Section 220-RICR-90-00-1.5 - Qualified Health Plan Eligibility and EnrollmentA. In General - §1311 of the ACA establishes exchanges to facilitate the purchase of Qualified Health Plans. §1311 and its implementing regulations, 45 C.F.R. §§ 155.305 and 155.400, incorporated above at § 1.3 of this Part, respectively, establish eligibility requirements and requirements for enrollment in a Qualified Health Plan.B. Eligibility for Enrollment in a QHP through the Exchange - The Exchange shall determine an applicant eligible for enrollment in a Qualified Health Plan if he or she meets the requirements in 45 C.F.R. § 155.305, incorporated above at § 1.3 of this Part, including the following requirements: 1. Citizenship, status as a national, or lawful presence. Is a citizen, or national of the United States, or is a non-citizen who is lawfully present in the United States and is reasonably expected to be a citizen, national or a non-citizen who is lawfully present for the entire period for which enrollment is sought;2. Incarceration. Is not incarcerated, other than incarceration pending the disposition of charges;3. Residency. Meets the applicable residency standards as defined in 45 C.F.R. § 155.305(a)(3), incorporated above at § 1.3 of this Part.C. QHP Selection - The Exchange shall accept a Qualified Health Plan selection from an applicant determined eligible for enrollment in a QHP. The Exchange shall notify the issuer of the applicant's selected QHP and transmit information necessary to enable the QHP issuer to enroll the applicant.D. QHP Enrollment - Enrollment of a qualified individual in a QHP shall be limited to the annual open enrollment period, or a special enrollment period.E. Appeals - An applicant has the right to an appeal of an eligibility determination pursuant to the appeals process as described in these Regulations and as may be set forth in 210-RICR- 10-05-2, Appeals Process and Procedures for EOHHS Agencies and Programs.220 R.I. Code R. 220-RICR-90-00-1.5
Amended effective 12/22/2019
Amended effective 12/31/2020
Amended effective 4/2/2023