Cost Effective Health Care Coverage - MA
Medical Assistance (MA) clients are required to maintain or enroll in other health care coverage if it is determined to be cost effective. Evaluate health care policies for MA clients for potential cost effectiveness at application, renewal, and any time a client reports access to other health care coverage.
Clients eligible to enroll on their own behalf in a cost effective group health plan must enroll at the earliest possible time (such as next open enrollment depending on the insurance provided) to maintain eligibility for MA. Clients already enrolled in a cost effective group health plan must remain enrolled to be eligible for MA.
If the policy is not determined cost effective, notify the client of the decision and of the right to appeal the action. Denials will be reconsidered if the client provides additional information to support a finding of cost effectiveness.
If the policy is not cost effective, the client may cancel the policy; it is the worker's responsibility to notify the client of that option. If the client decides to keep the policy, the premium payments can be used to meet an ongoing MA spenddown.