Utah Administrative Code (Current through November 1, 2019) |
R414. Health, Health Care Financing, Coverage and Reimbursement Policy |
R414-310. Medicaid Primary Care Network Demonstration Waiver |
R414-310-13. Change Reporting and Benefit Changes
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(1) Unless otherwise stated, the provisions in Section R414-308-7 apply to the PCN program.
(2) Reportable changes are defined in Subsection R414-310-3(2).
(3) For a decrease in income, the following provisions apply:
(a) If a change is already anticipated in a best estimate of income, the eligibility agency may only re-determine eligibility if the enrollee requests a redetermination of benefits.
(b) If a change is not anticipated, the agency shall re-determine eligibility.
(c) If a change makes the enrollee eligible for Medicaid, the effective date of the change is the first day of the month of report, if the change is verified timely.
(d) If a change is not verified timely, the change is effective on the first day of the month the change is verified.
(4) If an enrollee requests enrollment for a spouse, the application date for the spouse is the date of the request, and the following provisions apply:
(a) The eligibility agency does not require a new application;
(b) Eligibility is determined in accordance with Section R414-310-11;
(c) The effective date of enrollment is determined in accordance with Section R414-310-12; and
(d) The applicant must meet all other eligibility requirements.