapter 312)
18. RMA—Family with Children (see Supplemental Handbook, Chapter 730)
19. SSI-Ineligible Children (PJ 98) (see Section 387.65)
20. Children with Special Needs (PH 95).
21. Healthy Horizons Cost-Sharing (see Chapter 319)
22. Medicare Buy-In (payment of monthly Medicare premiums) (see Chapter 388)
23. Prison Inmate—children (see Supplemental Handbook, Chapter 850)
24. Special Eligibles – SelectPlan for Women (PSF-00)
Updated February 14, 2012, Replacing June 28, 2007