Common use of Eligibility Exclusions Clause in Contracts

Eligibility Exclusions. Notwithstanding the criteria outlined in this section or in Table A, the following individuals are excluded from this demonstration. Payments or expenditures related to uncompensated care for such individuals as defined in STC 54, and for DSHP as described in STC 58, however, may be included as allowable expenditures under the Safety Net Care Pool (SNCP). In addition, SUD services described in STC 40 provided to MassHealth eligible individuals age 65 and over as well as benefits provided to recipients of state veteran annuities, regardless of age, described in the expenditure authority, may be included as an allowable expenditure under the demonstration. Individuals 65 years and older, to the extent that such an exclusion is authorized by MGL Ch118E Sec 9A, except for individuals eligible in accordance within 42 CFR 435.110 Participants in Program of All-Inclusive Care of the Elderly (PACE), except as otherwise described at STC 20(a) Refugees served through the Refugee Resettlement Program Enrollment Caps. The Commonwealth is authorized to impose enrollment caps on populations made eligible solely through the demonstration, except that enrollment caps may not be imposed for the demonstration expansion population groups listed as “Hypotheticals” in Table A. Setting and implementing specific caps are considered amendments to the demonstration and must be made consistent with section III, STC 7. Twelve Month Continuous Eligibility for Student Health Insurance Program Population. Individuals who are enrolled in a cost-effective Student Health Insurance Program will be continuously eligible for a period of up to 12 months while enrolled in the SHIP plan, until the end of the policy year date. The policy year will end on either July 31 or August 31 of each year. The Commonwealth will determine the individual’s eligibility at the completion of each policy year to ensure that the individual remains eligible.

Eligibility Exclusions. Notwithstanding the eligibility criteria outlined in this section or in Table A, the following individuals are excluded from this demonstration. Payments or expenditures related to uncompensated care for such individuals as defined in STC 54, section VIII and for DSHP as described in STC 58section VIII, however, may be included as allowable expenditures under the Safety Net Care Pool (SNCP). In addition, SUD services described in STC 40 section VI provided to MassHealth eligible individuals age 65 and over as well as benefits provided to recipients of state veteran annuities, regardless of age, described in the expenditure authority, may be included as an allowable expenditure under the demonstration. Individuals 65 years and older, to the extent that such an exclusion is authorized by MGL Ch118E Sec 9A, except for individuals eligible in accordance within 42 CFR 435.110 Individuals who are eligible based on institutional status Participants in Program of All-Inclusive Care of the Elderly (PACE), except as otherwise described at STC 20(a) Refugees served through the Refugee Resettlement Program Enrollment Caps. The Commonwealth is authorized to impose enrollment caps on populations made eligible solely through the demonstration, except that enrollment caps may not be imposed for the demonstration expansion population groups listed as “Hypotheticals” in Table A. Setting and implementing specific caps are considered amendments to the demonstration and must be made consistent with section III, STC 7. Twelve Month Continuous Eligibility for Student Health Insurance Program Population. Individuals who are enrolled in a cost-effective Student Health Insurance Program Plan will be continuously eligible for a period of up to no greater than 12 months while enrolled in the SHIP planSHIP, until the end of the policy year date. The policy year will end on either July 31 or August 31 of each year. The Commonwealth will determine redetermine the individual’s eligibility at the completion of each policy year to ensure that the individual remains eligible.

Eligibility Exclusions. Notwithstanding the criteria outlined in this section or in Table A, the following individuals are excluded from this demonstration. Payments or expenditures related to uncompensated care for such individuals as defined in STC 5453, and for DSHP as described in STC 5857, however, may be included as allowable expenditures under the Safety Net Care Pool (SNCP). In addition, SUD services described in STC 40 provided to MassHealth eligible individuals age 65 and over as well as benefits provided to recipients of state veteran annuities, regardless of age, described in the expenditure authority, may be included as an allowable expenditure under the demonstration. Individuals 65 years and older, to the extent that such an exclusion is authorized by MGL Ch118E Sec 9A, except for individuals eligible in accordance within 42 CFR 435.110 Participants in Program of All-Inclusive Care of the Elderly (PACE), except as otherwise described at STC 20(a) Refugees served through the Refugee Resettlement Program Enrollment Caps. The Commonwealth is authorized to impose enrollment caps on populations made eligible solely through the demonstration, except that enrollment caps may not be imposed for the demonstration expansion population groups listed as “Hypotheticals” in Table A. Setting and implementing specific caps are considered amendments to the demonstration and must be made consistent with section III, STC 7. Twelve Month Continuous Eligibility for Student Health Insurance Program Population. Individuals who are enrolled in a cost-effective Student Health Insurance Program will be continuously eligible for a period of up to 12 months while enrolled in the SHIP plan, until the end of the policy year date. The policy year will end on either July 31 or August 31 of each year. The Commonwealth will determine the individual’s eligibility at the completion of each policy year to ensure that the individual remains eligible.

Eligibility Exclusions. Notwithstanding the criteria outlined in this section or in Table A, the following individuals are excluded from this demonstration. Payments or expenditures related to uncompensated care for such individuals as defined in STC 5453, and for DSHP as described in STC 5857, however, may be included as allowable expenditures under the Safety Net Care Pool (SNCP). In addition, SUD services described in STC 40 provided to MassHealth eligible individuals age 65 and over as well as benefits provided to recipients of state veteran annuities, regardless of age, described in the expenditure authority, may be included as an allowable expenditure under the demonstration. Individuals 65 years and older, to the extent that such an exclusion is authorized by MGL Ch118E Sec 9A, except for individuals eligible in accordance within 42 CFR 435.110 Participants in Program of All-Inclusive Care of the Elderly (PACE), except as otherwise described at STC 20(a) Refugees served through the Refugee Resettlement Program Enrollment Caps. The Commonwealth is authorized to impose enrollment caps on populations made eligible solely through the demonstration, except that enrollment caps may not be imposed for the demonstration expansion population groups listed as “Hypotheticals” in Table A. Setting and implementing specific caps are considered amendments to the demonstration and must be made consistent with section III, STC 7. Twelve Month Continuous Eligibility for Student Health Insurance Program Population. Individuals who are enrolled in a cost-effective Student Health Insurance Program will be continuously eligible for a period of up to 12 months while enrolled in the SHIP plan, until the end of the policy year date. The policy year will end on either July 31 or August 31 of each year. The Commonwealth will determine the individual’s eligibility at the completion of each policy year to ensure that the individual remains eligible.