Common use of ELIGIBLE, EXEMPT AND EXCLUDED POPULATIONS Clause in Contracts

ELIGIBLE, EXEMPT AND EXCLUDED POPULATIONS. 5.1 Eligible Populations a) Except as specified in Section 5.1(b) and 5.3below, all persons IN the following Medicaid-eligible beneficiary categories who reside in the service area shall be eligible for enrollment in the Contractor's plan: i) Singles/Childless Couples - Cash and Medicaid only ii) Low Income Families with Children - Cash and Medicaid only iii) Aid to Families with Dependent Children - Medicaid only iv) Pregnant women whose net available income is at or below two hundred percent (200%) of the federal poverty level for the applicable household size. v) Children aged one (1) year or below whose family's net available income is at or below two hundred percent (200%) of the federal poverty level for the applicable household size. vi) Children between ages one (1) and five (5), whose family's net available income is at or below one hundred and thirty-three percent (133%) of the federal poverty level for the applicable household size. vii) Children age six (6) up to age nineteen (19), whose family's net available income is at or below one hundred and thirty-three percent (133%) of the federal poverty level for the applicable household size. viii) Transitional Medical Assistance Beneficiaries ix) Supplemental Security Income (cash) and Supplemental Security Income Related (Medicaid only). b) Medicaid eligible individuals in the following categories may be eligible for enrollment in the Contractor's plan at the LDSS' option, as indicated by an X below. i) Foster care children in the direct care of LDSS. Xxxxatory county - children in IDSS direct care are mandatorily enrolled X Mandatory OR voluntary county - children in LDSS direct care are enrolled on a case-by-case basis. Mandatory OR voluntary county - all foster care children are excluded from managed cxxx. SECTION 5 ( ELIGIBLE, EXEMPT AND EXCLUDED POPULATIONS) OCTOBER 1, 2004 5-1

ELIGIBLE, EXEMPT AND EXCLUDED POPULATIONS. 5.1 Eligible Populations a) Except as specified in Section 5.1(b) and 5.3below5.3 below, all persons IN in the following Medicaid-eligible beneficiary categories who reside in the service area shall be eligible for enrollment in the Contractor's plan: i) Singles/Childless Couples - Cash and Medicaid only ii) Low Income Families with Children - Cash and Medicaid only iii) Aid to Families with Dependent Children - Medicaid only iv) Pregnant women whose net available income is at or below two hundred percent (200%) of the federal poverty level for the applicable household size. v) Children aged one (1) year or below whose family's net available income is at or below two hundred percent (200%) of the federal poverty level for the applicable household size. vi) Children between ages one (1) and five (5), whose family's net available income is at or below one hundred and thirty-three percent (133%) of the federal poverty level for the applicable household size. vii) Children age six (6) up to age nineteen (19), whose family's net available income is at or below one hundred and thirty-three percent (133%) of the federal poverty level for the applicable household size. viii) Transitional Medical Assistance Beneficiaries ix) Supplemental Security Income (cash) and Supplemental Security Income Related (Medicaid only). b) Medicaid eligible individuals in the following categories may be eligible for enrollment in the Contractor's plan at the LDSS' option, as indicated by an X below. i) Foster Xxxxxx care children in the direct care of LDSS. Xxxxatory county - children in IDSS direct care are mandatorily enrolled X __ Mandatory OR voluntary county - children in LDSS direct care are enrolled on a case-by-case basis. Mandatory OR voluntary county - all foster care children are excluded from managed cxxxmandatorily enrolled. SECTION 5 ( ELIGIBLE, EXEMPT AND EXCLUDED POPULATIONS) OCTOBER 1, 2004 5-1

ELIGIBLE, EXEMPT AND EXCLUDED POPULATIONS. 5.1 Eligible Populations a) Except as specified in Section 5.1(b5.1 (b) and 5.3below5.3 below, all persons IN in the following Medicaid-eligible beneficiary categories who reside in the service area shall be eligible for enrollment in the Contractor's plan: i) Singles/Childless Couples - Cash and Medicaid only ii) Low Income Families with Children - Cash and Medicaid only iii) Aid to Families with Dependent Children - Medicaid only iv) Pregnant women whose net available income is at or below two hundred percent (200%) of the federal poverty level for the applicable household size. v) Children aged one (1) year or below whose family's net available income is at or below two hundred percent (200%) of the federal poverty level for the applicable household size. vi) Children between ages one (1) and five (5), whose family's net available income is at or below one hundred and thirty-three percent (133%) of the federal poverty level for the applicable household size. vii) Children age six (6) up to age nineteen (19), whose family's net available income is at or below one hundred and thirty-three percent (133%) of the federal poverty level for the applicable household size. viii) Transitional Medical Assistance Beneficiaries ix) Supplemental Security Income (cash) and Supplemental Security Income Related (Medicaid only). b) Medicaid eligible individuals in the following categories may be eligible for enrollment in the Contractor's plan at the LDSS' option, as indicated by an X below. i) Foster Xxxxxx care children in the direct care of LDSS. Xxxxatory [ ] Mandatory county - children in IDSS LDSS direct care are mandatorily enrolled X enrolled. [X] Mandatory OR voluntary county - children in LDSS direct care are enrolled on a case-by-case basis. [ ] Mandatory OR voluntary county - all foster xxxxxx care children are excluded from managed cxxxcare. SECTION 5 ( ELIGIBLE, EXEMPT AND EXCLUDED POPULATIONS) OCTOBER 1, 2004 5-1

