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UPP |
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Obsolete Policy |
Allow a person to come back on the UPP program from Medicaid even if they are currently enrolled in their health insurance plan as long as they were on UPP initially when they went to Medicaid and there was not a break in coverage. It does not have to be an UPP open enrollment period.
Medicaid recipients returning to UPP are not sanctioned if they maintain their insurance. The person may be currently enrolled in their health insurance plan as long as they were on UPP prior to Medicaid and there was no break in coverage. UPP reimbursement may begin the month following the Medicaid closure.
A. Reopening UPP with the Same Certification Period
1. Do not require a new application.
2. Determine the health insurance plan is an “UPP Qualified Health Plan”.
3. Determine that their health insurance meets the cost of coverage requirements by doing a new best estimate of the household's current income to determine the cost of coverage.
4. Do not do a new income determination.
5. The individual must meet all the eligibility requirements for UPP.
6. Open UPP for the remainder of the certification period.
B. UPP to Medicaid to UPP When UPP 12 Month Certification Period Has Ended
1. Do not require a new application.
2. Do a complete re-determination of all eligibility factors.
o Exception: The person may be currently enrolled in their health insurance plan as long as they were on UPP prior to Medicaid and there was no break in coverage.
3. Open UPP and authorize a new 12-month certification period.
If married adults were both UPP recipients and only one of them changed to a Medicaid program, follow the policy in section 1009-3 to add the spouse back to UPP.