§ 1983 - Eligibility
§ 1983. Eligibility
(a)(1) Except as provided in subdivisions (3), (4), and (5) of this subsection, an individual shall be eligible for Catamount Health assistance if the individual is an uninsured Vermont resident without access to an approved employer-sponsored insurance plan under section 1974 of this title.
(2) An individual who has access to an employer-sponsored insurance shall be eligible for assistance under this subchapter only if the individual does not have employer-sponsored insurance approved for premium assistance under section 1974 of this title or if it is more cost-effective to the state for the individual to purchase Catamount Health with the assistance under this subchapter than for the state to provide premium assistance under section 1974 of this title. In addition, an individual may receive assistance under this subchapter temporarily until the individual is able to enroll in an approved employer-sponsored plan and receive premium assistance under section 1974. Decisions regarding plan approval and cost-effectiveness are matters fully within the agency's discretion. On appeal pursuant to section 3091 of Title 3, the human services board may overturn the agency's decision only if it is arbitrary or unreasonable.
(3) An individual shall not be eligible for Catamount Health assistance if the individual is of the age of majority and is claimed on a tax return as a dependent of a resident of another state.
(4) An individual who is or becomes eligible for Medicare shall not be eligible for premium assistance under this subchapter.
(5) Notwithstanding any other provision of law, when an individual is enrolled in Catamount Health solely under the high deductible standard outlined in subdivision 4080f(a)(9) of Title 8, the individual shall not be eligible for premium assistance for the 12-month period following the date of enrollment in Catamount Health.
(b)(1) An individual receiving benefits under Medicaid, the Vermont health access plan, Dr. Dynasaur, or premium assistance for employer-sponsored insurance under section 1974 of this title or any other health benefit plan authorized under Title XIX or Title XX of the Social Security Act within 12 months of applying for Catamount Health assistance shall not be required to wait 12 months to be eligible.
(2) An individual who has been enrolled in Catamount Health without assistance shall not be subject to a 12-month waiting period before becoming eligible for assistance under this subchapter.
(c) The agency of administration or designee shall establish rules pursuant to chapter 25 of Title 3 on the specific criteria to demonstrate eligibility consistent with the requirements essential for federal financial participation, including criteria for and proof of residency, income, and insurance status.
(d) If the emergency board determines that the funds appropriated for the Catamount Health assistance program under this subchapter are insufficient to meet the projected costs of enrolling new program participants, the emergency board shall suspend new enrollment in that program or restrict enrollment to eligible lower income individuals. (Added 2005, No. 191 (Adj. Sess.), § 16; amended 2007, No. 70, §§ 16-18; 2007, No. 203 (Adj. Sess.), § 7, eff. June 10, 2008.)