Utah Admin. Code R382-10-18 - Enrollment Period and Benefit Changes
(1)
Subject to Subsection (2), a child determined eligible for CHIP receives 12
months of coverage that begins with the effective month of
enrollment.
(2) CHIP coverage may
end or change before the end of the 12-month certification period if the child:
(a) turns 19 years of age;
(b) moves out of the state;
(c) becomes eligible for Medicaid;
(d) leaves the household;
(e) is not eligible, or is eligible for a
different plan due to a change described in Subsection R382-10-4(6)(b);
(f) enters a public institution or
an institution for mental disease; or
(g) fails to respond to a request to verify
reportable changes as described in Subsection R382-10-4(6)(b); or
(h) gained lawfully present eligibility as
defined in Subsection R382-10-6(3), and subsequently lost lawfully present
status.
(3) A child who
becomes pregnant while enrolled in the program retains eligibility for the
remainder of the pregnancy and the 12-month post-partum period.
(4) The agency evaluates changes and may
redetermine eligibility when it receives a change report as described in
Subsection R382-10-4(6). If the agency requests verification of the change, the
agency shall give the member at least ten days to provide verification. The
agency shall provide proper notice of an adverse action.
(5) If a member reports a change that occurs
during the certification period and requests a redetermination, the agency
shall redetermine eligibility.
(a) If a member
gains access to health insurance under an employer-sponsored plan or COBRA
coverage, the member may switch to UPP. The member must report the health
insurance within ten calendar days of enrolling, or within ten calendar days of
when coverage begins, whichever is later. The employer-sponsored plan must meet
UPP criteria.
(b) If the change
would cause an adverse action, eligibility would remain unchanged through the
end of the certification period.
(c) If the change makes the enrollee eligible
for Medicaid, the eligibility agency shall end CHIP eligibility and enroll the
child in Medicaid.
(6)
Failure to make a timely report of a reportable change may result in an
overpayment of benefits and case closure.
Notes
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