R414-310-13. Change Reporting and Benefit Changes

  (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.