16 Del. Admin. Code § 15000-15400

Current through Register Vol. 28, No. 7, January 1, 2025

Section 15000-15400 - Adult Group

This section describes the eligibility requirements for the Adult Group.

15400.1Definitions

The following words and terms, when used in the context of these policies, will have the following meaning unless the context clearly indicates otherwise:

"Minimum essential coverage" means coverage defined in section 5000A(f) of subtitle D of the Internal Revenue Code, as added by section 1401 of the Affordable Care Act, and implementing regulations of such section issued by the Secretary of the Treasury. Minimum essential coverage includes any of the following:

*	Medicare Part A;

*

Medicaid;

*	Children's Health Insurance Program (CHIP);

*	Medical coverage under chapter 55 of Title 10, United States Code, including coverage under the TRICARE program;

*	a health care program under chapter 17 or 18 of Title 38, United States Code, as determined by the Secretary of Veterans Affairs, in coordination with the Secretary of Health and Human Services and the Secretary of the Treasury;

*	a health plan under section 2504(e) of Title 22, United States Code (relating to Peace Corps volunteers);

*	The Nonappropriated Fund Health Benefits Program of the Department of Defense, established under section 349 of the National Defense Authorization Act for Fiscal Year 1995 (Public Law 103-337; 10 United States Code 1587 note).

15400.2Adult Group General Eligibility Requirements

An adult must meet the general eligibility requirements described in Section 14000.

15400.3Technical Eligibility

An adult must:

a) be age 19 or older and under age 65;

b) not be pregnant;

c) not be entitled to or enrolled in Medicare Part A or B;

d) not be eligible under the following mandatory groups - Supplement Security Income (SSI) and related groups, Parent/Caretaker Relative, Transitional, Prospective, Pregnant Woman, Deemed Newborn, Children, Former Foster Child, or Title IV-E Foster Children.

A parent or caretaker relative living with a dependent child as defined in Section 15100.1 shall not be eligible in the Adult Group unless the child is enrolled in minimum essential coverage.

15400.4Financial Eligibility

Financial eligibility is determined using the modified adjusted gross income (MAGI) methodologies in Section 16000.

Household income must not exceed 133% of the Federal Poverty Level (FPL).

16 Del. Admin. Code § 15000-15400

17 DE Reg. 503( 11/1/2013)(Final)