70.01 Enrollment when no premium obligation

Official source

Prospective enrollment. Except when a spenddown is necessary, an individual approved for Medicaid without a premium obligation will be enrolled in Medicaid on the first day of the month within which their application is received by AHS provided they are eligible for that month. (b) Retroactive eligibility122 Retroactive eligibility is effective no earlier than the first day of the third month before the month an individual’s application is received by AHS, regardless of whether the individual is alive when application is made, if the following conditions are met: (i) Eligibility is determined and a budget computed separately for each of the three months; (ii) A medical need exists, as evidenced by the receipt of Medicaid services, at any time during the retroactive period, of a type covered under the state’s Medicaid State plan; and (iii) Elements of eligibility were met at some time during each month. An individual may be eligible for the retroactive period (or any single month(s) of the retroactive period) even though ineligible for the prospective period. If an individual, at the time of application, declares that they incurred medical expenses during the 120 42 CFR § 431.214. 121 42 CFR § 431.246. 122 § 1902(a)(34) of the Act; 42 CFR § 435.915. Eligibility-and-Enrollment Procedures Part 7 – Page 56 (Sec.70.00, Sub.70.02) retroactive period and eligibility is not approved, the individual’s case record must contain documentation of the reason the individual was not eligible in one or more months of the retroactive period.

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70.01 Enrollment when no premium obligation

Official source

Prospective enrollment. Except when a spenddown is necessary, an individual approved for Medicaid without a premium obligation will be enrolled in Medicaid on the first day of the month within which their application is received by AHS provided they are eligible for that month. (b) Retroactive eligibility122 Retroactive eligibility is effective no earlier than the first day of the third month before the month an individual’s application is received by AHS, regardless of whether the individual is alive when application is made, if the following conditions are met: (i) Eligibility is determined and a budget computed separately for each of the three months; (ii) A medical need exists, as evidenced by the receipt of Medicaid services, at any time during the retroactive period, of a type covered under the state’s Medicaid State plan; and (iii) Elements of eligibility were met at some time during each month. An individual may be eligible for the retroactive period (or any single month(s) of the retroactive period) even though ineligible for the prospective period. If an individual, at the time of application, declares that they incurred medical expenses during the 120 42 CFR § 431.214. 121 42 CFR § 431.246. 122 § 1902(a)(34) of the Act; 42 CFR § 435.915. Eligibility-and-Enrollment Procedures Part 7 – Page 56 (Sec.70.00, Sub.70.02) retroactive period and eligibility is not approved, the individual’s case record must contain documentation of the reason the individual was not eligible in one or more months of the retroactive period.