Md. Code Regs. 14.35.07.22

Current through Register Vol. 51, No. 24, December 2, 2024

Section 14.35.07.22 - Medicaid to Private Plan Enrollment Program

A. To the extent permissible by federal law, the Exchange shall enroll an individual into a QHP if the individual was enrolled in Medicaid or MCHP through the Exchange and loses Medicaid or MCHP eligibility after:

(1) A redetermination based on a change in circumstances reported after April 15, 2023, pursuant to which the individual is determined eligible for a QHP but does not enroll in a QHP following receipt of the QHP eligibility determination; or

(2) A renewal conducted between April 15, 2023, and April 30, 2024, provided the Exchange verifies that the individual's most recent attested income exceeds the Medicaid-eligible amount as described in Health-General Article, §15-103(a)(2), Annotated Code of Maryland, and the individual meets eligibility requirements under this chapter to enroll in a QHP.

B. The Exchange shall select a plan for an individual described in §A(1) of this regulation on a date no earlier than the seventh day after the date of the QHP eligibility determination.

C. To the extent permissible by federal law, the Exchange shall select a plan for an individual described in §A(2) of this regulation on a date no earlier than the day immediately following the day that the individual's Medicaid coverage terminates.

D. The QHP into which the Exchange enrolls an individual shall be determined by the Exchange using the following guidance:

(1) For an individual who has tax household members who are already enrolled in a QHP, the Exchange may enroll the individual into the household QHP if the Exchange determines that the enrollment would be in the best interest of the consumer.

(2) For an individual who is eligible for a CSR plan for up to 150 percent FPL or a CSR plan for 151-200 percent FPL and does not have household members already enrolled in a QHP, the Exchange shall enroll the individual in:

(a) The lowest-cost Silver plan in the individual's region, if the individual's former managed care organization does not have an affiliate offering QHPs in that region; or

(b) The lowest-cost Silver plan offered by an affiliate of the individual's former managed care organization, if an affiliate offers a QHP in the individual's region.

(3) For an individual who is eligible for a CSR plan for up to 150 percent FPL or a CSR plan for 151-200 percent FPL and does not have tax household members already enrolled in a QHP, the Exchange shall enroll the individual in a plan based on the following guidance:

(a) If an affiliate of the individual's former managed care organization offers QHPs in the individual's region, the Exchange shall enroll the individual in the lower-cost option of either:

(i) The lowest-cost Gold plan offered by the managed care organization affiliate; or

(ii) The lowest-cost Silver plan offered by the managed care organization affiliate.

(b) If an affiliate of the individual's former managed care organization does not offer QHPs in the individual's region, the Exchange shall enroll the individual in the lower-cost option of either:

(i) The lowest-cost Gold plan in the region; or

(ii) The lowest-cost Silver plan in the region.

E. For plans selected for an individual under §A(1) of this regulation, enrollment shall be effective on:

(1) The first day of the month following the date of QHP selection pursuant to §B of this regulation, if the selected plan has a premium greater than zero dollars; or

(2) The first day of the month following the individual's confirmation of enrollment, if the selected plan has a premium of zero dollars.

F. To the extent permissible by federal law, for plans selected for an individual under §A(2) of this regulation, enrollment shall be effective on:

(1) The first day of the month following the date of QHP selection pursuant to §C of this regulation, if the selected plan has a premium greater than zero dollars; or

(2) The first day of the month following the individual's confirmation of enrollment, if the selected plan has a premium of zero dollars.

G. References to "cost" under this regulation mean premium cost to the consumer after APTCs and State-based subsidies are applied.

Md. Code Regs. 14.35.07.22

Regulation .22 adopted effective 50:11 Md. R. 444, eff. 5/10/2023; adopted effective 50:20 Md. R. 889, eff. 10/16/2023