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us-vt/manual/dvha/medicaid/hbee-part-7 — Health Benefits Eligibility and Enrollment Rules, Part 7 Eligibility-and-Enrollment Procedures · Axiom
Axiom
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Vermont
/
Manual
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Dvha
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Medicaid
Health Benefits Eligibility and Enrollment Rules, Part 7 Eligibility-and-Enrollment Procedures
66 sections
52.01
52.01 In general
52.02
52.02 Application filing4
54.01
54.01 Definitions
54.02
54.02 Declaration of citizenship or immigration status
54.03
54.03 Verification frequency
54.04
54.04 Electronic verification17
54.05
54.05 Inconsistencies and inability to verify information18
54.07
54.07 Documentary evidence of citizenship and identity
54.08
54.08 Documentation of immigration status for qualified non-citizens
55.01
55.01 Attestation only
55.02
55.02 Verification of attestation
56.01
56.01 Data
56.02
56.02 Verification process for Medicaid
56.03
56.03 Verification process for APTC and CSR – general procedures
56.04
56.04 Eligibility for alternate APTC and CSR verification procedures
56.10
56.10 Education and assistance
56.11
56.11 Acceptance of attestation52
58.01
58.01 In general60
58.02
58.02 Special rules relating to APTC eligibility67
59.01
59.01 Eligibility for CSR
59.02
59.02 Special cost-sharing rule for Indians regardless of income
59.03
59.03 Verification related to Indian status71
60.01
60.01 In general73
60.02
60.02 Definition74
60.03
60.03 Coverage month75
60.04
60.04 Federal premium-assistance amount78
60.05
60.05 Monthly premium for ABP80
60.06
60.06 Applicable benchmark plan (ABP)81
60.07
60.07 Applicable percentage83
60.08
60.08 Plan covering more than one household86
60.10
60.10 Additional benefits88
60.11
60.11 Pediatric dental coverage91
60.12
60.12 Households that include individuals who are not lawfully present93
64.01
64.01 In general
64.02
64.02 Public-notice requirements for Medicaid101
64.04
64.04 Ongoing Medicaid premium billing and payment
64.05
64.05 Partial payments
64.06
64.06 Late payment/grace period
64.07
64.07 Dr. Dynasaur disenrollment protection103
64.09
64.09 Medical incapacity for VPharm
64.10
64.10 Medicaid premium payment balances
64.11
64.11 Refund of prospective Medicaid premium payments
64.13
64.13 Appeal of Medicaid
66.01
66.01 Basis
66.02
66.02 In general
66.03
66.03 Procedures
66.04
66.04 Presumptive coverage111
66.05
66.05 Notice and fair hearing rules112
67.01
67.01 Use of electronic notices114
68.01
68.01 Notice of decision concerning eligibility115
68.02
68.02 Advance notice of Medicaid adverse action decision118
70.01
70.01 Enrollment when no premium obligation
70.02
70.02 Premium obligation; initial billing and payment
71.01
71.01 In general
71.02
71.02 Annual open enrollment periods129
71.03
71.03 Special enrollment periods (SEP)134
73.01
73.01 General requirement
73.02
73.02 Verification of reported changes
73.03
73.03 Reestablishment of annual renewal date for Medicaid enrollees155
73.04
73.04 Periodic examination of data sources156
73.05
73.05 Redetermination and notification of eligibility159
73.06
73.06 Effective dates for QHP eligibility redeterminations162
73.07
73.07 Recalculation of APTC/CSR163
75.01
75.01 In general
75.02
75.02 Renewal procedures for QHP enrollment
75.03
75.03 Renewal procedures for Medicaid
