Continuous Eligibility Period i. Effective February 1, 2010, the state is authorized to provide a 12-month continuous eligibility period to the groups of individuals specified in Table 4 who are otherwise eligible under the Medicaid state Plan, regardless of the delivery system through which they receive Medicaid benefits. Once the state begins exercising this authority, each newly eligible individual’s 12-month period shall begin at the initial determination of eligibility; for those individuals who are re-determined to be eligible consistent with Medicaid state plan rules, the 12-month period begins at that point. At each annual eligibility redetermination thereafter, if an individual is re-determined to be eligible under Medicaid state plan rules, the individual is guaranteed a subsequent 12-month continuous eligibility period. Table 4: Groups Eligible for a 12-Month Continuous Eligibility Period State Plan Mandatory and Optional Groups Social Security Act/Code of Federal Regulations Reference Pregnant women aged 19 or older • 1902(a)(10)(A)(i)(III) or (IV) and • 1902(a)(10)(A)(ii)(I) and (II) Children aged 19 or 20 1902(a)(10)(A)(ii)(I) and (II) Parents or other caretaker relatives aged 19 or older 1902(a)(10)(A)(ii)(I) and (II) Members of low-income families, except for children up to age 19 1931 and 1925 Disabled children who lose SSI due to a change in the SSI definition of disability 1902(a)(10)(A)(i)(II) Individuals who meet the income and resource requirements of SSI but are not in receipt of cash 1902(a)(10)(A)(ii)(I) Medically needy individuals including children under 21, pregnant women, parents/caretaker relatives, the aged, blind, and disabled Without spend-down under 1902(a)(10)(C)(i)(III) • 42 CFR § 435.308 • 42 CFR § 435.310 • 42 CFR § 435.320 • 42 CFR § 435.322 • 42 CFR § 435.324 Disabled widows/widowers who lost SSI or state supplements due to Social Security benefit increases in 1984 and who applied for continued Medicaid coverage before 1988 1634(b) Note: Children under 19 who are eligible at the applicable FPL already receive 12-month continuous eligibility period under the Medicaid state plan. State Plan Mandatory and Optional Groups Social Security Act/Code of Federal Regulations Reference Disabled adult children who lose SSI due to Old Age, Survivor’s and Disability Insurance (OASDI) 1634(c) Disabled widows and widowers aged 60 through 64 who would be eligible for SSI except for early receipt of social security benefits 1634(d) Individuals who are ineligible f...
Continuous Eligibility Period
