R414-311-4. General Eligibility Requirements

  Unless otherwise stated, the provisions in Rule R414-302 and Section R414-306-4 apply to applicants and enrollees.

  (1) The following individuals are not eligible for Targeted Adult Medicaid:

  (a) Individuals who do not meet the coverage group criteria of being chronically homeless, justice involved, or needing treatment as defined in Section R414-311-2;

  (b) Individuals who have a dependent child under 19 years old; or

  (c) Individuals eligible for a Medicaid program without a spenddown.

  (2) An individual must be at least 19 years old and not yet 65 years old to enroll in Targeted Adult Medicaid.

  (a) The month in which an individual turns 19 years old is the first month in which the individual may enroll in Targeted Adult Medicaid.

  (b) An individual may only enroll in Targeted Adult Medicaid through the month in which the individual turns 65 years old.

  (3) The eligibility agency only enrolls applicants during an open enrollment period. The eligibility agency may limit the number it enrolls and may stop enrollment at any time. The open enrollment period may be limited to a coverage group or a subgroup within the coverage group.

  (4) The eligibility agency shall waive the open enrollment requirement for the following situations:

  (a) The individual who was previously on Targeted Adult Medicaid, and is moving from another Medicaid program back to Targeted Adult Medicaid, is otherwise eligible, and there is no break in coverage between the medical programs;

  (b) The individual is no longer eligible for PCN, is otherwise eligible, and there is no break in coverage between the two medical programs; or

  (c) The enrollee completes a review within three months of case closure as outlined in Section R414-308-6.

  (5) A resource test is not required.