reglab/statecodes huggingface dataset:
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1715.1 - FORMER FOSTER CARE CHILDREN GROUP › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1715.1-22 - Benefits

Current through June, 2024
(a) An individual eligible in accordance with
				  this chapter who is enrolled in a health plan shall be provided a standard
				  benefits package by a participating health plan and other services when
				  appropriate as described in chapter 17-1720.
(b) An individual identified in section
				  17-1735.1-2(a) shall be provided coverage under the fee-for-service provisions
				  as described in chapter 171737.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1715.1 - FORMER FOSTER CARE CHILDREN GROUP › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1715.1-23 - Disenrollment from a health plan

Current through June, 2024
An enrollee shall be disenrolled from a health plan under
					 the provisions as described in chapter 171720.1.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1716 - PREGNANT WOMEN GROUP › Subchapter 1 - GENERAL PROVISIONS › Section 17-1716-1 - Purpose

Current through June, 2024
This chapter establishes the Pregnant Women Group. The
					 Pregnant Women Group, created through the enactment of the Affordable Care Act,
					 provides Medicaid eligibility for a woman who is pregnant, to include a
					 pregnant individual under age nineteen years, whose household income exceeds
					 the age-specific income standard for a household of applicable size for
					 participation under Title XIX of the Social Security Act, or under age
					 twenty-one years and in receipt of foster care, kinship guardianship, or
					 adoption assistance.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1716 - PREGNANT WOMEN GROUP › Subchapter 1 - GENERAL PROVISIONS › Section 17-1716-2 - General requirements

Current through June, 2024
The confidentiality, administrative appeal, fraud, medical
					 assistance recovery, application processing, eligibility review, and adverse
					 action notice provisions described in subtitle 12 shall pertain to a pregnant
					 woman who applies or is eligible under this chapter.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1716 - PREGNANT WOMEN GROUP › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1716-9 - Basic requirements

Current through June, 2024
A pregnant woman whose eligibility is being determined
					 under this chapter shall meet the basic eligibility requirements which include,
					 but are not limited to, citizenship, qualified non-citizen or a lawfully
					 present non-citizen status, State residency, verification of identity, not
					 residing in a public institution, and the provision of a social security
					 number, as described in chapter 17-1714.1.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1716 - PREGNANT WOMEN GROUP › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1716-10 - Categorical requirements

Current through June, 2024
(a) A woman who
				  self-attests that she is pregnant shall be eligible to participate in the
				  Pregnant Women Group throughout her pregnancy.
(b) A pregnant woman is not required to
				  assist the State in establishing paternity for purposes of her eligibility,
				  other than through reasonable attestation unless there is conflicting
				  information that is not reasonably compatible with the attestation.
(c) A pregnant individual under age nineteen
				  years, whose household income exceeds the age-specific income standard for a
				  household of applicable size for participation under Title XIX of the Social
				  Security Act, and an individual under age twenty-one years, who is in receipt
				  of foster care, kinship guardianship, or adoption assistance, shall be subject
				  to the provisions of this chapter. If ineligible under this chapter, the
				  individual shall have eligibility determined under the Children
				  Group.
(d) Eligibility under this
				  chapter shall continue throughout the pregnancy and the post-partum period,
				  which begins on the date the pregnancy ends, extends sixty days, and ends on
				  the last day of the month in which the sixty-day period ends. Eligibility shall
				  be redetermined under another eligibility group effective the month following
				  the month in which the sixty-day period ends.
(e) A blind or disabled pregnant woman
				  described in subsection (a) who is applying on the basis of blindness or
				  disability shall be subject to the provisions of chapters 17-1719, 17-1724.1,
				  and 17-1725.1.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1716 - PREGNANT WOMEN GROUP › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1716-11 - Income requirements

Current through June, 2024
(a) The modified
				  adjusted gross income (MAGI) methodology described in chapter 17-1724.2 shall
				  be used to determine the countable income for a pregnant woman.
(b) The income standard for participation in
				  the Pregnant Women Group is one hundred eighty-five per cent of the federal
				  poverty level for a household of applicable size, which includes the number of
				  unborn child(ren) expected, plus the income conversion percentage of six per
				  cent. An income disregard of five per cent of the applicable federal poverty
				  level is added to the highest income standard for an individual using
				  MAGI-based methodology under the applicable title of the Social Security
				  Act.
(c) Regardless of changes in
				  household income, eligibility under this group shall continue through the last
				  day of the month in which the post-partum period ends.
(d) A woman who is determined ineligible
				  under this chapter shall have eligibility determined under other applicable
				  eligibility groups.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1716 - PREGNANT WOMEN GROUP › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1716-13 - Eligibility review requirements

