loading…
loading…
loading…
community engagement activities will transition to commercial healthcare coverage. the number of individuals enrolled in the demonstration eligibility group who have commercial health insurance using information from the eligibility system and data matches through information used to identify third party liability. enrolled in the demonstration PCR eligibility groups who have obtained commercial health insurance. As a result of adding eligibility for this group, the demonstration will improve enrollment continuity for current members who experience an increase in income or change in circumstance. SCDHHS will track patterns of Medicaid enrollment for members who transition from existing Medicaid categories into this category as they experience an increase in income or other change in circumstance. The number of members who transition from existing Medicaid categories into this category. Section 05: Demonstration Eligibility Current data indicates that up to 17,700 individuals are potentially eligible for the demonstration. However, the state intends to limit the number of individuals who can be served under the demonstration, based upon available state funding, to no more than 11,400 individuals. If the total enrollment of 11,400 members is reached, a demonstration-eligible individual will be placed on a waiting list for enrollment in the program. If a waiting list is in place, the state will enroll individuals from the waiting list based on their application date. A chronological list will be maintained, and individuals will be targeted for enrollment in the order of application. Before an individual can move from the waiting list into the waiver demonstration, they must demonstrate compliance with community engagement qualifying activities in the most recent month prior to the start of eligibility. The standards and methodologies used to determine eligibility for this demonstration are outlined in the Program Description. The following table identifies information regarding the population SCDHHS is including in this demonstration waiver: Table 2: Demonstration Population Eligibility Group Social Security Act and CFR Citation Income Level Parent Caretaker Relatives (PCR) SSA §1931;SSA §1902(a)(10)(A)(i); and 42 CFR §435.110 Over 67% and up to 95% of FPL with a 5% disregard 10