Common use of Guaranteed Eligibility Clause in Contracts

Guaranteed Eligibility. Except as may otherwise be required by law: 9.1 New Enrollees, other than those identified in Sections 9.2 who would otherwise lose Medicaid eligibility during the first six (6) months of enrollment will retain the right to remain enrolled in the Contractor's plan under this Agreement for a period of six (6) months from their Effective Date of Enrollment. 9.2 Guaranteed eligibility is not available to Enrollees who lose Medicaid eligibility for one of the following reasons: a) death, moving out of State, or incarceration; b) being a woman with a net available income in excess of medically necessary income but at or below 200% of the federal poverty level who is only eligible for Medicaid while she is pregnant and then through the end of the month in which the sixtieth (60th) day following the end of the pregnancy occurs. 9.3 If, during the first six (6) months of enrollment in the Contractor's plan, an Enrollee becomes eligible for Medicaid only as a spend-down, the Enrollee will be eligible to remain enrolled in the Contractor's plan for the remainder of the six (6) month guarantee period. During the six (6) month guarantee period, an Enrollee eligible for spend-down and in need of wraparound services has the option of spending down to gain full Medicaid eligibility for the wraparound services. In this situation, the LDSS will monitor the Enrollee's need for wrap around services and manually set coverage codes as appropriate. 9.4 The services covered during the Guaranteed Eligibility period shall be those contained in the Benefit Package, as specified in Appendix K, including free access to family planning services as set forth in Section 10.12 of this Agreement. During the Guaranteed Eligibility period Enrollees are also eligible for pharmacy services on a Medicaid fee-for-service basis. 9.5 An Enrollee-initiated disenrollment from the Contractor's plan terminates the Guaranteed Eligibility period. 9.6 Enrollees who lose and regain Medicaid eligibility within a three (3) month period will not be entitled to a new period of six (6) months Guaranteed Eligibility. 9.7 During the guarantee period, an Enrollee may not change health plans. An Enrollee may choose to disenroll from the Contractor's Plan during the guarantee period but is not eligible to enroll in any other MCO because he/she has lost eligibility for Medicaid. SECTION 9 (GUARANTEED ELIGIBILITY) October 1, 2004 9-1

Guaranteed Eligibility. Except as may otherwise be required by law: 9.1 New Enrollees, other than those identified in Sections 9.2 who would otherwise lose Medicaid eligibility during the first six (6) months of enrollment will retain the right to remain enrolled in the Contractor's plan under this Agreement for a period of six (6) months from their Effective Date of Enrollment. 9.2 Guaranteed eligibility is not available to Enrollees who lose Medicaid eligibility for one of the following reasons: a) death, moving out of State, or incarceration; b) being a woman with a net available income in excess of medically necessary income but at or below 200% of the federal poverty level who is only eligible for Medicaid while she is pregnant and then through the end of the month in which the sixtieth (60th) day following the end of the pregnancy occurs. 9.3 If, during the first six (6) months of enrollment in the Contractor's plan, an Enrollee becomes eligible for Medicaid only as a spend-spend down, the Enrollee will be eligible to remain enrolled in the Contractor's plan for the remainder of the six (6) month guarantee period. During the six (6) month guarantee period, an Enrollee eligible for spend-spend down and in need of wraparound wrap around services has the option of spending down to gain full Medicaid eligibility for the wraparound wrap around services. In this situation, the LDSS will monitor the Enrollee's need for wrap around services and manually set coverage codes as appropriate. 9.4 The services covered during the Guaranteed Eligibility period shall be those contained in the Benefit Package, as specified in Appendix K, including free access to family planning services as set forth in Section 10.12 of this Agreement. During the Guaranteed Eligibility period Enrollees are also eligible for pharmacy services on a Medicaid fee-for-service basis. 9.5 An Enrollee-initiated disenrollment from the Contractor's plan terminates the Guaranteed Eligibility period. 9.6 Enrollees who lose and regain Medicaid eligibility within a three (3) month period will not be entitled to a new period of six (6) months Guaranteed Eligibility. 9.7 During the guarantee period, an Enrollee may not change health plans. An Enrollee may choose to disenroll from the Contractor's Plan during the guarantee period but is not eligible to enroll in any other MCO because he/she has lost eligibility for Medicaid. SECTION 9 (GUARANTEED ELIGIBILITY) October OCTOBER 1, 2004 9-1