Current through June, 2024
(a) An eligible
				  pregnant woman shall receive an annual eligibility review every twelve
				  months,
(b) Eligibility shall be
				  redetermined in accordance with chapter 17-1712.1 and subchapter
				  5 of chapter 17-1714.1.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1716 - PREGNANT WOMEN GROUP › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1716-19 - Purpose

Current through June, 2024
This subchapter addresses and refers to the provisions of
					 freedom of choice, enrollment, benefits and disenrollment for a pregnant woman
					 who is eligible in accordance with this chapter.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1716 - PREGNANT WOMEN GROUP › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1716-20 - Freedom of choice

Current through June, 2024
(a) A pregnant
				  woman eligible in accordance with this chapter, with the exception of an
				  individual identified in section
				  17-1735.1-2(a),
				  shall be provided a choice of a health plan and a provider as described in
				  chapter 17-1720.1.
(b) A pregnant
				  woman identified in section
				  17-1735.1-2(a)
				  shall choose a department approved provider as described in section
				  17-1736-3.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1716 - PREGNANT WOMEN GROUP › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1716-21 - Enrollment into a participating health plan

Current through June, 2024
(a) A
				  pregnant woman eligible in accordance with this chapter, with the exception of
				  an individual identified in section
				  17-1735.1-2(a),
				  shall be enrolled in a health plan as described in chapter 17-1720.1.
(b) A pregnant woman identified in section
				  17-1735.1-2(a)
				  shall not be enrolled into a health plan and their healthcare services shall be
				  provided on a fee-for-service basis.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1716 - PREGNANT WOMEN GROUP › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1716-22 - Benefits

Current through June, 2024
(a) A pregnant woman eligible in accordance
				  with this chapter who is enrolled in a health plan shall be provided a standard
				  benefits package by a participating health plan and other services when
				  appropriate as described in chapter 17-1720.
(b) A pregnant woman identified in section
				  17-1735.1-2(a)
				  shall be provided coverage under the fee-for-service provisions as described in
				  chapter 17-1737.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1716 - PREGNANT WOMEN GROUP › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1716-23 - Disenrollment from a health plan

Current through June, 2024
An enrollee shall be disenrolled from a health plan under
					 the provisions as described in chapter 17-1720.1.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1717 - PARENTS AND OTHER CARETAKER RELATIVES GROUP › Subchapter 1 - GENERAL PROVISIONS › Section 17-1717-1 - Purpose

Current through June, 2024
This chapter establishes the Parents and Other Caretaker
					 Relatives Group. The Parents and Other Caretaker Relatives Group, created
					 through the enactment of the Affordable Care Act, consolidates Medicaid
					 eligibility for a parent or other caretaker relative living with a child under
					 age nineteen years.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1717 - PARENTS AND OTHER CARETAKER RELATIVES GROUP › Subchapter 1 - GENERAL PROVISIONS › Section 17-1717-2 - General requirements

Current through June, 2024
The confidentiality, administrative appeal, fraud, medical
					 assistance recovery, application processing, eligibility review, and adverse
					 action provisions described in subtitle 12 shall pertain to a parent or other
					 caretaker relative who applies or is eligible under this
					 chapter.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1717 - PARENTS AND OTHER CARETAKER RELATIVES GROUP › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1717-8 - Purpose

Current through June, 2024
This subchapter describes the eligibility requirements for
					 participation in the Parents and Other Caretaker Relatives
					 Group.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1717 - PARENTS AND OTHER CARETAKER RELATIVES GROUP › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1717-9 - Basic requirements

Current through June, 2024
An individual whose eligibility is being determined under
					 this chapter shall meet the basic eligibility requirements which include, but
					 are not limited to, citizenship, qualified non-citizen or a lawfully present
					 non-citizen status, State residency, verification of identity, not residing in
					 a public institution, and the provision of a social security number, as
					 described in chapter 17-1714.1.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1717 - PARENTS AND OTHER CARETAKER RELATIVES GROUP › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1717-10 - Categorical requirements

