R414-310-12. Effective Date of Enrollment and Enrollment Period

  (1) Subject to the limitations in Sections R414-306-4 and R414-310-6, the effective date of PCN enrollment is the first day of the application month with the following exceptions:

  (a) An applicant may be eligible for PCN if the applicant applies during an open enrollment period and will turn 19 before the end of the month in which open enrollment ends.

  (i) Enrollment in PCN may not begin before an individual turns 19 years of age.

  (ii) If an applicant qualifies for Medicaid or CHIP in the application month, enrollment in PCN begins the month after eligibility for Medicaid or CHIP ends.

  (b) If the individual is moving from UPP, the effective date of enrollment is the first day after the health insurance coverage ends.

  (c) If the individual is moving from Medicaid, or is eligible for Medicaid in the application month or the month following the application month, the effective date of enrollment is the first day of the month after Medicaid coverage ends. To enroll in PCN, Medicaid eligibility must end by the end of the month following the application month.

  (2) The effective date of reenrollment for PCN after the eligibility agency completes the periodic review is the first day after either the review month or due process month. Subsection R414-310-11(5) defines the effective date of reenrollment when the enrollee completes the review process in the three calendar months after the case is closed for incomplete review.

  (3) The eligibility agency shall end eligibility for any of the following reasons:

  (a) the individual turns 65 years of age;

  (b) the individual enrolls in a health coverage plan as defined in Subsection 414-310-6(2);

  (c) the individual gains access to an employer-sponsored health plan that meets the requirements of Subsection R414-310-6(2);

  (d) a change in income or household composition results in the individual exceeding the income limit;

  (e) the individual dies;

  (f) the individual moves out of state or cannot be located; or

  (g) the individual enters a public institution or an Institution for Mental Disease.

  (4) An enrollee who gains access to or enrolls in an employer-sponsored health plan may switch to the UPP program if the enrollee meets UPP eligibility requirements.