Enrollment Caps Sample Clauses

Enrollment Caps. The Commonwealth is authorized to impose enrollment caps on populations made eligible solely through the demonstration, except that enrollment caps may not be imposed for the demonstration expansion population groups listed as “Hypotheticals” in Table A. Setting and implementing specific caps are considered amendments to the demonstration and must be made consistent with section III, STC 7.
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Enrollment Caps. OHCA, at its sole discretion, may impose a cap on the Contractor’s enrollment, in response to a request by the Contractor or as part of a corrective action occurring under Section 1.22: “Non-Compliance Remedies” of this Contract.
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Enrollment Caps. The Commonwealth is authorized to impose enrollment caps on populations made eligible solely through the Demonstration. Setting and implementing specific caps are considered amendments to the Demonstration and must be made consistent with Section III, paragraph 7. Enrollment caps are not permitted for populations receiving hypothetical treatment under the budget neutrality agreement. Demonstration Approval Period: December 22, 2008 through June 30, 2011 7 MassHealth Base Populations* (See para. 57. (d) for terminology.) Medicaid Mandatory and Optional State Plan Groups (Categorical Eligibility) Federal Poverty Level (FPL) and/or Other Qualifying Criteria Funding Stream Expenditure and Eligibility Group (EG) Reporting MassHealth Demonstration Program Comments AFDC-Poverty Level infants < Age 1: 0 through 185% Title XIX Base Families Standard** Up to 60 days presumptive eligibility for children with unverified income Medicaid Expansion infants < Age 1: 185.1 through 200% • Title XIX if insured at the time of application • Title XXI if uninsured at the time of application • Funded through title XIX if title XXI is exhausted 1902(r)(2) Children 1902(r)(2) XXI RO Standard Up to 60 days presumptive eligibility for children with unverified income AFDC-Poverty Level Children and Independent Xxxxxx Care Adolescents • Age 1 - 5: 0 through 133% • Age 6 - 17: 0 through 114% • Independent Xxxxxx Care Adolescents aged out of DCF until the age of 21 without regard to income or assets Title XIX Base Families Standard Up to 60 days presumptive eligibility for children with unverified income AFDC-Poverty Level Children Medicaid Expansion Children I • Age 6 - 17: 114.1% through 133% • Age 18: 0 through 133% • Title XIX if insured at the time of application • Title XXI if uninsured at the time of application • Funded through title XIX if title XXI is exhausted Base Families Base Families XXI RO Standard Up to 60 days presumptive eligibility for children with unverified income Demonstration Approval Period: December 22, 2008 through June 30, 2011 8 MassHealth Base Populations (continued)* Medicaid Mandatory and Optional State Plan Groups (Categorical Eligibility) Federal Poverty Level (FPL) and/or Other Qualifying Criteria Funding Stream Expenditure and Eligibility Group (EG) Reporting MassHealth Demonstration Program Comments Medicaid Expansion Children II Ages 1 - 18: 133.1 through 150% • Title XIX if insured at the time of application • Title XXI if uninsured at the time of...
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Related to Enrollment Caps

  • Enrollment The School shall maintain accurate and complete enrollment data and daily records of student attendance.

  • Enrollment Period 4.2.9.1 After enrolling in the CONTRACTOR’s MCO (whether as the result of selection, assignment, or auto assignment), Members shall have one (1) opportunity anytime during the three (3) month period immediately following the effective date of enrollment with the CONTRACTOR’s MCO to request to change MCOs. After exercising this right to change MCOs, a Member shall remain enrolled with the MCO until the annual choice period described in Section 4.2.9.2 of this Agreement, unless disenrolled in accordance with Section

  • Enrollment Process The Department may, at any time, revise the enrollment procedures. The Department will advise the Contractor of the anticipated changes in advance whenever possible. The Contractor shall have the opportunity to make comments and provide input on the changes. The Contractor will be bound by the changes in enrollment procedures.

  • Enrollment Procedures The District shall establish an open enrollment period each year for unit members to participate in the Catastrophic Leave Bank. The enrollment period shall be September 1 through December 1. Once a unit member becomes a participant in the Catastrophic Leave Bank, he/she shall not be required to reenroll each year.

  • Open Enrollment Period Open Enrollment is a period of time each year when you and your eligible dependents, if family coverage is offered, may enroll for healthcare coverage or make changes to your existing healthcare coverage. The effective date will be on the first day of your employer’s plan year. Special Enrollment Period A Special Enrollment Period is a time outside the yearly Open Enrollment Period when you can sign up for health coverage. You and your eligible dependents may enroll for coverage through a Special Enrollment Period by providing required enrollment information within thirty (30) days of the following events: • you get married, the coverage effective is the first day of the month following your marriage. • you have a child born to the family, the coverage effective date is the date of birth. • you have a child placed for adoption with your family, the coverage effective date is the date of placement. Special note about enrolling your newborn child: You must notify your employer of the birth of a newborn child and pay the required premium within thirty -one (31) days of the date of birth. Otherwise, the newborn will not be covered beyond the thirty -one (31) day period. This plan does not cover services for a newborn child who remains hospitalized after thirty-one (31) days and has not been enrolled in this plan. If you are enrolled in an Individual Plan when your child is born, the coverage for thirty- one (31) days described above means your plan becomes a Family Plan for as long as your child is covered. Applicable Family Plan deductibles and maximum out-of-pocket expenses may apply. In addition, if you lose coverage from another plan, you may enroll or add your eligible dependents for coverage through a Special Enrollment Period by providing required enrollment information within thirty (30) days following the date you lost coverage. Coverage will begin on the first day of the month following the date your coverage under the other plan ended. In order to be eligible, the loss of coverage must be the result of: • legal separation or divorce; • death of the covered policy holder; • termination of employment or reduction in the number of hours of employment; • the covered policy holder becomes entitled to Medicare; • loss of dependent child status under the plan; • employer contributions to such coverage are being terminated; • COBRA benefits are exhausted; or • your employer is undergoing Chapter 11 proceedings. You are also eligible for a Special Enrollment Period if you and/or your eligible dependent lose eligibility for Medicaid or a Children’s Health Insurance Program (CHIP), or if you and/or your eligible dependent become eligible for premium assistance for Medicaid or a (CHIP). In order to enroll, you must provide required information within sixty (60) days following the change in eligibility. Coverage will begin on the first day of the month following our receipt of your application. In addition, you may be eligible for a Special Enrollment Period if you provide required information within thirty (30) days of one of the following events: • you or your dependent lose minimum essential coverage (unless that loss of coverage is due to non-payment of premium or your voluntary termination of coverage); • you adequately demonstrate to us that another health plan substantially violated a material provision of its contract with you; • you make a permanent move to Rhode Island: or • your enrollment or non-enrollment in a qualified health plan is unintentional, inadvertent, or erroneous and is the result of error, misrepresentation, or inaction by us or an agent of HSRI or the U.S. Department of Health and Human Services (HHS).

  • Re-enrollment Any eligible employees who wish to join the Sick Leave Bank after their first year of eligibility will contribute two (2) days upon joining. Such membership may only be made during the month of October using the appropriate forms. The two (2) required days of leave shall be donated from their account upon enrollment in the Sick Leave Bank.

  • Disenrollment Adverse Benefit Determination taken by the Division, or its Agent, to remove a Member's name from the monthly Member Listing report following the Division's receipt and approval of a request for Disenrollment or a determination that the Member is no longer eligible for Enrollment in the Contractor.

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