Section R382-10-18 - Enrollment Period and Benefit Changes(1) Subject to Subsection (2), a child determined eligible for CHIP receives 12 months of coverage that begins with the effective month of enrollment.(2) CHIP coverage may end or change before the end of the 12-month certification period if the child: (a) turns 19 years of age;(b) moves out of the state;(c) becomes eligible for Medicaid;(d) leaves the household;(e) is not eligible, or is eligible for a different plan due to a change described in Subsection R382-10-4(6)(b); (f) enters a public institution or an institution for mental disease; or(g) fails to respond to a request to verify reportable changes as described in Subsection R382-10-4(6)(b); or (h) gained lawfully present eligibility as defined in Subsection R382-10-6(3), and subsequently lost lawfully present status.(3) A child who becomes pregnant while enrolled in the program retains eligibility for the remainder of the pregnancy and the 12-month post-partum period.(4) The agency evaluates changes and may redetermine eligibility when it receives a change report as described in Subsection R382-10-4(6). If the agency requests verification of the change, the agency shall give the member at least ten days to provide verification. The agency shall provide proper notice of an adverse action.(5) If a member reports a change that occurs during the certification period and requests a redetermination, the agency shall redetermine eligibility.(a) If a member gains access to health insurance under an employer-sponsored plan or COBRA coverage, the member may switch to UPP. The member must report the health insurance within ten calendar days of enrolling, or within ten calendar days of when coverage begins, whichever is later. The employer-sponsored plan must meet UPP criteria.(b) If the change would cause an adverse action, eligibility would remain unchanged through the end of the certification period.(c) If the change makes the enrollee eligible for Medicaid, the eligibility agency shall end CHIP eligibility and enroll the child in Medicaid.(6) Failure to make a timely report of a reportable change may result in an overpayment of benefits and case closure.Utah Admin. Code R382-10-18
Amended by Utah State Bulletin Number 2014-22, effective 11/1/2014Amended by Utah State Bulletin Number 2015-8, effective 4/1/2015Amended by Utah State Bulletin Number 2015-23, effective 11/16/2015Amended by Utah State Bulletin Number 2024-14, effective 7/1/2024