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to as a “lock-in” to a specific MCE. Every year between November 1st and December 15th, enrolled HIP members are eligible to pick a new MCE for the following year.

All changes will be effective January 1st and stay in effect for the next calendar year, even if the member has a gap in coverage during the year. If a new application is submitted and a different MCE is picked and/or paid, the member will automatically be reassigned to their calendar year MCE and payment will be refunded and HIP will not open until the correct MCE is paid. The member is not eligible to be opened for a past month paid to a wrong MCE, and a member (or ICP or AR) who mistakenly paid the wrong MCE cannot call the enrollment broker to move payment or change MCE.

The only time a HIP applicant can change an MCE with the enrollment broker is:

• When they are completely new to the system, they have not already paid an MCE, and have never been fully open in HIP during the current calendar year. These pending/conditional members have 55 days to make a change but their 60 days to pay does not restart. • During the annual MCE Selection period for HIP which occurs every year from November 1 to December 15. The new assignment will not be effective until January 1 of the next year. • At any time of the year, when a member requests a “Just Cause” review of their MCE selection because they are completely unable to access the needed provider type (preference for a specific provider is not a “Just Cause”) within their currently assigned MCE. This request should first be made to their current MCE. If the current MCE cannot assist or member is not satisfied with decision, member should contact Maximus. Maximus will coordinate with MCE, and if they believe it to be a “Just Cause” will then forward it to OMPP for a final decision.

3515.00.00 GENERAL ELIGIBILITY REQUIREMENTS: AGE AND HEALTH INSURANCE

To qualify for HIP, an individual must mee the following requirements:1

• Be at least age 19 but not yet age 65 • Not be enrolled in or eligible for enrollment in the federal Medicare program • Not be eligible and not enrolled in another Medicaid assistance category • Have countable household income equal to or less than 133% (plus the 5% disregard) of the federal poverty level (FPL).

An applicant who may be eligible both for HIP and another Medicaid category will first have their eligibility assessed for the other category of Medicaid. An individual may be enrolled in HIP only if they are ineligible for the other aid category.