Section 128.240  Eligibility Determination and Enrollment Process

a)         The applicant's military discharge status, time spent in active duty, health insurance status and eligibility for Veterans Administration healthcare will be reviewed first.

b)         For the purpose of determining eligibility under this Part, applicants who are not found ineligible under subsection (a) of this Section will be screened for eligibility for medical assistance under the Public Aid Code or health benefits, including rebates, under the Children's Health Insurance Program Act.  Veterans who are likely to be eligible for these other programs will be directed to apply for them.  Veterans may be enrolled under this Part while an application for coverage under another program is pending.

c)         If the monthly countable income is below the Veterans Care income standard, the application will be approved if all other factors of eligibility are met.  The Veterans Care income standard is 25% of the Federal Poverty Level plus the Veterans Administration Geographic Means Test threshold. If fewer than 1,500 veterans are enrolled in the program by February 1, 2007, the Department may determine, at its sole discretion, that resources are available to raise this standard to 50 percent of the Federal Poverty Level plus the Veterans Administration Geographic Means Test threshold effective March 1, 2007.

1)         If the veteran's income is equal to or less than 25 percent of the Federal Poverty Level plus the Veterans Administration Geographic Means Test threshold, the veteran shall be enrolled in Veterans Care Premium Level I.

2)         If the veteran's income is more than 25 percent of the Federal Poverty Level plus the Veterans Administration Geographic Means Test threshold and equal to or less than 50 percent of the Federal Poverty Level plus the Veterans Administration Geographic Means Test threshold, the veteran shall be enrolled in Veterans Care Premium Level II.

d)         Applicants will be notified, in writing, regarding the outcome of their eligibility determination.

e)         Eligibility determinations for the program made by the 10^th day of a month will be effective the first day of the following month.  Eligibility determinations for the program made after the 10^th day of a month will be effective no later than the first day of the second month following that determination.

f)          The duration of eligibility for the program will be 12 months unless one of the events described in Section 128.210(b) occurs or the Department shortens the enrollment period to maintain program spending within available funding.

g)         Veterans may obtain backdated medical coverage for the month of application plus up to three months prior to the month of application but no earlier than the beginning of the program on September 1, 2006.  This coverage shall be subject to the veteran paying the premiums for the months of backdated coverage requested.  The veteran may choose the month for which backdated coverage will begin.  Backdated months of coverage shall be consecutive beginning with the initial month of backdated coverage requested.

h)         At the sole discretion of the Department, the Department may reduce the income threshold established in subsection (c) of this Section if necessary to keep the cost of the program within available funding.