R414-311-5. Application, Eligibility Reviews and Improper Medical Assistance

  (1) Unless otherwise stated, the provisions of Rule R414-308 apply to applicants and enrollees.

  (2) Subject to the provisions of Subsection R414-311-5(3), an individual who is determined eligible shall receive 12 months of coverage that begins with the first month of enrollment.

  (3) Coverage for Targeted Adult Medicaid may end before the end of the 12-month certification period if the individual:

  (a) turns 65 years old;

  (b) moves out of state;

  (c) becomes eligible for another Medicaid program;

  (d) enters a public institution or an institution for mental disease, except as described in Section R414-302-6;

  (e) is convicted of fraud; or

  (f) leaves the household.

  (4) An individual who leaves prison, jail or the Utah State Hospital must submit an application within 60 days of release or discharge.

  (5) An enrollee must verify at each review that he meets the criteria of a coverage group as defined in Section R414-311-2. An enrollee who no longer meets criteria of a coverage group is no longer eligible for Targeted Adult Medicaid.