Current through June, 2024
(a) To be eligible
				  under the Parents and Other Caretaker Relatives Group, an individual is not
				  required to be a parent or a relative of the child but is required to have
				  primary responsibility for the care and control of a child under age nineteen
				  years with whom the individual is living; including, but not limited to, a
				  child who is under the jurisdiction of the court, or whose legal custody is
				  held by a public agency that does not have physical custody of the
				  child.
(b) An individual who meets
				  the provisions of subsection (a), may be:
(1)
				  Aged, blind, or disabled, when age, blindness, or disability is not a condition
				  of eligibility; or
(2) In receipt
				  of or eligible for Medicare benefits.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1717 - PARENTS AND OTHER CARETAKER RELATIVES GROUP › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1717-11 - Income requirements

Current through June, 2024
(a) The modified
				  adjusted gross income (MAGI) methodology described in chapter 17-1724.2 shall
				  be used to determine the countable income for an individual subject to an
				  income limit.
(b) The income
				  standard for participation in the Parents and Other Caretaker Relatives Group
				  is one hundred per cent of the federal poverty level for a household of
				  applicable size. An income disregard of five per cent of the applicable federal
				  poverty level is added to the highest income standard for an individual using
				  MAGI-based methodology under the applicable title of the Social Security
				  Act.
(c) An individual who meets
				  the requirements of section
				  17-1717-10(a)
				  may, but is not required to, claim the child in the household as a tax
				  dependent for federal income tax purposes. An individual who is determined
				  ineligible under this chapter, shall have eligibility determined under another
				  eligibility-group.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1717 - PARENTS AND OTHER CARETAKER RELATIVES GROUP › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1717-12 - Asset requirements

Current through June, 2024
Assets shall not be considered in the determination of
					 eligibility for participation in the Parents and Other Caretaker Relatives
					 Group.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1717 - PARENTS AND OTHER CARETAKER RELATIVES GROUP › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1717-13 - Eligibility review requirements

Current through June, 2024
(a) An eligible
				  individual shall receive an annual eligibility review every twelve
				  months.
(b) Eligibility shall be
				  redetermined in accordance with chapter 17-1712.1 and subchapter
				  5 of chapter 17-1714.1.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1717 - PARENTS AND OTHER CARETAKER RELATIVES GROUP › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1717-19 - Purpose

Current through June, 2024
This subchapter addresses and refers to the provisions of
					 freedom of choice, enrollment, benefits and disenrollment for an individual who
					 is eligible in accordance with this chapter.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1717 - PARENTS AND OTHER CARETAKER RELATIVES GROUP › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1717-20 - Freedom of choice

Current through June, 2024
(a) An individual
				  eligible in accordance with this chapter, with the exception of an individual
				  identified in section
				  17-1735.1-2(a),
				  shall be provided a choice of a health plan and a provider as described in
				  chapter 17-1720.1.
(b) An
				  individual identified in section
				  17-1735.1-2(a)
				  shall choose a department approved provider as described in section
				  17-1736-3.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1717 - PARENTS AND OTHER CARETAKER RELATIVES GROUP › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1717-21 - Enrollment into a participating health plan

Current through June, 2024
(a) An
				  individual eligible in accordance with this chapter, with the exception of an
				  individual identified in section
				  17-1735.1-2(a),
				  shall be enrolled in a health plan as described in chapter 17-1720.1.
(b) An individual identified in section
				  17-1735.1-2(a)
				  shall not be enrolled into a plan and their healthcare services shall be
				  provided on a fee-for-service basis.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1717 - PARENTS AND OTHER CARETAKER RELATIVES GROUP › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1717-22 - Benefits

Current through June, 2024
(a) An individual eligible in accordance with
				  this chapter who is enrolled in a health plan shall be provided a standard
				  benefits package by a participating health plan and other services when
				  appropriate as described in chapter 17-1720.
(b) An individual identified in section
				  17-1735.1-2(a)
				  shall be provided coverage under the fee for-service provisions as described in
				  chapter 17-1737.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1717 - PARENTS AND OTHER CARETAKER RELATIVES GROUP › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1717-23 - Disenrollment from a health plan

