Eligible Populations. The Demonstration will be available to individuals who meet all of the following criteria: Age 21 and older at the time of enrollment; Entitled to benefits under Medicare Part A and enrolled under Medicare Parts B and D, and receiving full Medicaid benefits; and Enrolled in the Medicaid Aid to the Aged, Blind, and Disabled (AABD) category of assistance. Eligible populations include: Beneficiaries who meet all other Demonstration criteria and are in the following Medicaid 1915(c) waivers: o Persons who are Elderly; o Persons with Disabilities; o Persons with HIV/AIDS; o Persons with Brain Injury and o Persons residing in Supportive Living Facilities. Individuals with End Stage Renal Disease (ESRD) at the time of enrollment. The following populations will be excluded from enrollment: Individuals under the age of 21; Individuals receiving developmental disability institutional services or who participate in the HCBS waiver for Adults with Developmental Disabilities; The Medicaid Spend-down population; Beneficiaries in the Illinois Medicaid Breast and Cervical Cancer program; Individuals enrolled in partial benefit programs; and Individuals enrolled in both Medicare and Medicaid who have Comprehensive Third Party Insurance. Medicare-Medicaid beneficiaries who are in Medicare fee-for-service and meet the eligibility criteria above will be eligible for Passive Enrollment beginning January 1, 2014, unless they elect to opt out of the Demonstration, as discussed in C.2 below. Those beneficiaries who are enrolled in a Medicare Advantage plan that is operated by the same parent organization that operates a Demonstration Plan will also be eligible for Passive Enrollment into the Demonstration Plan operated by the same parent organization beginning January 1, 2014. Eligible beneficiaries enrolled in a Medicare Advantage plan that is operated by a parent organization that is not offering a Demonstration Plan may enroll into the Demonstration if they elect to disenroll from their current Medicare Advantage plan.
Eligible Populations. All residents living within the coalition target area as defined in this Contract.
Eligible Populations a. The categories of eligible Medicaid Recipients authorized to be enrolled in the Health Plan are:
Eligible Populations. This demonstration affects mandatory and optional Medicaid state plan populations as well as populations eligible for benefits only through the demonstration. Table A at the end of section IV of the STCs shows each specific group of individuals; under what authority they are made eligible for the demonstration; the name of the eligibility and expenditure group under which expenditures are reported to CMS and the budget neutrality expenditure agreement is constructed; and the corresponding demonstration program under which benefits are provided. Attachment A provides a complete overview of MassHealth coverage for children, including the separate title XXI CHIP program, which is incorporated by reference. Eligibility is determined based on an application by the beneficiary or without an application for eligibility groups enrolled based on receipt of benefits under another program. XxxxXxxxxx defines the age of a dependent child for purposes of the parent/caretaker relative coverage type as a child who is younger than age 19. A caretaker relative is eligible under this provision only if the parent is not living in the household. Retroactive Eligibility. Retroactive eligibility is provided in accordance to Table D. Calculation of Financial Eligibility. Financial eligibility for demonstration programs is determined by comparing the family’s Modified Adjusted Gross Income (MAGI) with the applicable income standard for the specific coverage type, with the exception of adults aged 19 and above who are determined eligible on the basis of disability and whose financial eligibility is determined as described below. MAGI income counting methodologies will also be applied to disabled adults in determining eligibility for MassHealth Standard and CommonHealth; however, household composition for disabled adults will always be determined using non-tax filer rules, regardless of whether the individual files income taxes or is claimed as a dependent on another person’s income taxes. In determining eligibility for MassHealth Standard and CommonHealth for disabled adults, the Commonwealth will apply the five percent income disregard that is also applied to non-disabled adults.
Eligible Populations. This demonstration affects mandatory and optional Medicaid state plan populations as well as populations eligible for benefits only through the demonstration. Table A at the end of section IV of the STCs shows each specific group of individuals; under what authority they are made eligible for the demonstration; the name of the eligibility and expenditure group under which expenditures are reported to CMS and the budget neutrality expenditure agreement is constructed; and the corresponding demonstration program under which benefits are provided. Attachment A provides a complete overview of MassHealth coverage for children, including the separate title XXI CHIP program, which is incorporated by reference. Eligibility is determined based on an application by the beneficiary or without an application for eligibility groups enrolled based on receipt of benefits under another program. XxxxXxxxxx defines the age of a dependent child for purposes of the parent/caretaker relative coverage type as a child who is younger than age 19. A caretaker relative is eligible under this provision only if the parent is not living in the household.
