Special Considerations

Reasonable Opportunity Period (ROP) is allowed for ELE determinations.

Child(ren) eligible for PeachCare for Kids® may be subject to a premium. Send a determination notice to advise client to report any changes and the ability to opt out of ELE at any time.

If SNAP, TANF, CC, WIC, or RCA closes due to information not provided from VCL, the ELE case will remain active until the end of the ELE POE.

If retroactive months are requested and case is approved for ELE, the retroactive months need to follow the regular MAGI eligibility determination process.

If SNAP, TANF, CC, WIC, or RCA is active with at least one ongoing month at the end of the ELE renewal POE, the ELE case will be automatically renewed using the ELE process.

If SNAP, TANF, CC, WIC, or RCA is not active at the end of the ELE renewal POE, the ELE case would no longer be considered ELE, and renewal must follow the regular MAGI eligibility determination process.

Administrative renewals should not be completed for Medicaid cases whose Medicaid eligibility has been determined using Express Lane Eligibility (ELE).

Gateway should not allow an ELE determination if an individual member is currently receiving Medical Assistance including:

SSI or Medicare for ELE-CU19

SSI, Medicare or TPL for ELE-PCK.

ELE determinations do not apply to:

Expedited SNAP applications that are not approved for a full period of eligibility (POE)

Transitional SNAP recipients

Disaster Supplemental Nutrition Assistance Program (DSNAP) recipients

Disaster Temporary Assistance for Needy Families (DTANF) recipients