Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-302

Eligibility Requirements

Notice of Proposed Rule

(Amendment)

DAR File No.: 33572
Filed: 04/22/2010 04:26:45 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to allow the Department to establish an electronic match system with the Social Security Administration to verify citizenship, and to clarify who may receive Medicaid coverage when residing in an institution.

Summary of the rule or change:

This amendment includes language that allows the Department to implement an electronic match system with the Social Security Administration for the purpose of verifying citizenship and to identify new Medicaid applicants. This change also removes language from Section R414-302-3 that is no longer necessary and reserves this section for future changes. It further amends language in the text to include the age ranges of individuals who may receive Medicaid while residing in an institution for mental disease.

State statutory or constitutional authorization for this rule:

• Section 211(a) of Pub. L. No. 111-3
• Section 26-18-3

Anticipated cost or savings to:

the state budget:

There may be some administrative costs associated with the establishment of an electronic match system with the Social Security Administration. These costs, however, are negligible and there is no data to quantify what those costs would be.

local governments:

There is no impact to local governments because they do not determine Medicaid eligibility and do not fund or provide Medicaid services.

small businesses:

There are no new administrative costs to small businesses because they do not verify citizenship or identify new Medicaid applicants. In addition, these changes do not affect provider revenue because they do not affect Medicaid services. Further, only the Department will bear any cost associated with the establishment of an electronic match system with the Social Security Administration.

persons other than small businesses, businesses, or local governmental entities:

There are no new administrative costs to Medicaid providers because they do not verify citizenship or identify new Medicaid applicants. In addition, these changes do not affect provider revenue and do not impact Medicaid clients because they do not affect Medicaid services. Further, only the Department will bear any cost associated with the establishment of an electronic match system with the Social Security Administration.

Compliance costs for affected persons:

There are no compliance costs to a single Medicaid provider because the provider does not verify citizenship or identify new Medicaid applicants. In addition, these changes do not affect provider revenue and do not impact a single Medicaid client because they do not affect Medicaid services. Further, only the Department will bear any cost associated with the establishment of an electronic match system with the Social Security Administration.

Comments by the department head on the fiscal impact the rule may have on businesses:

Streamlined verification of identity and citizenship will benefit all persons entitled to receive services and have an overall positive fiscal impact.

David N. Sundwall, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Health Care Financing, Coverage and Reimbursement Policy
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at cdevashrayee@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

06/14/2010

This rule may become effective on:

06/21/2010

Authorized by:

David Sundwall, Executive Director

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

R414-302. Eligibility Requirements.

R414-302-1. Citizenship and Alienage.

(1) The Department incorporates by reference 42 CFR 435.406 2008 ed., which requires applicants and recipients to be U.S. citizens or qualified aliens and to provide verification of their U.S. citizenship or lawful alien status.

(2) The definitions in R414-1 and R414-301 apply to this rule.

(3) The Department shall decide if a public or private organization no longer exists or is unable to meet an alien's needs. The Department shall base the decision on the evidence submitted to support the claim. The documentation submitted by the alien must be sufficient to prove the claim.

(4) One adult household member must declare the citizenship status of all household members who will receive Medicaid. The client must provide verification of citizenship and identity as described in 42 CFR 435.407.

(5) A qualified alien, as defined in 8 U.S.C. 1641 who was residing in the United States prior to August 22, 1996, may receive full Medicaid, QMB, SLMB, or Qualifying Individuals (QI) services.

(6) A qualified alien, as defined in 8 U.S.C. 1641 newly admitted into the United States on or after August 22, 1996, may receive full Medicaid, QMB, SLMB, or Qualifying Individuals (QI) services after five years have passed from the person's date of entry into the United States.

(7) The Department accepts as verification of citizenship documents from federally recognized Indian tribes evidencing membership or enrollment in such tribe including those with international borders as required under Section 221(b)(1) of [T]the Children's Health Insurance Program Reauthorization Act of 2009, Pub. L. No. 111 3, or as prescribed by the Secretary.

(8) The Department provides reasonable opportunity for applicants or clients to present satisfactory documentation of citizenship as required under Section 221(b)(2) of [T]the Children's Health Insurance Program Reauthorization Act of 2009, Pub. L. No. 111 3.

(9) The Department considers that an infant born to a mother who is eligible for Medicaid at the time of such infant's birth has provided satisfactory evidence of citizenship. The Department does not require further verification of citizenship for such infant as required under Section 221(b)(3) of [T]the Children's Health Insurance Program Reauthorization Act of 2009, Pub. L. No. 111 3.

(10) The Department may implement an electronic match system with the Social Security Administration to verify citizenship or nationality, and the identity of an applicant for medical assistance. The electronic match system shall meet the requirements of Section 211(a) of the Children's Health Insurance Program Reauthorization Act of 2009, Pub. L. No. 111 3.

 

R414-302-3. [Local Office Residence]Reserved.

[Applicants may apply at any local office or outreach location. The Department may require applicants also applying for services from the Department of Workforce Services or foster care Medicaid to apply at the local office in the area where they reside.]Reserved.

 

R414-302-4. Residents of Institutions.

(1) The Department provides Medicaid coverage to individuals who are residents of institutions subject to the limitations related to residents of public institutions, patients in an institution for mental diseases who do not meet the age criteria, and patients in an institution for tuberculosis as defined in 42 CFR 435.1009, 2009 ed., which is incorporated by reference. The Department also incorporates by reference the definitions in 42 CFR 435.1010, 2009 ed.

(2) The Department does not consider persons under the age of 18 to be residents of an institution if they are living temporarily in the institution while arrangements are being made for other placement.

(3) The Department does not consider an individual who resides in a temporary shelter for a limited period of time as a resident of an institution.

(4) The Department considers ineligible residents of institutions for mental disease (IMD) who are ages 21 through 64 as non-residents while on conditional or convalescent leave from the institution. A resident of an IMD who is under 21 years of age, or is under 22 years of age and enters an IMD before reaching 21 years of age, is considered to be a resident while on conditional or convalescent leave from the institution.

(5) [The]For individuals under 22 years of age who become residents of an IMD before reaching 21 years of age, the Department limits Medicaid eligibility [for residents of institutions for mental disease ]to individuals residing in the Utah State Hospital[ who meet the age requirements and other eligibility criteria].

 

KEY: public assistance programs, application, eligibility, Medicaid

Date of Enactment or Last Substantive Amendment: [April 1, ]2010

Notice of Continuation: January 25, 2008

Authorizing, and Implemented or Interpreted Law: 26-18-3