Eligibility. To be eligible for the program, an applicant
shall meet all the following eligibility requirements in addition to
R9-31-302 :
1. Age. Is less than 19 years of age. A
child's coverage shall continue through the month in which a child turns age 19
if the child is otherwise eligible;
2.
Citizenship. Is a United States citizen or a
qualified alien under A.R.S. §
36-2983 ;
3.
Residency. Is a resident of the state of Arizona
under A.R.S. §
36-2983 .
An Arizona resident is a person who currently lives in Arizona and intends to
remain in Arizona indefinitely;
4.
2. Income. Meets the
income requirements in
R9-31-304;
5.
3.
Cost sharing. Pays the cost sharing premium amount when premiums are required
as specified in A.R.S. §§
36-2982
and
36-2903.01;
6.
Social security number (SSN). Provides a SSN or
applies for a SSN within 30 days after submitting an
application.
7.
Assignment. Assigns rights to any first- or
third-party coverage of medical care as specified in 9 A.A.C. 31, Article
10;
8.
4. Other federal program. Is not eligible for Medicaid
or other federally operated or financed health care insurance program, except
the Indian Health Service as specified in A.R.S. §
36-2983;
9.
Inmate of a public institution. Is not an inmate of
a public institution, as specified in A.R.S. §
36-2983 ;
10.
5. Patient in an institution for mental disease. Is
not a patient in an institution for mental disease at the time of application,
or at the time of redetermination, as specified in A.R.S. §
36-2983;
11.
6.
Other health coverage. Is not covered under:
a. An employer's group health insurance
plan,
b. Family or individual
health insurance, or
c. Other
health insurance;
12.
7. State health
benefits. Is not eligible for health benefits coverage under a state health
benefit plan based on a family member's employment with a public agency in the
state of Arizona;
13.
8. Prior health insurance coverage. Has not been
covered by health insurance during the previous 90 days unless that health
insurance was discontinued due to the involuntary loss of employment or other
involuntary reason as specified in A.R.S. §
36-2983.
The 90 days of ineligibility due to previous insurance coverage shall not apply
to a child if:
a.
A newborn as defined in
R9-31-309 ;
b.
A Title XIX member as specified in 9 A.A.C. 22,
Article 1;
c.
An applicant who is seriously ill under
R9-31-101 or chronically ill under A.R.S. §
36-2983 ;
d.
A member under this Article who loses insurance
coverage;
e.
A CRS member; or
f.
A Native American member receiving services from IHS
or a Tribal Facility.
a.
Following the loss of eligibility for and enrollment in Medicaid or another
insurance affordability program;
b.
The premium paid by the family for coverage of the child under the group health
plan exceeded 5 percent of household income;
c. The child's parent is determined eligible
for advance payment of the premium tax credit for enrollment in a QHP through
the Exchange because the ESI in which the family was enrolled is determined
unaffordable in accordance with 26 CFR
1.36 B- 2(c)(3)(v);
d. The cost of family coverage that includes
the child exceeds 9.5 percent of the household income;
e. The employer stopped offering coverage of
dependents (or any coverage) under an employer-sponsored health insurance
plan;
f. A change in employment,
including involuntary separation, resulted in the child's loss of
employer-sponsored insurance (other than through full payment of the premium by
the parent under COBRA);
g. The
child has special health care needs; or
h. The child lost coverage due to the death
or divorce of a parent.
Notes
Ariz. Admin. Code §
R9-31-303
Adopted under an
exemption from A.R.S. Title 41, Chapter 6, pursuant to Laws 1998, Ch. 4, §
11, 4th Special Session, effective October 23, 1998 (Supp. 98-4). Amended by
exempt rulemaking at 5 A.A.R. 3670, effective September 10, 1999 (Supp. 99-3).
Amended by final rulemaking at 7 A.A.R. 5846, effective December 7, 2001 (Supp.
01-4). Amended by exempt rulemaking at 9 A.A.R. 4560, effective October 1, 2003
(Supp. 03-4). Amended by final rulemaking at 9 A.A.R. 5150, effective January
3, 2004 (Supp. 03-4). Amended by final rulemaking at 20 A.A.R. 193, effective
1/7/2014.