Current through June, 2024
An enrollee shall be disenrolled from a health plan under
					 the provisions as described in chapter 17-1720.1.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1717.1 - TRANSITIONAL MEDICAL ASSISTANCE › Subchapter 1 - GENERAL PROVISIONS › Section 17-1717.1-1 - Purpose

Current through June, 2024
This chapter establishes and describes the provisions of
					 transitional medical assistance for a pregnant woman, or parent or caretaker
					 relative, to include a qualified non-citizen, living with a child under age
					 nineteen or an individual who is under age twenty-one and in receipt of foster
					 care, kinship guardianship or adoption assistance, who becomes ineligible for
					 medical assistance as a result of increased earned income, or collection or
					 increased collection of spousal support payments under section 1925 of the
					 Social Security Act.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1717.1 - TRANSITIONAL MEDICAL ASSISTANCE › Subchapter 1 - GENERAL PROVISIONS › Section 17-1717.1-2 - General requirements

Current through June, 2024
The confidentiality, administrative appeal, fraud, medical
					 assistance recovery, application processing, eligibility review, and adverse
					 action provisions described in subtitle 12 shall pertain to the household who
					 applies or is eligible under this chapter.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1717.1 - TRANSITIONAL MEDICAL ASSISTANCE › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1717.1-8 - Purpose

Current through June, 2024
This subchapter describes the eligibility requirements for
					 participation in transitional medical assistance for a household consisting of
					 a pregnant woman or parent or caretaker relative with a child(ren) described in
					 Section 1925 of the Social Security Act subject to federal
					 authorization.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1717.1 - TRANSITIONAL MEDICAL ASSISTANCE › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1717.1-9 - Basic requirements

Current through June, 2024
The household shall meet the basic eligibility
					 requirements, which include but are not limited to, citizenship, qualified
					 non-citizen status, state residency, verification of identity, not residing in
					 a public institution and the provision of a social security number, as
					 described in chapter 17-1714.1.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1717.1 - TRANSITIONAL MEDICAL ASSISTANCE › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1717.1-10 - Categorical requirements

Current through June, 2024
(a) A pregnant
				  woman, or parent or caretaker relative with a child(ren) under age nineteen or
				  an individual who is under age twenty-one and in receipt of foster care,
				  kinship guardianship or adoption assistance who continues to reside in the
				  household shall be eligible under this chapter when the household received
				  medical assistance in at least three of the six months preceding the month the
				  household became ineligible for the Pregnant Women Group, or the Parents or
				  Caretakers Relative Group as follows:
(1) Due
				  to an increase in earned income, the household is eligible to receive an
				  initial six months in accordance with section 17-1717.1-11(a); and
(2) An additional six months of coverage in
				  accordance with section 17-1717.1-11(b); or
(3) Due to the collection or increased
				  collection of spousal support payments, the household is eligible to receive
				  four months of coverage in accordance with section 17-1717.1-11(c).
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1717.1 - TRANSITIONAL MEDICAL ASSISTANCE › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1717.1-11 - Extension periods

Current through June, 2024
(a) Initial
				  six-month period for transitional medical assistance:
(1) Shall be extended to a household who is
				  terminated solely because of increased income from employment or increased
				  hours of employment of the household;
(2) Received assistance at least three of the
				  six-months immediately preceding the month in which the household became
				  ineligible in the Pregnant Women Group, or the Parents or Caretakers Relative
				  Group; and
(3) Shall include a
				  child as defined in this chapter, or eligibility shall terminate at the end of
				  the first month in which the household ceases to include the child.
(4) The department shall notify the household
				  of the option to receive an additional six-month period of transitional medical
				  assistance during the third and sixth month of this initial six-month
				  period.
(5) Shall terminate at the
				  end of the sixth month period when the household fails to meet the reporting
				  requirements of section 17-1717.1-12(a), unless the household establishes good
				  cause for failure to report timely. Failure to submit timely due to physical or
				  psychiatric limitations may constitute good cause.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1717.1 - TRANSITIONAL MEDICAL ASSISTANCE › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1717.1-12 - Income requirements

