Effective Date: August 1, 2018

Previous Policy

Meet the enrollee‘s medical need by determining eligibility for benefits accurately and timely.

Provide information about CHIP and any Medicaid programs available, including those requiring a spenddown, so each enrollee can make informed decisions.

Provide information about the Federally Facilitated Marketplace (FFM) and the Advanced Premium Tax Credit (APTC)

Help the enrollee determine which programs are applicable to their circumstances and best meets their needs.

Monitor and re-determine eligibility.

Keep records which document eligibility, such as:

actions taken in the electronic eligibility system that changes the eligibility;

opening/approving;

closing;

benefit/program changes;

household changes;

evidence changes; and

all circumstances that could affect an individual's eligibility.

See 801-1 for case narration requirements.

Observe the rights of the enrollee.

Safeguard information and protect confidentiality.