7330 Eligibility Periods for Medical Programs - An eligibility or base period is the length of time used in determining financial eligibility for an individual or family. The length of the base period varies from one to six months depending on the medical program and any changes of circumstance as referenced in 7330 (1). Eligibility shall be determined from the date of application. (Refer to 1411.2.)
The month of application establishes the first month of the current eligibility base period provided all eligibility factors have been met. On request of the client, a 3 month prior eligibility base period shall be established. (See 7330 (2).) For cases determined eligible without a spenddown, the effective date of eligibility will correspond with the beginning of the eligibility base and will begin with the first day of the first month of the medical base period. For Medically Needy cases, eligibility cannot be certified until the spenddown has been met. However, the effective date of eligibility may precede the date on which the spenddown is actually met.
Since suspension, closure, and denial are alternative administrative procedures that result in the withholding of benefits to the client when there is unmet spenddown, a base period can be established and maintained regardless of which procedure is chosen. Denied applications establish an eligibility base period and an application month when the reason for denial is excess income resulting in spenddown. (See 1414.2 (4).) Closures within an eligibility base period because of increased spenddown do not change the base period. A reapplication received outside of a previously established base shall be treated as a new application without regard to any previous base except for a determination of prior medical eligibility. (See 7330 (2).) Once an eligibility base is established, it can be shortened or changed in accordance with 7330 (1). Ineligible months are counted as part of the eligibility base period only when ineligibility occurs within an established base period.
Current
Eligibility Periods - Eligibility based on receipt of cash
(TANF, SSI, or State Supplemental payments) continues as long as cash
eligibility exists. (See 2620 and
subsections). This includes qualifying persons who are eligible for
a payment of less than $10. Automatic eligibility for cases which
are not the responsibility of EES continues as long as DCF has the
responsibility for payment.
A one month eligibility base is used for the Working
Healthy, QMB, LMB, QWD programs as well as the protected medical groups
(see 2680). A one month base period is also used for all long term care (LTC) months beginning with the month the LTC living arrangement begins through the month the LTC arrangement ends. A six month base is applicable
for Medically Needy programs. The six month base shall be shortened
in the following circumstances:
When a recipient becomes eligible
for medical assistance based on the receipt of cash assistance
(or SSI) .
When a recipient begins receiving
long term care in a Medicaid-approved institution.
When a recipient begins HCBS
(see 8200.2).
When a recipient is interprogram
transferred from MA to MS or vice versa.
When the only person in an assistance
plan dies .
If the applicant dies or if an application is made on behalf of
a deceased person, eligibility will begin no earlier than the
third month prior to the month of application.
When the only recipient on an
MA or MS case becomes eligible for Medicaid poverty level coverage,
through foster care or adoption support related coverage.
When two or more MA or MS recipient
family groups combine into one assistance plan. In such instances,
the previous bases shall be shortened and a new base period started
with the combined family group.
When a recipient requests and
is eligible for Expanded LMB.
When participating members of
the assistance plan physically separate or divorce so that separate
plans are required per 4310 except
when one or both spouses begin receiving LTC or Working Healthy.
The existing base ends no later than the month following the month
of the separation or divorce.
When a case moves to or from
Presumptive Medical Disability status.
When a recipient requests and
is eligible for Working Healthy (WH).
Prior Medical Eligibility (Not
Applicable to MediKan, QMB or QWD) - An applicant for cash or
medical assistance may request a determination of medical eligibility
for a 3 month period prior to the month of application. The month
of application establishes this prior medical period. A request for
prior medical must be made in the month of application or the two
following months. Requests made after this time shall be denied as
they would be more than 3 months from the applicable prior period.
Prior eligibility can be established even though there
is no eligibility for the current base period. However, there is no
eligibility in any prior month for an individual who does not qualify
for Medicaid.
Except for persons requesting Working Healthy, or LMB,
a 3 month eligibility base shall be used unless one of the following
conditions exist:
Part or all of the prior base
period falls into a previously established medical base period.
Part or all of the base period
falls within any month in which the client was a cash recipient
(SSI).
The individual is not categorically
eligible for any medical program in one or more months of the
base period (i.e., is not aged, disabled, a child, a pregnant
woman, or a caretaker).
The individual was not part
of the current family group in one or more months of the base
period.
If, in the above instances, the assistance request
includes other individuals in the family group, only the individual
would be excluded for the applicable months. If the assistance request
is only for the individual, the prior base period shall be shortened
to exclude those months.
For LMB, Working Healthy and the Protected groups
(2680); a one month base period shall
be used in accordance with 7330 (1) for each month
of the prior period. Eligibility can be determined for any one or
all of the 3 prior months.
Financial factors of eligibility apply to the entire
base period. Eligibility factors other than the income shall affect
eligibility for each of the months separately. Eligibility shall be
effective only for the months in which the client meets both the financial
and nonfinancial factors of eligibility.