ACA Eligible Individuals Health Care Coverage 510-03-30-20

(Revised 1/1/2024 ML #3776)

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Individuals determined eligible under ACA Medicaid are assigned their Health Care Coverage under either Traditional Medicaid or the Alternative Benefit Plan (ABP), which is currently provided through Sanford Health Plan (SHP) through December 31, 2021 and through Blue Cross and Blue Shield of North Dakota effective January 1, 2022.

 

1. Individuals who have their coverage under Traditional Medicaid are:
   1. Eligible children under age 19.
   2. Eligible parents and caretaker/relatives of deprived children under age 18 (through the month the child attains age 18) and their spouses with income below 46% of the FPL.
   3. Eligible parents and caretaker/relatives of deprived children under age 18 (through the month the child attains age 18), their spouses and children who are eligible as Transitional or Extended Medicaid.
   4. Eligible pregnant women with income below 175% of the Federal Poverty Level (FPL) and through the end of the twelfth month postpartum period.
   5. Eligible Former Foster Care children.
   6. Eligible individuals who have been approved for the Medicaid Breast and Cervical Cancer Early Detection Program and whose income is greater than 138% and less than 200% of the FPL.
   7. Medically Needy eligible pregnant women, children under age 19 (through the month they attain age 19) and parents/caretaker relatives of deprived children under age 18. See Non-ACA Medicaid Policy income considerations, income deductions and income disregards.
   8. Effective January 1, 2022, eligible individuals between the ages of 19 (the month following the month of their 19th birthday) and 20 (month prior to the month of their 21st birthday)
      
      
2. Individuals who have their coverage under the Alternative Benefit Plan (ABP) are:
   1. Eligible individuals between the ages of 21 (month following the month of their 21st birthday) and 64 (month prior to the month of their 65th birthday).
   2. Eligible individuals age 19 and 20 prior to January 1, 2022.
      
      
3. Individuals who have the option to receive either the Traditional Medicaid Coverage or receive their coverage through the Alternative Benefit Plan (ABP) are:
   1. Eligible adults who meet the Medically Frail criteria (includes eligible individuals age 19 and 20 prior to January 1, 2022;
   2. Eligible individuals who have been approved for the Medicaid Breast and Cervical Cancer Early Detection Program whose income is less than 138% of the FPL (includes eligible individuals age 19 and 20 prior to January 1, 2022.
   3. Eligible women who become pregnant while they are covered through the Alternative Benefit Plan (ABP).
      
      
4. Individuals who have coverage under the Optional Children's Group are: Eligible children under age 19 (thru the end of the month they turn 19) who do not have other creditable health insurance coverage.