R414-320-13. Change Reporting and Benefit Changes

  (1) Enrollees are required to report changes to the eligibility agency as defined in Subsection R414-320-3(2).

  (a) The eligibility agency shall determine the effect of the change and make the appropriate change in the enrollee's eligibility.

  (b) The eligibility agency shall send proper notice of changes in eligibility.

  (2) An enrollee who fails to report changes or return verification timely must repay any overpayment of benefits for which the enrollee is not eligible to receive.

  (3) An eligible household may request enrollment for an individual not enrolled in UPP; the application date for the individual is the date of the request.

  (a) A new application form is not required.

  (b) The eligibility agency determines the individual's eligibility for UPP in accordance with Section R414-320-11.

  (c) The eligibility agency shall determine the effective date of enrollment for individuals in accordance with Section R414-320-12.

  (d) The eligibility agency shall waive the requirement found in Subsection R414-320-6(2) if the individual is a newborn or adopted child, and the request to add the child is made within 30 days of the date of birth or adoption.

  (e) A new income test must be completed for the individual. If the individual's income places the UPP household over the income limit for UPP, the individual is not eligible to enroll in UPP.

  (f) All other eligibility requirements must be met.

  (4) If an eligible household requests a new eligibility determination for any household member during the certification period, the eligibility agency shall determine if any enrolled household member is eligible for Medicaid coverage.

  (a) An enrollee who is eligible for Medicaid coverage without a cost is no longer eligible for UPP.

  (b) An enrollee who must meet a spenddown or MWI premium to receive Medicaid and chooses not to meet the spenddown or MWI premium may remain on UPP.