Continuous Eligibility Periods 510-05-53-15

(Revised 7/1/09 ML #3183)

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  1. Continuous eligibility may be established from the first day of the application month, or if later, the first day that the individual becomes eligible for Medicaid under a coverage group other than medically needy. Continuous eligibility periods cannot be established when re-working a prior month.  

Example 1:  A child applies for Medicaid on June 8 and is determined to be poverty level eligible.  The child becomes continuously eligible effective June 1.

 

Example 2:  A child is eligible for Medicaid as medically needy.  When determining eligibility for August, the family’s income decreased so the child becomes poverty level eligible for August. The child becomes continuously eligible effective August 1.

 

Example 3:  An application was taken for the month of September and the child was determined medically needy for September and October.  When determining eligibility for November, the family’s income decreased so the child becomes poverty level eligible for November.  The child becomes continuously eligible effective November 1 and their continuous eligibility period end date would be equal to the redetermination due date of August 31. In November the parents provide verification of decreased income for October and when re-working the month of October the child is now poverty level eligible.  The child’s continuous eligibility period would remain November thru August.

  1. If retroactive eligibility is approved for an applicant, the continuous eligibility period does not begin during any of the retroactive months. An individual may be Medicaid eligible during the retroactive months; however, their eligibility is based on their actual circumstances during those months.

Example:  A family with children applies for Medicaid on October 9 and requests Medicaid for the three prior months.  The application is processed and it is determined that the children are poverty level eligible for October, and they are eligible for the three prior months.  The children become continuously eligible effective October 1 regardless of their coverage group status during the three prior months.

  1. Except as identified in subsection 5, once an individual becomes continuously eligible, they remain eligible for Medicaid without regard to changes in circumstances, until they have been on Medicaid for 12 consecutive months.  They do not have to have been continuously eligible for the entire 12 months.  

  2. When a redetermination of eligibility is completed an eligible individual may be determined to be eligible for a new continuous eligibility period.  Redeterminations must be completed at least annually, but may be scheduled earlier in order to align continuous eligibility periods within a case between children, or to align redetermination dates with other programs.

  1. If the individual’s previous continuous eligibility period ended, the individual must meet all eligibility criteria to continue eligible for Medicaid.  

  2. If a redetermination is being completed before the individual’s continuous eligibility period has ended, and the individual meets all Medicaid eligibility criteria, the individual begins a new continuous eligibility period.

  3. If a redetermination is being completed before the individual’s continuous eligibility period has ended, and the individual fails to meet all Medicaid eligibility criteria, the individual remains eligible only until the end of their current continuous eligibility period.  A new redetermination of eligibility is required at that time to establish any further eligibility.

  1. A continuous eligibility period must be ended earlier than redetermination for any of the following reasons:

  1. The recipient turns age 19;

  2. The recipient loses state residency;

  3. The recipient requests that their coverage end;

  4. The recipient dies; or

  5. The agency has lost contact with the recipient.

Afghan and Iraqi immigrant children who become continuously eligible are only entitled to Medicaid for the first eight months they are in the country, and not for the normal 12-month period.  Their continuous period must be ended at the end of the eight month period.  Note:  It will be necessary to contact the Helpdesk to do a data change to shorten the period.

 

A continuous eligibility period must also be ended if it is determined that the recipient should not have become continuously eligible because the individual was approved in error; approval was based on fraudulent information; an appealed ending is upheld in favor of the agency.