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37.82.430    COBRA CONTINUATION BENEFICIARIES, APPLICATION, AND ELIGIBILITY FOR MEDICAID

(1) A person is a COBRA continuation beneficiary eligible for Medicaid, if:

(a) the person meets the nonfinancial criteria in (2) of this rule;

(b) the person has countable resources which do not exceed twice the federal supplemental security income (SSI) resource limitation set forth at 42 USC 1382(a)(3)(A) and (B). The department hereby incorporates 42 USC 1382(a)(3)(A) and (B) as amended through April 1, 1991. Copies of 42 USC 1382(a)(3)(A) and (B), as amended through April 1, 1991, are available from the Department of Public Health and Human Services, Human and Community Services Division, Cogswell Building, 1400 Broadway, P.O. Box 202952, Helena, MT 59620-2952;

(c) the person has countable income not in excess of 100% of the federal poverty income standard as defined by the Executive Office of Management and Budget (EOMB) and revised annually;

(d) the person is eligible for coverage under a group health plan provided by an employer with at least 75 employees pursuant to Title XXII of the Public Health Service Act, subsection 4980B of the Internal Revenue Code of 1986, or Title VI of the Employee Retirement Income Security Act (ERISA) of 1974 due to a qualifying event;

(i) a COBRA continuation coverage qualifying event is:

(A) death of the covered employee;

(B) termination or reduction of hours of the covered employee's employment;

(C) divorce or legal separation of the covered employee from the employee's spouse;

(D) the covered employee becoming eligible for benefits under Medicare; or

(E) a dependent child ceases to be a dependent child under the applicable plan requirements.

(e) it is cost effective to pay the health plan premiums according to the definition of cost effective in (2) of ARM 37.82.424.

(2) The nonfinancial criteria for determining eligibility of a COBRA continuation beneficiary are that the person:

(a) has or takes the necessary steps to obtain a social security number;

(b) meets the citizenship or alienage requirements of ARM 37.82.401; and

(c) meets the residency requirements of ARM 37.82.402.

(3) A person applying for and receiving Medicaid as a COBRA continuation beneficiary is subject to the following provisions:

(a) ARM 37.82.201 concerning application requirements;

(b) ARM 37.82.204 concerning determinations of eligibility;

(c) ARM 37.82.205 concerning redetermination;

(d) ARM 37.82.407 concerning limitation on the financial responsibility of relatives; and

(e) ARM 37.82.415 concerning application for other benefits.

(4) Medical assistance for a person eligible for Medicaid only as a COBRA continuation beneficiary shall be limited to payment of COBRA continuation premiums. The department will not pay coinsurance or deductibles under the group health plan or any other Medicaid benefits for a COBRA continuation beneficiary.

History: 53-2-201, 53-6-111, 53-6-113, MCA; IMP, 53-6-101, 53-6-103, 53-6-131, MCA; NEW, 1991 MAR p. 1021, Eff. 6/28/91; TRANS, from SRS, 2000 MAR p. 476.

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