Page 291

MRG

UPDATED: JUNE 2010

717

OTHER ELIGIBILITY REQUIREMENTS

CONSOLIDATED OMNIBUS BUDGET RECONCILATION ACT (COBRA)

• Covered employee’s entitlement to Medicare • Dependent child loses dependent status under the requirements of the group health plan • For a covered retiree, the filing of Chapter 11 bankruptcy by the employer under certain circumstances.

A CCB may be eligible for Medicaid to pay the COBRA premium when they meet the following criteria:

• Coverage is available through an employer with 75 or more employees • The insurance is cost effective • The A/R’s income, using SSI budgeting (See INCOME SSI- RELATED DISREGARDS) does not exceed 100% of the Federal Poverty Level • The A/R’s resources, using SSI budgeting (See RESOURCES SSI-RELATED DISREGARDS) do not exceed twice the SSI resource level • The A/R meets all other non-financial requirements for Medicaid eligibility.

When a member of the household, other than the former employee, is eligible for the COBRA Continuation Program Coverage, Medicaid may pay for family coverage. For example: A mother and her 3 children apply for coverage. The mother is receiving Unemployment benefits and her oldest child is receiving child support. The income of the mother and the second child is below 100% of the FPL. The oldest child has income above 100% of the FPL and is not eligible for Medicaid payment of COBRA COVERAGE. However, because the youngest child is eligible for COBRA Continuation Program coverage, Medicaid will pay the premium for family coverage. If it is determined cost effective, the mother and both children will receive health insurance coverage.

Medicaid pays the health insurance premium only. The recipient incurs any co-payments.