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Incarceration or Institutionalization End of the month prior to the month incarceration or institutionalization starts and lasts more than 30 calendar days Enrollment in a Waiver program or Long-Term Care MCO End of the month prior to the LTC MCO enrollment start date or up to the last day of the month a member is enrolled in a Waiver program. Note: Waiver Medicaid enrollment can run concurrently with HMO enrollment, but LTC MCO enrollment cannot. Mail was returned for the member’s household with no forwarding address, and an up-to-date address has not been received. End of the month in which it is determined an up-to- date address cannot be received.

21.6.4.2 Voluntary Disenrollment The member may disenroll from the HMO for any reason as long as they are no longer in their lock-in period. If the member is still in the lock-in period, the member, the member’s family, or the legal guardian must request disenrollment based on a qualifying reason. Qualifying reasons for disenrollment include but are not limited to: • A temporary loss of eligibility caused the member to miss their open enrollment period. • The HMO does not cover the service the member seeks, due to moral or religious objections. • The member needs related services (for example, a cesarean section and tubal ligation) to be performed at the same time, but not all related services are within the provider network and the member’s primary care provider or another provider determines that the risk of receiving services separately would subject the member to unnecessary risk. • The member is enrolled in both Medicaid and a Medicare Dual Eligible Special Needs Plan (D- SNP) and is requesting to align their Medicaid-HMO with their Medicare D-SNP. • Other reasons, including poor quality of care, lack of access to services, or lack of access to providers experienced in dealing with the member’s care needs. Voluntary disenrollments are effective no later than the first day of the month following the month in which the disenrollment was requested. If the SSI HMO fails to complete a required assessment and care plan during the first 90 days of enrollment and is able to demonstrate a good faith process to complete the assessment, the open enrollment period will be extended an additional 30 days. 21.6.4.3 Involuntary Disenrollment The Department of Health Services may approve involuntary disenrollments with an effective date of the following month, if approved with the exception of a just- cause disenrollment, which may require additional review of the effective date of disenrollment based on the circumstances. The HMO must submit a disenrollment request to the Department and include evidence attesting to the reason. The HMO must direct all members for whom an involuntary disenrollment request has been made to the HMO Enrollment Specialist for assistance and/or for choice counseling.