58.01 In general60

MAGI screen.61 For each individual who has submitted an application for a health- benefits program (i.e., health benefits other than enrollment in a QHP without APTC or CSR), whose eligibility is being renewed, or whose eligibility is being redetermined, and who meets the nonfinancial requirements for eligibility (or for whom AHS is providing an opportunity to verify citizenship or immigration status), AHS will do the following: Promptly and without undue delay, consistent with timeliness standards established under § 61.00, furnish MAGI-based Medicaid to each such individual whose household income is at or below the applicable MAGI-based standard. For each individual described in paragraph (c) of this subsection (individuals subject to determination of Medicaid eligibility on a basis other than the applicable MAGI-based income standard), collect such additional information as may be needed to determine whether such individual is eligible for Medicaid on any basis other than the applicable MAGI-based income standard, and furnish Medicaid on such basis. For an individual who submits an application or renewal form which includes sufficient information to determine Medicaid eligibility, or whose eligibility is being renewed pursuant to a change in circumstance, and whom AHS determines is not eligible for Medicaid, promptly and without undue delay, determine eligibility for other health benefits. (b) MAGI-based income standards for certain individuals enrolled for Medicare benefits.62 In the case of an individual who has attained at least age 65 and an individual who has attained at least age 19 and who is entitled to or enrolled for Medicare benefits under part A or B or Title XVIII of the Act, non-MAGI-based income standards will be used, except that in the case of such an individual: Who is also pregnant, the applicable MAGI-based standard is the standard established under § 7.03(a)(2); and Who is also a parent or caretaker relative (as defined in § 3.00), the applicable MAGI-based standard is the standard established under § 7.03(a)(1). 59 42 CFR § 435.911; 45 CFR § 155.310; 45 CFR § 155.345. 60 42 CFR §§ 435.911(c) and 435.1200(e). 61 42 CFR § 435.911(c). 62 42 CFR § 435.911(b)(2). Eligibility-and-Enrollment Procedures Part 7 – Page 29 (Sec.58.00, Sub.58.01) (c) Individuals subject to determination of Medicaid eligibility on basis other than the applicable MAGI-based income standard.63 For purposes of paragraph (a)(2) of this subsection, an individual includes: An individual who is identified, on the basis of information contained in an application or renewal form, or on the basis of other information available, as potentially eligible on a basis other than the applicable MAGI-based standard; and An individual who otherwise requests a determination of eligibility on a basis other than the applicable MAGI-based standard. (d) Individuals requesting additional screening.64 AHS will notify an applicant of the opportunity to request a full determination of eligibility for Medicaid on a basis other than the applicable MAGI-based income standard, and will provide such an opportunity. Such notification will also be made to an enrollee, and such opportunity provided in any redetermination of eligibility. (e) Determination of eligibility for Medicaid on a basis other than the applicable MAGI-based income standard.65 If an individual is identified as potentially eligible for Medicaid on a basis other than the applicable MAGI-based income standard or an individual requests a full determination for Medicaid under paragraph (d) of this subsection, and the individual provides all additional information needed to determine eligibility for such benefits, eligibility will be determined promptly and without undue delay, as provided in this section. (f) Eligibility for APTC and CSR, pending determination of eligibility for Medicaid.66 An individual who is described in paragraph (e) of this subsection and has not been determined eligible for Medicaid based on MAGI-based income standards will be considered as ineligible for Medicaid for purposes of eligibility for APTC or CSR until the individual is determined eligible for Medicaid. (g) Determination of eligibility for Medicare savings programs from LIS leads data. Definition of Low-income Subsidy application data (LIS leads data). For purposes of this paragraph (g), Low-income Subsidy application data (LIS leads data) means data from a Medicare part D eligible individual’s application for federal low-income subsidies that the Social Security Administration (SSA) electronically transmits to AHS as described in section 1144(c)(1) of the Social Security Act. For each individual who has applied for the Medicare part D Low-income Subsidy through SSA and granted permission for SSA to share LIS leads data with the Medicaid agency for the purpose of submitting an application for the Medicare savings programs described at § 8.07(b), AHS will: 63 42 CFR § 435.911(d). 64 45 CFR § 155.345(c). 65 42 CFR § 435.911(c); 45 CFR § 155.345(d). 66 45 CFR § 155.345(e). Eligibility-and-Enrollment Procedures Part 7 – Page 30 (Sec.59.00, Sub.0) (i) Accept, via secure electronic interface, LIS leads data transmitted to AHS from SSA; and (ii) Treat received LIS leads data relating to an individual as an application for eligibility under the Medicare savings programs, without requiring submission of another application.