36-2983

36-2983. Eligibility for the program

A. The administration shall establish a streamlined eligibility process for
applicants to the program and shall issue a certificate of eligibility at the time
eligibility for the program is determined. Eligibility shall be based on gross household
income for a member as defined in section 36-2981. The administration shall not apply a
resource test in the eligibility determination or redetermination process.

B. The administration shall use a simplified eligibility form that may be mailed to
the administration. Once a completed application is received, including adequate
verification of income, the administration shall expedite the eligibility determination
and enrollment on a prospective basis.

C. The date of eligibility is the first day of the month following a determination
of eligibility if the decision is made by the twenty-fifth day of the month. A person
who is determined eligible for the program after the twenty-fifth day of the month is
eligible for the program the first day of the second month following the determination of
eligibility.

D. An applicant for the program who appears to be eligible pursuant to section
36-2901, paragraph 6, subdivision (a) shall have a social security number or shall apply
for a social security number within thirty days after the applicant submits an
application for the program.

E. In order to be eligible for the program, a person shall be a resident of this
state and shall meet title XIX requirements for United States citizenship or qualified
alien status in the manner prescribed in section 36-2903.03.

F. In determining the eligibility for all qualified aliens pursuant to this
article, the income and resources of a person who executed an affidavit of support
pursuant to section 213A of the immigration and nationality act on behalf of the
qualified alien and the income and resources of the spouse, if any, of the sponsoring
individual shall be counted at the time of application and for the redetermination of
eligibility for the duration of the attribution period as specified in federal law.

G. Pursuant to federal law, a person is not eligible for the program if that person
is:

1. Eligible for title XIX or other federally operated or financed health care
insurance programs, except the Indian health service.

2. Covered by any group health plan or other health insurance coverage as defined
in section 2791 of the public health service act. Group health plan or other health
insurance coverage does not include coverage to persons who are defined as eligible
pursuant to the premium sharing program.

3. A member of a family that is eligible for health benefits coverage under a state
health benefit plan based on a family member's employment with a public agency in this
state.

4. An inmate of a public institution or a patient in an institution for mental
diseases. This paragraph does not apply to services furnished in a state operated mental
hospital or to residential or other twenty-four hour therapeutically planned structured
services.

H. A child who is covered under an employer's group health insurance plan or
through family or individual health care coverage shall not be enrolled in the program.
If the health insurance coverage is voluntarily discontinued for any reason, except for
the loss of health insurance due to loss of employment or other involuntary reason, the
child is not eligible for the program for a period of three months from the date that the
health care coverage was discontinued. The administration may waive the three month
period for any child who is seriously or chronically ill. For the purposes of the waiver,
"chronically ill" means a medical condition that requires frequent and ongoing treatment
and that if not properly treated will seriously affect the child's overall health. The
administration shall establish rules to further define conditions that constitute a
serious or chronic illness.

I. Pursuant to federal law, a private insurer, as defined by the secretary of the
United States department of health and human services, shall not limit enrollment by
contract or any other means based on the presumption that a child may be eligible for the
program.