Section 441.76.4. Express lane eligibility.

For purposes of the initial enrollment of a child in medical assistance, the department will use express lane procedures as allowed by 42 U.S.C. § 1396a(e)(13) and as described in this rule.

       76.4(1) For purposes of initial enrollment, the department shall rely on a determination of the child’s eligibility for food assistance pursuant to 441—Chapter 65 as establishing that a child under the age of 19 meets all eligibility requirements established in 441—subrule 75.1(28) except for citizenship or alienage requirements, unless:

        a.           The child’s household already includes other persons receiving Medicaid based on the use of the modified adjusted gross income methodology, or

        b.           The child was previously granted express lane eligibility and the household has not had at least a two-month break in food assistance eligibility since that time, or

        c.           The household’s income as calculated by the food assistance program exceeds the income limit for the mothers and children coverage group found at 441—subparagraph 75.1(28)“a”(1).

       76.4(2) To obtain express lane enrollment for a child, the child’s household must request medical assistance for the child on Express Lane Medicaid for Children, Form 470-4851 or Form 470-4851(S). The department shall send Form 470-4851 or Form 470-4851(S) to the household when a child eligible for express lane enrollment is approved for food assistance pursuant to 441—Chapter 65. An adult member of the child’s household or a child receiving food assistance as head of household must sign Form 470-4851 or Form 470-4851(S) and return it to the department within 30 calendar days of issuance.

       76.4(3) As a condition of express lane enrollment, the child must meet the citizenship or alienage requirements of rule 441—75.11(249A).

       76.4(4) The month of application for express lane enrollment is the month of the child’s food assistance effective date. Express lane eligibility begins on the first day of the month of the child’s food assistance effective date.

       76.4(5) Retroactive enrollment is available for any of the three months before the month of the child’s food assistance effective date when the child:

        a.           Has medical bills for covered services that were received in that period, and

        b.           Would have been eligible for medical assistance benefits in the month services were received if the application for medical assistance had been made in that month and the eligibility determination was made without regard to food assistance eligibility.

       76.4(6) After the initial express lane enrollment, all redeterminations of medical assistance eligibility shall be made without reliance on any food assistance eligibility determination.

[ARC 1069C, IAB 10/2/13, effective 10/1/13]