Disenrollment Due to Loss of Eligibility. In addition to the reasons outlined in the PACE Agreement, Appendix G, and 42 C.F.R. § 460.164, Members admitted to an IMD when the service is authorized by the PACE IDT should not be disenrolled. Members may make choices below, that result in the loss of eligibility. When a member makes one of the following choices, the PACE organization will complete the change routing form and send it to the income maintenance agency and the resource center. The income maintenance agency will end the waiver eligibility and the resource center will process the disenrollment: Chooses a primary care provider who is not in the PACE organization provider network, or Chooses to enroll in any other Medicare or Medicaid prepayment plan or optional benefit, including hospice benefit. Informing the Resource Center When the PO provides information to the income maintenance agency or another agency that may result in the member being disenrolled, the PO will also inform the resource center. The income maintenance agency will determine whether the person is ineligible. If the member is found ineligible for Medicaid, the disenrollment will occur automatically in ForwardHealth interChange. The PO must offer the member an opportunity to pay the PACE premium to remain in the PACE program. The member may elect to enroll in the PACE program with a premium or disenroll from the PACE program following the determination of Medicaid ineligibility.
Disenrollment Due to Loss of Eligibility. For those Members who are disenrolled because they are no longer eligible for CHIP, CONTRACTOR will receive from the Administrative Services Contractor notice informing CONTRACTOR that the Members' coverage will end on a particular date. Disenrollment due to loss of eligibility includes, but is not limited to: "Aging-out" when a child turns nineteen; Failure to re-enroll at the conclusion of the 12-month eligibility period; Change in health insurance status, such as a child enrolling in an employer-sponsored health plan; Failure to meet monthly cost-sharing obligation; Death of a child; The child permanently moves out of the state; and Data match with the Medicaid system indicates dual enrollment in Medicaid and CHIP. If a child is disenrolled from CHIP, the child loses his or her CHIP eligibility and must re-apply for a determination of CHIP eligibility in the future. Regardless of the reason for retroactive disenrollment, recoupment of premium payments by HHSC shall be in accordance with section 10.05. Under no circumstances may HHSC recoup premiums paid for a period greater than two (2) months.
Disenrollment Due to Loss of Eligibility. In addition to the reasons outlined in the PACE Agreement, Appendix G, and 42
Disenrollment Due to Loss of Eligibility. For those Members who are disenrolled because they are no longer eligible for CHIP, CONTRACTOR will receive from the Administrative Services Contractor notice informing CONTRACTOR that the Members' coverage will end on a particular date. Disenrollment due to loss of eligibility includes, but is not limited to:
Disenrollment Due to Loss of Eligibility. “For those Members who are disenrolled because they are no longer eligible for CHIP, CONTRACTOR will receive from the Administrative Services Contractor notice informing CONTRACTOR that the Members’ coverage will end on a particular date. Disenrollment due to loss of eligibility includes, but is not limited to: • “Aging-out” when a child turns nineteen; • Failure to re-enroll at the conclusion of the 6-month term of coverage; • Change in health insurance status, such as a child enrolling in an employer-sponsored health plan; • Failure to meet monthly cost-sharing obligation; • Death of a child; • The child permanently moves out of the state; and • Data match with the Medicaid system indicates dual enrollment in Medicaid and CHIP. In most cases, if a child is disenrolled from CHIP, the child loses his or her CHIP eligibility and will have to re-apply for a determination of CHIP eligibility. Children not subject to re-application include, but are not necessarily limited to: Children who meet reinstatement requirements after disenrollment due to failure to meet cost-share obligation; and, Children who successfully re-enroll in the first month after disenrollment due to failure to re-enroll by the conclusion of their 6-month term of coverage. Regardless of the reason for retroactive disenrollment, recoupment of premium payments by HHSC shall be in accordance with section 10.05. Under no circumstances may HHSC recoup premiums paid for a period greater than two (2) months.”
