7330 Eligibility Periods

An eligibility or base period is the length of time used in determining financial eligibility for an individual or family. The length of the base period varies from one to six months depending on the medical program and any changes of circumstance as referenced in 7330 (1) . Eligibility shall be determined from the date of application, refer to 1411.2 .

The month of application establishes the first month of the current eligibility base period provided all eligibility factors have been met. On request of the client, a 3-month prior eligibility base period shall be established, see 7330 (2) . For cases determined eligible without a spenddown, the effective date of eligibility will correspond with the beginning of the eligibility base and will begin with the first day of the first month of the medical base period. For Medically Needy cases, eligibility cannot be certified until the spenddown has been met. However, the effective date of eligibility may precede the date on which the spenddown is actually met.

Since suspension, closure, and denial are alternative administrative procedures that result in the withholding of benefits to the client when there is unmet spenddown, a base period can be established and maintained regardless of which procedure is chosen. Denied applications establish an eligibility base period and an application month when the reason for denial is excess income resulting in spenddown., see 1414.2 (4) . Closures within an eligibility base period because of increased spenddown do not change the base period.

A reapplication received outside of a previously established base shall be treated as a new application without regard to any previous base except for a determination of prior medical eligibility, see 7330 (2) . Once an eligibility base is established, it can be shortened or changed in accordance with 7330 (1) . Ineligible months are counted as part of the eligibility base period only when ineligibility occurs within an established base period.

Current Eligibility Periods - Eligibility based on receipt of cash (SSI, or State Supplemental payments) continues as long as cash eligibility exists. (See 2630 and subsections). A one month eligibility base is used for the Working Healthy, QMB, LMB, QWD programs as well as the protected medical groups (see 2680 ). A one-month base period is also used for all long term care (LTC) months beginning with the month the LTC living arrangement begins through the month the LTC arrangement ends. A six-month base is applicable for Medically Needy programs. The six-month base shall be shortened in the following circumstances: When a recipient becomes eligible for medical assistance based on the receipt of cash assistance (or SSI). When a recipient begins receiving long term care in a Medicaid-approved institution. When a recipient begins HCBS, see 8200.2 . When a recipient is interprogram transferred from Caretaker Medical to Medically Needy or vice versa. When the only person in an assistance plan dies or if an application is made on behalf of a deceased person, eligibility will begin no earlier than the third month prior to the month of application. When the only recipient on a Medically Needy case becomes eligible for Medicaid poverty level coverage, through foster care or adoption support related coverage. When two or more Medically Needy recipient family groups combine into one assistance plan. In such instances, the previous bases shall be shortened, and a new base period started with the combined family group. When a recipient requests and is eligible for Expanded LMB. When participating members of the assistance plan physically separate or divorce so that separate plans are required per 4310 except when one or both spouses begin receiving LTC or Working Healthy. The existing base ends no later than the month following the month of the separation or divorce. When a case moves to or from Presumptive Medical Disability status. When a recipient requests and is eligible for Working Healthy (WH).

Prior Medical Eligibility (Not Applicable to MediKan, QMB or QWD) - An applicant for medical assistance may request a determination of medical eligibility for a 3-month period prior to the month of application. The month of application establishes this prior medical period. A request for prior medical must be made in the month of application or the two following months. When a request for coverage is not processed within the application case disposition time line as defined in 1413 , the period to request prior medical is extended to 12-days following the date of the determination. Requests made after this time shall be denied as they would be more than 3 months from the applicable prior period. Prior eligibility can be established even though there is no eligibility for the current base period. However, there is no eligibility in any prior month for an individual who does not qualify for Medicaid. Except for persons requesting Working Healthy, or LMB, a 3-month eligibility base shall be used unless one of the following conditions exist: Part or all of the prior base period falls into a previously established medical base period. Part or all of the base period falls within any month in which the client was a cash recipient (SSI). The individual is not categorically eligible for any medical program in one or more months of the base period (i.e., is not aged, disabled, a child, a pregnant woman, or a caretaker). The individual was not part of the current family group in one or more months of the base period. If, in the above instances, the assistance request includes other individuals in the family group, only the individual would be excluded for the applicable months. If the assistance request is only for the individual, the prior base period shall be shortened to exclude those months.

For LMB, Working Healthy and the Protected groups ( 2680 ); a one month base period shall be used in accordance with 7330 (1) for each month of the prior period. Eligibility can be determined for any one or all of the 3 prior months.

Financial factors of eligibility apply to the entire base period. Eligibility factors other than the income shall affect eligibility for each of the months separately. Eligibility shall be effective only for the months in which the client meets both the financial and nonfinancial factors of eligibility.

For individuals transitioning from a long term care (LTC) living arrangement to independent living, the Medically Needy spenddown base period begins the month after the month the LTC arrangement ends. Individuals transitioning from LTC to independent living to live with a spouse who has an existing MN spenddown shall be added to the spenddown the month after the month the LTC arrangement ends.

When a MediKan recipient becomes eligible for Social Security Disability payments (SSDI), Medically Needy (MN) coverage will begin with the month of the original request for assistance if receipt of SSDI is reported within 90 days of the date of application. If SSDI eligibility is reported or discovered more than 90 days from the date of application, Medically Needy (MN) coverage may commence with the month of report or discovery. However, the following additional provisions apply: When the date of report or discovery establishes the first month of the Medically Needy (MN) base period, the recipient may request three-month prior medical coverage from the month of report or discovery. Medically Needy (MN) coverage shall be approved beginning with the month of report or discovery if the recipient is eligible without a spenddown or if there is a spenddown and the recipient indicates the spenddown will be met. Otherwise, Medically Needy (MN) coverage shall not be approved until the month after the month of MediKan closure, allowing timely notice.

See also 1414.1 (2) and 2662.10 .