Ariz. Admin. Code § 9-31-303

Current through Register Vol. 30, No. 50, December 13, 2024

Section R9-31-303 - Eligibility Criteria

Eligibility. To be eligible for the program, an applicant shall meet all the following eligibility requirements in addition to R9-31-302:

1. Age. Is less than 19 years of age. A child's coverage shall continue through the month in which a child turns age 19 if the child is otherwise eligible;

2. Income. Meets the income requirements in R9-31-304;

3. Cost sharing. Pays the cost sharing premium amount when premiums are required as specified in A.R.S. §§ 36-2982 and 36-2903.01;

4. Other federal program. Is not eligible for Medicaid or other federally operated or financed health care insurance program, except the Indian Health Service as specified in A.R.S. § 36-2983;

5. Patient in an institution for mental disease. Is not a patient in an institution for mental disease at the time of application, or at the time of redetermination, as specified in A.R.S. § 36-2983;

6. Other health coverage. Is not covered under:

a. An employer's group health insurance plan,

b. Family or individual health insurance, or

c. Other health insurance;

7. State health benefits. Is not eligible for health benefits coverage under a state health benefit plan based on a family member's employment with a public agency in the state of Arizona;

8. Prior health insurance coverage. Has not been covered by health insurance during the previous 90 days unless that health insurance was discontinued due to the involuntary loss of employment or other involuntary reason as specified in A.R.S. § 36-2983. The 90 days of ineligibility due to previous insurance coverage shall not apply to a child if:

a. Following the loss of eligibility for and enrollment in Medicaid or another insurance affordability program;

b. The premium paid by the family for coverage of the child under the group health plan exceeded 5 percent of household income;

c. The child's parent is determined eligible for advance payment of the premium tax credit for enrollment in a QHP through the Exchange because the ESI in which the family was enrolled is determined unaffordable in accordance with 26 CFR 1.36 B- 2(c)(3)(v);

d. The cost of family coverage that includes the child exceeds 9.5 percent of the household income;

e. The employer stopped offering coverage of dependents (or any coverage) under an employer-sponsored health insurance plan;

f. A change in employment, including involuntary separation, resulted in the child's loss of employer-sponsored insurance (other than through full payment of the premium by the parent under COBRA);

g. The child has special health care needs; or

h. The child lost coverage due to the death or divorce of a parent.

Ariz. Admin. Code § R9-31-303

Adopted under an exemption from A.R.S. Title 41, Chapter 6, pursuant to Laws 1998, Ch. 4, § 11, 4th Special Session, effective October 23, 1998 (Supp. 98-4). Amended by exempt rulemaking at 5 A.A.R. 3670, effective September 10, 1999 (Supp. 99-3). Amended by final rulemaking at 7 A.A.R. 5846, effective December 7, 2001 (Supp. 01-4). Amended by exempt rulemaking at 9 A.A.R. 4560, effective October 1, 2003 (Supp. 03-4). Amended by final rulemaking at 9 A.A.R. 5150, effective January 3, 2004 (Supp. 03-4). Amended by final rulemaking at 20 A.A.R. 193, effective 1/7/2014.