Eligibility Determination. EOHHS will have sole authority for determining whether individuals or families meet any of the eligibility criteria and therefore are eligible to enroll in a Health Plan.
Eligibility Determination. The State or its designee will make eligibility determinations for each of the HHSC HMO Programs.
Eligibility Determination. The State or its designee will make eligibility determinations for each of the HHSC MCO Programs.
Eligibility Determination. The Department will determine the initial and ongoing eligibility for services of each enrollee or potential enrollee under this Contract.
Eligibility Determination. BMS will determine the initial and ongoing eligibility for medical assistance of each enrollee or potential enrollee under this Contract.
Eligibility Determination. The Department shall have the exclusive right to determine an individual’s eligibility for the Medicaid Program and eligibility to become a Member of the Contractor. Such determination shall be final and is not subject to review or appeal by the Contractor. Nothing in this section prevents the Contractor from providing the Department with information the Contractor believes indicates that the Member’s eligibility has changed.
Eligibility Determination. 14.1.1 TDH will identify Medicaid recipients who are eligible for participation in the STAR program using the eligibility status described below.
14.1.2 Individuals in the following categories who reside in any part of the Service Area must enroll in one of the health plans providing services in the Service Areas:
14.1.2.1 TANF ADULTS - Individuals age 21 and over who are eligible for the TANF program. This category may also include some pregnant women.
14.1.2.2 TANF CHILDREN - Individuals under age 21 who are eligible for the TANF program. This category may also include some pregnant women and some children less than one year of age.
Eligibility Determination. Teachers will be eligible for longevity stipends at the beginning of their 25 year of experience in Saint Xxxx Public Schools.
Eligibility Determination. Any Arizona hospital that qualifies for funding in Groups 1, 1A, 2, 2A, or 4 s eligible for funding through Group 5. Group 5 is created to enable DSH-eligible hospitals to get qualifying DSH payments matched via voluntary intergovernmental agreements (IGAs). Per State Medicaid Director Letter #10-010, the state will require the appropriate documentation that the funding has been voluntarily provided. Group 5 DSH payments are on top of the Groups 1, 1A, 2, 2A, and 4 DSH payments, but no individual hospital will receive aggregate DSH payments that exceed its OBRA limit. Funding for any hospital in Group 5 must be arranged via a voluntary intergovernmental agreement with a political subdivision, tribal government or public university, through certified public expenditures (for governmental c hospitals) or an intergovernmental transfer of public funds not derived from impermissible sources, such as impermissible provider-related donations or impermissible health care-related taxes, as a match to draw down DSH payments. Political subdivisions, tribal governments and public universities will notify AHCCCS of the hospitals designated to receive funds from Pool 5 and of the amount of matching funds that are available through their IGAs or through a certification of public expenditures. For hospitals that qualify for Group 5, a “LOM” score will be calculated by multiplying the hospital’s LIUR times the hospital’s full OBRA limit, times the hospital’s MIUR. Hospital A OBRA = $54,734,467, MIUR = 0.3542, LIUR = 0.2946 Group 5 LOM score for Hospital A = $54,734,467 x 0.3542 x 0.2946 = $5,711,394 For the first round of distributions, allocations will be provided to hospitals located outside of the Phoenix and Tucson metropolitan statistical areas which have an agreement with a political subdivision, tribal government, or public university for intergovernmental transfer of the non-federal share funding. Each participating hospital’s percentage of the total LOM score will be calculated using the hospital’s LOM score as the numerator and the total of all participating hospitals’ LOM scores as the denominator. The total amount of DSH available as a result of the IGAs (Group 5 DSH funds) will be multiplied by each hospital’s LOM percentage of this first round. If any allocation from this round is higher than a hospital’s OBRA limit (remaining after Group 1, 1A, 2, 2A, and 4 DSH distributions) or higher than the matching funds (in total computable) for that hospital, the lowe...
Eligibility Determination. The State shall have sole authority for determining whether individuals meet the eligibility criteria and therefore are eligible to enroll in a Dental Plan.