Guaranteed Eligibility. Except as may otherwise be required by law: 9.1 New Enrollees, other than those identified in Sections 9.2 who would otherwise lose Medicaid eligibility during the first six (6) months of enrollment will retain the right to remain enrolled in the Contractor's plan under this Agreement for a period of six (6) months from their Effective Date of Enrollment. 9.2 Guaranteed eligibility is not available to Enrollees who lose Medicaid eligibility for one of the following reasons: a) death, moving out of State, or incarceration; b) being a woman with a net a available income in excess of medically necessary income but at or below 200% of the federal poverty level who is only eligible for Medicaid while she is pregnant and then through the end of the month in which the sixtieth (60th) day following the end of the pregnancy occurs. 9.3 If, during the first six (6) months of enrollment in the Contractor's plan, an Enrollee becomes eligible for Medicaid only as a spend-down, the Enrollee will be eligible to remain enrolled in the Contractor's plan for the remainder of the six (6) month guarantee period. During the six (6) month guarantee period, an Enrollee eligible for spend-down and in need of wraparound services has the option of spending down to gain full Medicaid eligibility for the wraparound services. In this situation, the LDSS will monitor the Enrollee's need for wrap around services and manually set coverage codes as a appropriate. 9.4 The services covered during the Guaranteed Eligibility period shall be those contained in the Benefit Package, as specified in Appendix K, including free access to family planning services as set forth in Section 10.12 of this Agreement. During the Guaranteed Eligibility period Enrollees are also eligible for pharmacy services on a Medicaid fee-for-service basis. 9.5 An Enrollee-initiated disenrollment from the Contractor's plan terminates the Guaranteed Eligibility period. 9.6 Enrollees who lose and regain Medicaid eligibility within a three (3) month period will not be entitled to a new period of six (6) months Guaranteed Eligibility. 9.7 During the guarantee period, an Enrollee may not change health plans. An Enrollee may choose to disenroll from the Contractor's Plan during the guarantee period but is not eligible to enroll in any other MCO because he/she has lost eligibility for Medicaid. SECTION 9 (GUARANTEED ELIGIBILITY) October 1, 2004 9-1

Guaranteed Eligibility. Except as may otherwise be required by law: 9.1 New Enrollees, other than those identified in Sections 9.2 who would otherwise lose Medicaid eligibility during the first six (6) months of enrollment will retain the right to remain enrolled in the Contractor's plan under this Agreement for a period of six (6) months from their Effective Date of Enrollment. 9.2 Guaranteed eligibility is not available to Enrollees who lose Medicaid eligibility for one of the following reasons: a) death, moving out of State, or incarceration; b) being a woman with a net available income in excess of medically necessary income but at or below 200% of the federal poverty level who is only eligible for Medicaid while she is pregnant and then through the end of the month in which the sixtieth (60th) day following the end of the pregnancy occurs. 9.3 If, during the first six (6) months of enrollment in the Contractor's plan, an Enrollee becomes eligible for Medicaid only as a spend-down, the Enrollee will be eligible to remain enrolled in the Contractor's plan for the remainder of the six (6) month guarantee period. During the six (6) month guarantee period, an Enrollee eligible for spend-down and in need of wraparound services has the option of spending down to gain full Medicaid eligibility for the wraparound services. In this situation, the LDSS will monitor the Enrollee's need for wrap around services and manually set coverage codes as appropriate. 9.4 The services covered during the Guaranteed Eligibility period shall be those contained in the Benefit Package, as specified in Appendix K, including free access to family planning services as set forth in Section 10.12 of this Agreement. During the Guaranteed Eligibility period Enrollees are also eligible for pharmacy services on a Medicaid fee-for-service basis. 9.5 An Enrollee-initiated disenrollment from the Contractor's plan terminates the Guaranteed Eligibility period. 9.6 Enrollees who lose and regain Medicaid eligibility within a three (3) month period will not be entitled to a new period of six (6) months Guaranteed Eligibility. 9.7 During the guarantee period, an Enrollee may not change health plans. An Enrollee may choose to disenroll from the Contractor's Plan during the guarantee period but is not eligible to enroll in any other MCO because he/she has lost eligibility for Medicaid. SECTION 9 (GUARANTEED ELIGIBILITY) October 1, 2004 9-1

