§ 600.320 - Determination of eligibility for and enrollment in a standard health plan.

§ 600.320 Determination of eligibility for and enrollment in a standard health plan.

Cross Reference

Link to an amendment published at 89 FR 26419, Apr. 15, 2024.

(a) Determining eligibility to enroll in a standard health plan may be performed by a State or through delegation to a local governmental entity, including a governmental entity that determines eligibility for Medicaid or CHIP, and may be delegated by the State to an Exchange that is a government agency.

(b) Timely determinations. The terms of 42 CFR 435.912 (relating to timely determinations of eligibility under the Medicaid program) apply to eligibility determinations for enrollment in a standard health plan exclusive of § 435.912(c)(3)(i). The standards established by the State must be included in the BHP Blueprint.

(c) Effective date of eligibility. The State must establish a uniform method of determining the effective date of eligibility for enrollment in a standard health plan following either which—

(1) Follows the Exchange effective date standards at 45 CFR 155.420(b)(1)

or

;

(2) Follows the Medicaid

process at 42 CFR

effective date standards at § 435.915 of this chapter exclusive of § 435.915(a);or

(3) Follows an effective date of eligibility of the first day of the month following the month in which BHP eligibility is determined; or

(4) Follows an effective date of eligibility standard established by the State and subject to HHS approval to ensure that the effective date is:

(i) No later than the first day of the second month following the date that an individual has been determined BHP-eligible; and

(ii) No more restrictive than paragraphs (c)(1) through (3) of this section.

(d) Enrollment periods. The State must either offer enrollment and special enrollment periods no more restrictive than those required for an Exchange at 45 CFR 155.410 and 155.420 or follow the Medicaid process permitting continuous open enrollment throughout the year.

[79 FR 14140, Mar. 12, 2014, as amended at 89 FR 26419, Apr. 15, 2024]