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1. If the hardship exemption request is approved for a given month, that month’s premium invoice will be cleared.

2. If the hardship exemption request is denied, the beneficiary will be required to pay the premium. 1.10.4 Loss of Employment or Eligibility A. A Ticket to Work beneficiary who loses employment may retain eligibility for up to four (4) months by continuing to pay the applicable cost share, whether a premium or LTSS cost of care payment. If the person is still unemployed at the end of the four (4) month period, Ticket to Work eligibility is terminated. Prior to taking this action, the State evaluates the Ticket to Work beneficiary for all other forms of Medicaid eligibility as well as for coverage for a commercial plan through HSRI, the State’s health insurance marketplace. 1.10.5 Available Services A. Services include the full scope of categorical Medicaid benefits, including home and community-based services if eligible for LTSS, including personal care services provided through an agency or through a self-directed program and services needed to facilitate and/or maintain employment, as described in Chapter 50 of this Title. Services are coordinated through the appropriate unit in EOHHS, DHS or BHDDH or a contractual designee of the agency. B. Services to maintain and support employment are determined when developing a service plan, or through an assessment of need utilizing a state approved assessment instrument or an EOHHS approved prior authorization plan. Authorized personal care services may be provided in the home, workplace or other necessary setting (such as a physician office).

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Page 19

Official source

1. If the hardship exemption request is approved for a given month, that month’s premium invoice will be cleared.

2. If the hardship exemption request is denied, the beneficiary will be required to pay the premium. 1.10.4 Loss of Employment or Eligibility A. A Ticket to Work beneficiary who loses employment may retain eligibility for up to four (4) months by continuing to pay the applicable cost share, whether a premium or LTSS cost of care payment. If the person is still unemployed at the end of the four (4) month period, Ticket to Work eligibility is terminated. Prior to taking this action, the State evaluates the Ticket to Work beneficiary for all other forms of Medicaid eligibility as well as for coverage for a commercial plan through HSRI, the State’s health insurance marketplace. 1.10.5 Available Services A. Services include the full scope of categorical Medicaid benefits, including home and community-based services if eligible for LTSS, including personal care services provided through an agency or through a self-directed program and services needed to facilitate and/or maintain employment, as described in Chapter 50 of this Title. Services are coordinated through the appropriate unit in EOHHS, DHS or BHDDH or a contractual designee of the agency. B. Services to maintain and support employment are determined when developing a service plan, or through an assessment of need utilizing a state approved assessment instrument or an EOHHS approved prior authorization plan. Authorized personal care services may be provided in the home, workplace or other necessary setting (such as a physician office).