Guaranteed Eligibility. Except as may otherwise be required by law: 9.1 New Enrollees, other than those identified in Sections 9.2 who would otherwise lose Medicaid eligibility during the first six (6) months of enrollment will retain the right to remain enrolled in the Contractor's plan under this Agreement for a period of six (6) months from their Effective Date of Enrollment. 9.2 Guaranteed eligibility is not available to Enrollees who lose Medicaid eligibility for one of the following reasons: a) a. death, moving out of State, incarceration, or incarcerationthe LDSS is unable to locate; bb. engagement in fraudulent activities prior to the Effective Date of Enrollment, which would render them ineligible for Medicaid; c. commitment of an international program violation by a single childless adult between the age of twenty-one (21) to sixty-five (65 ) who is not pregnant o r disabled prior to the Effective Date of Enrollment; d. being a woman with a net available income in excess of medically necessary income but at or below 200185% of the federal poverty level who is only eligible for Medicaid while she is pregnant and then through the end of the month in which the sixtieth (60th) day following the end of the pregnancy occurs. 9.3 If, during the first six (6) months of enrollment in the Contractor's plan, an Enrollee becomes eligible for Medicaid only as a spend-down, the Enrollee will be eligible to remain enrolled in the Contractor's plan for the remainder of the six (6) month guarantee period. During the six (6) month guarantee period, an Enrollee eligible for spend-down and in need of wraparound services has the option of spending down to gain full Medicaid eligibility for the wraparound services. In this situation, the LDSS will monitor the Enrollee's need for wrap around services and manually set coverage codes as appropriate. 9.4 The services covered during the Guaranteed Eligibility period shall be those contained in the Benefit Package, as specified in Appendix K, including free access to family planning services as set s et forth in Section 10.12 of this Agreement. During the Guaranteed Eligibility period Enrollees are also eligible for pharmacy services on a Medicaid fee-for-for service basis. 9.5 An Enrollee-initiated disenrollment from the Contractor's plan terminates the Guaranteed Eligibility period. 9.6 Enrollees who lose and regain Medicaid eligibility within a three (3) month period will not be entitled to a new period of six (6) months Guaranteed Eligibility. 9.7 During the guarantee period, an Enrollee may not change health plans. An Enrollee may choose to disenroll from the Contractor's Plan during the guarantee period but is not eligible to enroll in any other MCO because he/she has lost eligibility for Medicaid. SECTION 9 (GUARANTEED ELIGIBILITY) October 1, 2004 9-1

Guaranteed Eligibility. Except as may otherwise be required by law: 9.1 New Enrollees, other than those identified in Sections 9.2 who would otherwise lose Medicaid eligibility during the first six (6) months of enrollment will retain the right to remain enrolled in the Contractor's plan under this Agreement for a period of six (6) months from their Effective Date of Enrollment. 9.2 Guaranteed eligibility is not available to Enrollees who lose Medicaid eligibility for one of the following reasons: a) death, moving out of State, or incarceration; b) being a woman with a net available income in excess of medically necessary income but at or below 200% of the federal poverty level who is only eligible for Medicaid while she is pregnant and then through the end of the month in which the sixtieth (60th) day following the end of the pregnancy occurs. 9.3 If, during the first six (6) months of enrollment in the Contractor's plan, an Enrollee becomes eligible for Medicaid only as a spend-down, the Enrollee will be eligible to remain enrolled in the Contractor(contractor's plan for the remainder of the six (6) month guarantee period. During the six (6) month guarantee period, an Enrollee eligible for spend-down and in need of wraparound services has the option of spending down to gain full Medicaid eligibility for the wraparound services. In this situation, the LDSS will monitor the Enrollee's need for wrap around services and manually set coverage codes as appropriate. 9.4 The services covered during the Guaranteed Eligibility period shall be those contained in the Benefit Package, Package as specified in Appendix K, including free access to family planning services as set forth in Section 10.12 of this Agreement. During the Guaranteed Eligibility period Enrollees are also eligible for pharmacy services on a Medicaid fee-for-service basis. 9.5 An Enrollee-initiated disenrollment from the Contractor's plan terminates the Guaranteed Eligibility period. 9.6 Enrollees who lose and regain Medicaid eligibility within a three (3) month period will not be entitled to a new period of six (6) months Guaranteed Eligibility. 9.7 During the guarantee period, an Enrollee may not change health plans. An Enrollee may choose to disenroll from the Contractor's Plan during the guarantee period but is not eligible to enroll in any other MCO because he/she has lost eligibility for Medicaid. SECTION 9 (GUARANTEED ELIGIBILITY) October 1, 2004 9-1