ACA Eligible Individuals Health Care Coverage 510-03-30-20

(Revised 4/1/2020 ML #3576)

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IM 5443

 

 

Individuals determined eligible under ACA Medicaid are assigned their Health Care Coverage under either Traditional Medicaid or the Alternative Benefit Plan (ABP), which is currently provided through Sanford Health Plan (SHP).

 

  1. Individuals who have their coverage under Traditional Medicaid are:
    1. Eligible children under age 19.
    2. Eligible parents and caretaker/relatives of deprived children under age 18 (through the month the child attains age 18) and their spouses with income below 54% of the FPL.
    3. Eligible parents and caretaker/relatives of deprived children under age 18 (through the month the child attains age 18), their spouses and children who are eligible as Transitional or Extended Medicaid.
    4. Eligible pregnant women with income below 147% of the Federal Poverty Level (FPL) and for the duration of the 60 free day period.
    5. Eligible foster care children.
    6. Eligible Former Foster Care children.
    7. Eligible individuals who have been approved for the Medicaid Women’s Way Treatment Program and whose income is greater than 138% and less than 200% of the FPL.
    8. Medically Needy eligible pregnant women, children under age 19 (through the month they attain age 19) and parents/caretaker relatives of deprived children under age 18 and their spouses.
  2. Individuals who have their coverage under the Alternative Benefit Plan (ABP), which is currently provided through Sanford Health Plan (SHP) are:
    1. Eligible individuals between the ages of 19 (month following the month of their 19th birthday) and 65 (month prior to the month of their 65th birthday).
  3. Individuals who have the option to receive either the Traditional Medicaid Coverage or receive their coverage through the Alternative Benefit Plan (ABP), which is currently provided through Sanford Health Plan (SHP) are:
    1. Eligible adults who meet the Medically Frail criteria;
    2. Eligible individuals who have been approved for the Medicaid Women’s Way Treatment Program and whose income is less than 138% of the FPL.
    3. Eligible women who become pregnant while they are covered through the Alternative Benefit Plan (ABP), which is currently provided through Sanford Health Plan (SHP).
  4. Individuals who have coverage under the Optional Children's Group are: Eligible children under age 19 (thru the end of the month they turn 19) who do not have other creditable health insurance coverage.