Implementation of SB 75 and SB 104
- SB 75 – for children under 19 years of age started on May 16, 2016.
- SB 104 – for young adults 19 to 25 years of age is scheduled for January 1, 2020.
Impacted Population
Children and young adults impacted by the implementation of SB 75 and SB 104 have been divided into two groups:
- Transition population – children and young adults under age 26 without satisfactory immigration status currently receiving restricted scope MC.
- New enrollee population – children and young adults under age 26 without satisfactory immigration status not enrolled in MC.
Application Process
Children under 19 years of age who apply for MC after the implementation of SB 75 on May 16, 2016, must be approved for full scope benefits beginning the application month.
Young adults between 19 and 25 years of age who apply for MC after the implementation of SB 104 on January 1, 2020, must be approved for full scope benefits beginning the application month, if otherwise eligible.
Retroactive Coverage
For children under 19 years of age, requests for retroactive coverage for any of the three (3) months prior to implementation of SB 75 (February, March, April 2016), were evaluated for restricted scope benefits. Requests for retro coverage for the month of May 2016 forward, were evaluated for full scope benefits.
For young adults between 19 and 25 years of age, requests for retroactive coverage for any of the three (3) months prior to implementation of SB 104 (October, November, December 2019), should be evaluated for restricted scope benefits. Requests for retroactive coverage for months beginning January 2020, forward, should be evaluated for full scope benefits.
Transition Process
Children under 19 years who were receiving restricted scope MC at the time of SB 75 implementation were automatically transitioned into full scope MAGI or Non-MAGI aid codes on May 16, 2016.
Young adults between 19 and 25 years who are receiving restricted scope MC at the time of SB 104 implementation will be automatically transitioned into full scope MAGI or Non-MAGI aid codes on January 1, 2020.
MC Managed Care Enrollment
Children and young adults under age 26 who transitioned from restricted scope MC to full scope MC as a result of the implementation of SB 75 or SB 104 are required to enroll into a MC Managed Care Health Plan with the following exceptions:
- Children who turned 19 from May through October 2016 (the first six (6) months of the implementation of SB 75) were not required to enroll in a Managed Care Health Plan but could have enrolled voluntarily.
Example – Child turned 19 on July 30, 2016
On May 16, 2016, the date of the implementation of SB 75, this child was transitioned from restricted scope to full scope benefits but his/her enrollment into managed care was voluntary.
- Young adults who will turn 26 within the first six (6) months of the implementation of SB 104 (January through June 2020) are not required to enroll in a Managed Care Health Plan but may do so voluntarily.
Example – Young Adult turns 26 on May 30, 2020
On January 1, 2020, the date of the implementation of SB 104, this young adult will be transitioned from restricted scope to full scope benefits but his/her enrollment into managed care is voluntary.
Individuals being transitioned to full scope on January 1, 2020, who are not turning 26 from January to June 2020, will be placed in Fee-For-Service (FFS) full scope MC for up to two (2) months to allow them enough time to select a plan, but they must select a plan by the end of the second month.
If a plan is not selected by the end of the second month, the State will automatically assign a plan for the child or young adult.
Report Changes Within 10 Days
MC applicants and beneficiaries must report any changes to the citizenship or immigration status of any family member who is applying for or receiving MC to their Eligibility Worker (EW) within 10 days.