Eligibility Redeterminations Clause Samples
Eligibility Redeterminations. The state must ensure that redeterminations of eligibility for this component of the demonstration are conducted, at a minimum, once every 12 months. At the State’s option, redeterminations may be administrative in nature.
Eligibility Redeterminations i. Mid-benefit year. The NMHIX shall re-determine eligibility of Qualified Individuals during the plan year in accordance with 45 CFR §155.330, State laws and regulations, and as required by the OSI. In the event that a Carrier becomes aware of changes in a Qualified Individual’s circumstances during a plan year that could lead to a change in such Qualified Individual’s eligibility status, Carrier shall notify the NMHIX within a reasonable time thereafter and the NMHIX shall conduct an eligibility redetermination.
ii. Annual Eligibility Redeterminations. Annual redeterminations shall be conducted in accordance with 45 CFR §155.335, other applicable State and federal laws, and as required by the OSI.
Eligibility Redeterminations. Contractor must redetermine the eligibility of Enrollee in a MCE or HCCI program at least once every twelve (12) months.
A. These eligibility redeterminations cannot use income eligibility standards more restrictive during the period of redetermination than those “in effect” during the period of the MCE or HCCI recipient’s initial eligibility determination.
B. Each redetermination must include a reassessment of the recipient’s eligibility for Medi-Cal and the CHIP. If upon redetermination a recipient is determined ineligible the recipient shall be disenrolled in according with Provision 2, Disenrollment, and referred to the county Medi-Cal office, if appropriate.
Eligibility Redeterminations. Individuals enrolled in the GNOCHC program must have an eligibility redetermination at least once every 12 months. Each redetermination must include a reassessment of the individual’s eligibility for Medicaid and CHIP. A GNOCHC enrollee may apply for Medicaid and CHIP at any time for any reason. The State will determine eligibility and enroll individuals in programs for which they are found eligible.
Eligibility Redeterminations. 1. Mid-benefit year. The MHBE shall redetermine eligibility of Qualified Individuals during the plan year in accordance with 45 CFR §155.330, State laws and regulations, including but not limited to COMAR 14.35.07. In the event that Carrier becomes aware of changes in a Qualified Individual’s circumstance during a plan year that could lead to a change in such Qualified Individual’s eligibility status, Carrier shall notify the MHBE within a reasonable time thereafter and the MHBE shall conduct an eligibility redetermination.
Eligibility Redeterminations a. A demonstration enrollee may apply for eligibility under the Medicaid state plan at any time for any reason. The state must determine eligibility for Medicaid and CHIP and enroll individuals in programs for which they are found eligible, unless the individual is found eligible for a limited Medicaid benefit package and the individual chooses to enroll in the demonstration in lieu of the limited Medicaid benefit package.
b. As the state develops its eligibility systems to make determinations based on MAGI, redeterminations will be updated to allow for eligibility determinations as required under the Affordable Care Act.
c. Redeterminations for demonstration enrollees (who are found eligible in 2012) may take place after a period of greater than 12 months.
d. For those individuals who are found eligible in 2012, eligibility must be redetermined prior to January 1, 2014 to ensure that individuals are properly enrolled in a health coverage option beginning in January 2014. Therefore, determinations for demonstration enrollees (who are found eligible in 2012) may take place after a period of greater than 12 months. An individual would not need to be redetermined if the period is less than 12 months.