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MEDICAL SERVICES POLICY MANUAL,SECTION A

A 200 Health Care Coverage Periods

A-220 Fixed Eligibility MS Manual 01/01/14 Applicants in any Medicaid category may qualify for “Fixed” eligibility (retroactive and/or current) under certain conditions. The State is required to provide “fixed” eligibility to applicants who: 1. Receivedmedical services in the eligibility period (retroactive and/or current); and 2. Wereeligible when the services were received; 3. Died before eligibility was determined; or 4. Became ineligible following the monthof application, but before eligibility was determined. The caseworker will certify an individual for fixed eligibility in the system by showing a begin date and end date.

A-230 Twelve Month Continuous Coverage MS Manual 01/01/2024 Twelve (12) months continuous coverage means that children under nineteen (19) years of age are guaranteed twelve (12) months of continuous coverage regardless of changes in income and other eligibility criteria which could result in ineligibility.

There are eligibility groups that are ineligible to receive the twelve (12) months of continuous coverage. The groups that are ineligible to receive the twelve (12) months continuous coverage are: 1. Medically Needy Categories 2. Pregnant Woman Unborn 3. Foster Care Spenddown 4. Transitional Medicaid Changes in income and other eligibility criteria that occur during the year will not affect the child’s eligibility. Therefore, participants are not required to report changes in income until renewal. The only time a child loses eligibility during the twelve (12) month period is if the child dies, moves out of state, or reaches nineteen (19) years of age. NOTE: Some categories require certain eligibility requirements to remain eligible for that category of assistance. (For example: eligibility for adoption subsidies) If the recipient no longer meets requirements to stay in that category, they will be transitioned to ARKids A for the remainder of their twelve (12) months of continuous coverage. (The categories listed above that are ineligible to receive continuous coverage are not eligible to switch to ARKids A if they do not meet requirements of their program.)