ELIGIBLE, EXEMPT AND EXCLUDED POPULATIONS. 5.1 Eligible Populations a) Except as specified in Section 5.1(b) and 5.3below5.3 below, all persons IN in the following Medicaid-eligible beneficiary categories who reside in the service area shall be eligible for enrollment in the Contractor's plan: i) Singles/Childless Couples - Cash and Medicaid only ii) Low Income Families with Children - Cash and Medicaid only iii) Aid to Families with Dependent Children - Medicaid only iv) Pregnant women whose net available income is at or below two hundred percent (200%) of the federal poverty level for the applicable household size. v) Children aged one (1) year or below whose family's net available income is at or below two hundred percent (200%) of the federal poverty level for the applicable household size. vi) Children between ages one (1) and five (5), whose family's net available income is at or below one hundred and thirty-three percent (133%) of the federal poverty level for the applicable household size. vii) Children age six (6) up to age nineteen (19), whose family's net available income is at or below one hundred and thirty-three percent (133%) of the federal poverty level for the applicable household size. viii) Transitional Medical Assistance Beneficiaries ix) Supplemental Security Income (cash) and Supplemental Security Income Related (Medicaid only). b) Medicaid eligible individuals in the following categories may be eligible for enrollment in the Contractor's plan at the LDSS' option, as indicated by an X below. i) Foster Xxxxxx care children in the direct care of LDSS. Xxxxatory [ ] Mandatory county - children in IDSS LDSS direct care are mandatorily enrolled X enrolled. [X] Mandatory OR voluntary county - children in LDSS direct care are enrolled on a case-by-case basis. [ ] Mandatory OR voluntary county - all foster xxxxxx care children are excluded from managed cxxxcare. SECTION 5 ( ELIGIBLE, EXEMPT AND EXCLUDED POPULATIONS) OCTOBER 1, 2004 5-1

ELIGIBLE, EXEMPT AND EXCLUDED POPULATIONS. 5.1 Eligible Populations a) Except as specified in Section 5.1(b) and 5.3below5.3 below, all persons IN in the following Medicaid-eligible beneficiary categories who reside in the service area shall be eligible for enrollment in the Contractor's plan: i) Singles/Childless Couples - Cash and Medicaid only ii) Low Income Families with Children - Cash and Medicaid only iii) Aid to Families with Dependent Children - Medicaid only iv) Pregnant women whose net available income is at or below two hundred percent (200%) of the federal poverty level for the applicable household size. v) Children aged one (1) year or below whose family's net available income is at or below two hundred percent (200%) of the federal poverty level for the applicable household size. vi) Children between ages one (1) and five (5), whose family's net available income is at or below one hundred and thirty-three percent (133%) of the federal poverty level for the applicable household size. vii) Children age six (6) up to age nineteen (19), whose family's net available income is at or below one hundred and thirty-three percent (133%) of the federal poverty level for the applicable household size. viii) Transitional Medical Assistance Beneficiaries ix) Supplemental Security Income (cash) and Supplemental Security Income Related (Medicaid only). b) Medicaid eligible individuals in the following categories may be eligible for enrollment in the Contractor's plan at the LDSS' option, as indicated by an X below. i) Foster Xxxxxx care children in the direct care of LDSS. Xxxxatory __ Mandatory county - children in IDSS LDSS direct care are mandatorily enrolled X enrolled. __ Mandatory OR voluntary county - children in LDSS direct care are enrolled on a case-by-case basis. Mandatory OR voluntary county - all foster care children are excluded from managed cxxx. SECTION 5 ( ELIGIBLE, EXEMPT AND EXCLUDED POPULATIONS) OCTOBER 1, 2004 5-1