Eligible Populations. This demonstration affects mandatory and optional Medicaid state plan populations as well as populations eligible for benefits only through the demonstration. Table A at the end of section IV of the STCs shows each specific group of individuals; under what authority they are made eligible for the demonstration; the name of the eligibility and expenditure group under which expenditures are reported to CMS and the budget neutrality expenditure agreement is constructed; and the corresponding demonstration program under which benefits are provided. Eligibility is determined based on an application by the beneficiary or without an application for eligibility groups enrolled based on receipt of benefits under another program. XxxxXxxxxx defines the age of a dependent child for purposes of the parent/caretaker relative coverage type as a child who is younger than age 19. A caretaker relative is eligible under this provision only if the parent is not living in the household. Retroactive Eligibility. Retroactive eligibility is provided in accordance to STC 50 Table F. Calculation of Financial Eligibility. Financial eligibility for demonstration programs is determined by comparing the family’s Modified Adjusted Gross Income (MAGI) with the applicable income standard for the specific coverage type, with the exception of adults aged 19 and above who are determined eligible on the basis of disability and whose financial eligibility is determined as described below. MAGI income counting methodologies will also be applied to disabled adults in determining eligibility for MassHealth Standard and CommonHealth; however, household composition for disabled adults will always be determined using non-tax filer rules, regardless of whether the individual files income taxes or is claimed as a dependent on another person’s income taxes. In determining eligibility and making related calculations of deductibles and cost sharing for MassHealth Standard and CommonHealth for disabled adults, the Commonwealth may consider state veteran annuity as non-countable income as described below, and apply the five percent income disregard that is also applied to non-disabled adults. Section 6b of Chapter 115 of Massachusetts General Law authorizes a state veteran annuity payment to eligible disabled veterans and surviving Gold Star parents and spouses who have lost their child or spouse in combat. Except as described in the next sentence, the Commonwealth may consider such payment as non-countab...
Eligible Populations. Beneficiaries with one chronic condition and at risk of developing another are eligible for the State’s approved health home SPA #13-08, as summarized below:
Eligible Populations. The programs conducted by the parties to this agreement have overlapping populations and distinct target groups for specific services within eligible populations. The following descriptions are set out in order to define populations that may be impacted by this agreement.
Eligible Populations. Beneficiaries must meet all of the following criteria to be eligible for assignment to this Demonstration: ● Be enrolled in Medicare Parts A and B and eligible for Part D; and ● Receive full Medicaid benefits under FFS arrangements; ● Have no other private or public health insurance; and ● Be a resident of the State. Beneficiaries not eligible for assignment excluded from enrollment in this Demonstration include: Individuals enrolled in a Medicare Advantage plan, the Program of All-inclusive Care for the Elderly (PACE), the Denver Health Medicaid Choice Plan, or the Rocky Mountain Health Plan; Individuals who are residents of an Intermediate Care Facility for People with Intellectual Disabilities (ICF/ID); and Individuals who are participating in the Colorado House Bill 12-1281 ACC Program Payment Reform pilot. Such beneficiaries may be eligible for assignment and participate in this Demonstration if they disenroll from their existing programs. Beneficiaries that are enrolled and subsequently become ineligible will be disenrolled. CMS will work with the State to address beneficiary or provider participation in other Medicare shared savings programs or initiatives, such as Accountable Care Organizations (ACOs) or the Comprehensive Primary Care initiative. If a beneficiary qualifies for assignment to this Demonstration and another model that involves Medicare shared savings and both start on the same date, the beneficiary will be assigned to this Demonstration. Medicare-Medicaid enrollees in Colorado who are already assigned to a Medicare initiative involving shared savings as of the beginning of this Demonstration will remain assigned to that model and will not be assigned to this Demonstration until they no longer qualify for assignment to that model (see Appendix 7 for additional information).
Eligible Populations. The Demonstration will be available to individuals who meet all of the following criteria: • Age 21 and older at the time of enrollment; • Entitled to benefits under Medicare Part A and enrolled under Medicare Parts B and D, and receiving full Medicaid benefits; • Eligible for full Medicaid (Medi-Cal), including o Individuals enrolled in the Multipurpose Senior Services Program (MSSP). o Individuals who meet the share of cost provisions described below: ▪ Nursing facility residents with a share of cost, ▪ MSSP enrollees with a share of cost, and ▪ IHSS recipients who met their share of cost on the first day of the month, in the fifth and fourth months prior to their effective passive enrollment date for the Demonstration; o Individuals eligible for full Medicaid (Medi-Cal) per the spousal impoverishment rule codified at section 1924 of the Social Security Act as described below: ▪ For those enrollees who are nursing facility level of care, subacute facility level of care, or intermediate care facility level of care and reside or could reside outside of a hospital or nursing facility, the Department or its designee shall make a Medi-Cal eligibility determination “as if” the beneficiary were in a long-term care facility. Specifically, the spousal impoverishment rule codified section 1924 of the Act will apply to beneficiaries enrolled in the Participating Plans. The terms “intermediate care facility level of care” and “nursing facility level of care” and “subacute facility level of care” shall have the same meaning as defined in Title 22 of the California Code of Regulations sections 51120, 51124, and 52224.5; and • Reside in one of the following Demonstration counties: Alameda, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo, and Santa Xxxxx. o Up to 200,000 individuals in Los Angeles may be enrolled in Participating Plans for the Demonstration. CMS and the State will monitor the enrollment and stop participation when this enrollment cap is met. • Individuals residing in San Mateo or Orange county with a diagnosis of end stage renal disease (ESRD) at the time of enrollment. The following populations will be excluded from enrollment: • Individuals under age 21; • Individuals with other private or public health insurance; • Individuals receiving services through California’s regional centers or state developmental centers or intermediate care facilities for the developmentally disabled; • Individuals with a share of cost that do not meet ...
