36-2983
|
36-2983. Eligibility for the program A. The administration shall establish a streamlined eligibility process for applicants to the program and shall issue a certificate of eligibility at the time eligibility for the program is determined. Eligibility shall be based on gross household income for a member as defined in section 36-2981. The administration shall not apply a resource test in the eligibility determination or redetermination process. B. The administration shall use a simplified eligibility form that may be mailed to the administration. Once a completed application is received, including adequate verification of income, the administration shall expedite the eligibility determination and enrollment on a prospective basis. C. The date of eligibility is the first day of the month following a determination of eligibility if the decision is made by the twenty-fifth day of the month. A person who is determined eligible for the program after the twenty-fifth day of the month is eligible for the program the first day of the second month following the determination of eligibility. D. An applicant for the program who appears to be eligible pursuant to section 36-2901, paragraph 6, subdivision (a) shall have a social security number or shall apply for a social security number within thirty days after the applicant submits an application for the program. E. In order to be eligible for the program, a person shall be a resident of this state and shall meet title XIX requirements for United States citizenship or qualified alien status in the manner prescribed in section 36-2903.03. F. In determining the eligibility for all qualified aliens pursuant to this article, the income and resources of a person who executed an affidavit of support pursuant to section 213A of the immigration and nationality act on behalf of the qualified alien and the income and resources of the spouse, if any, of the sponsoring individual shall be counted at the time of application and for the redetermination of eligibility for the duration of the attribution period as specified in federal law. G. Pursuant to federal law, a person is not eligible for the program if that person is: 1. Eligible for title XIX or other federally operated or financed health care insurance programs, except the Indian health service. 2. Covered by any group health plan or other health insurance coverage as defined in section 2791 of the public health service act. Group health plan or other health insurance coverage does not include coverage to persons who are defined as eligible pursuant to the premium sharing program. 3. A member of a family that is eligible for health benefits coverage under a state health benefit plan based on a family member's employment with a public agency in this state. 4. An inmate of a public institution or a patient in an institution for mental diseases. This paragraph does not apply to services furnished in a state operated mental hospital or to residential or other twenty-four hour therapeutically planned structured services. H. A child who is covered under an employer's group health insurance plan or through family or individual health care coverage shall not be enrolled in the program. If the health insurance coverage is voluntarily discontinued for any reason, except for the loss of health insurance due to loss of employment or other involuntary reason, the child is not eligible for the program for a period of three months from the date that the health care coverage was discontinued. The administration may waive the three month period for any child who is seriously or chronically ill. For the purposes of the waiver, "chronically ill" means a medical condition that requires frequent and ongoing treatment and that if not properly treated will seriously affect the child's overall health. The administration shall establish rules to further define conditions that constitute a serious or chronic illness. I. Pursuant to federal law, a private insurer, as defined by the secretary of the United States department of health and human services, shall not limit enrollment by contract or any other means based on the presumption that a child may be eligible for the program. |