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222 (07/2026) Chapter 2:Eligibility • Section 5: Financial eligibility • Individuals who are determined ineligible at renewal will continue to receive the same level of coverage through the duration of their remaining CE period. Additional TOAs have been created in order for individuals to maintain benefits during their CE period when they no longer meet the non-financial eligibility requirements for any medical program. When a change is reported for an individual that would otherwise make them ineligible for any medical program, ONE will assign them to one of the following CE TOAs: • CEPACA • HOPCEPACA • CEOSIPMEPD • HOPCEEPD • CEEXADLT (Individuals will not transition to this TOA after July 1, 2024) • CEQMBP • CEQDWI • CESLMB • CEQSMF • CEPME • CEYSHCN • CEYSHCNSUP • HOPCEYSHCN Note: Not all existing medical TOAs that are subject to CE rules have a corresponding “CE TOA”. Other medical TOAs that are subject to CE rules will still have CE applied, even if “CE” is not in the TOA name. Except as noted in the following section, when a change is reported for an individual receiving benefits due to CE, a Request for Information (RFI) will not be generated unless the change could result in a better or additional benefit. For example: • A MAGI PCR recipient reports a change in income that puts them above 120% FPL. They will transition to ADLT and no RFI will be generated, even if the new income does not pass Reasonable Compatibility. The CE period will not change. • A QMBP recipient reports a change that makes them potentially eligible for SLMB, no RFIs will be sent and the individual will keep their QMBP coverage throughout the remainder of their CE period. • A MAGI PCR recipient reports that they started receiving Medicare. An RFI for an interview will be generated. If the recipient does not respond to the RFI, QMBP benefits will be denied but the MAGI PCR benefits and CE period will not change. Note: The individual will still have their Part B premium paid through the State Buy-In (SBI) process as long as they continue to receive OHP Plus with Medicare. • A MAGI ADLT recipient turns 65, which makes them potentially eligible for OSIPMAD. However, because this is not a better benefit and does not provide additional benefits, no RFIs will be sent.