Current through June, 2024
(a) The initial
				  six-month period of transitional medical assistance:
(1) The household income shall not be
				  considered in the determination of eligibility for participation.
(2) The household shall report to the
				  department, no later than the twenty-first day of the fourth month of the
				  initial six-month period, on the household:
(A) Gross monthly earned income for each of
				  the first three months of the initial six-month period; and
(B) Cost for childcare that is necessary for
				  the employment of the household for each of the first three months of the
				  initial six-month period.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1717.1 - TRANSITIONAL MEDICAL ASSISTANCE › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1717.1-19 - Purpose

Current through June, 2024
This subchapter addresses and refers to the provisions of
					 freedom of choice, enrollment, benefits and disenrollment for an individual
					 eligible in accordance with this chapter.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1717.1 - TRANSITIONAL MEDICAL ASSISTANCE › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1717.1-20 - Freedom of choice

Current through June, 2024
When relocation results in the non-service of the health
					 plan in which the household was enrolled, they shall be provided a choice of
					 health plan and a provider as described in chapter 17-1720.1.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1717.1 - TRANSITIONAL MEDICAL ASSISTANCE › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1717.1-21 - Enrollment into a participating health plan

Current through June, 2024
(a) An
				  individual eligible in accordance with this chapter, with the exception of an
				  individual identified in section 17-1735.1-2(a), shall continue to be enrolled
				  in the selected health plan as a recipient in accordance with chapter
				  17-1720.1, except for the provision of section 17-1717.1-20.
(b) An individual participating in
				  transitional medical assistance shall not participate in the annual health plan
				  open enrollment period.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1717.1 - TRANSITIONAL MEDICAL ASSISTANCE › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1717.1-22 - Benefits

Current through June, 2024
(a) An individual eligible in accordance with
				  this chapter who is enrolled in a health plan shall be provided a standard
				  benefits package by a participating health plan and other services when
				  appropriate as described in chapter 17-1720.
(b) An individual identified in section
				  17-1735.1-2(a) shall be provided coverage under the fee-for-service provisions
				  as described in chapter 17-1737.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1717.1 - TRANSITIONAL MEDICAL ASSISTANCE › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1717.1-23 - Disenrollment from a health plan

Current through June, 2024
An enrollee shall be disenrolled from a health plan under
					 the provisions as described in section 17-1720.1.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1718 - ADULTS GROUP › Subchapter 1 - GENERAL PROVISIONS › Section 17-1718-1 - Purpose

Current through June, 2024
This chapter establishes the Adults Group. The eligibility
					 group for individuals age nineteen years or older and under age sixty-five
					 years, an option created through the enactment of the Affordable Care Act and
					 commonly referred to as the Adults Group, provides coverage to eligible
					 adults.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1718 - ADULTS GROUP › Subchapter 1 - GENERAL PROVISIONS › Section 17-1718-2 - General requirements

Current through June, 2024
The confidentiality, administrative appeal, fraud, medical
					 assistance recovery, application processing, eligibility review, and adverse
					 action provisions described in subtitle 12 shall pertain to an individual who
					 applies or is eligible under this chapter.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1718 - ADULTS GROUP › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1718-9 - Basic requirements

Current through June, 2024
An individual whose eligibility is being determined under
					 this chapter shall meet the basic eligibility requirements which include, but
					 are not limited to, citizenship, qualified non-citizen or lawfully present
					 non-citizen status, State residency, verification of identity, not residing in
					 a public institution, and the provision of a social security number, as
					 described in chapter 17-1714.1.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1718 - ADULTS GROUP › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1718-10 - Categorical requirements

Current through June, 2024
(a) To be eligible
				  under the Adults Group, an individual shall meet the following requirements:
(1) Be age nineteen years or older, but under
				  sixty-five years of age;
(2) Not
				  entitled to or enrolled for Medicare;
(3) Not in receipt of Supplemental Security
				  Income (SSI); and
(4) Not eligible
				  under any of the following chapters:
(A)17-1715, Children Group;
(B)17-1715.1, Former Foster Care Children
				  Group;
(C)17-1716, Pregnant Women
				  Group;
(D)11-1711, Parents and
				  Other Caretaker Relatives Group; and
(E)17-1717.1, Transitional Medical
				  Assistance.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1718 - ADULTS GROUP › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1718-11 - Income requirements

Current through June, 2024
(a) The MAGI
				  methodology described in chapter 17-1724.2 shall be used to determine the
				  countable income for an individual subject to an income limit.
(b) The income standard for participation in
				  the Adults Group is one hundred thirty-three per cent of the federal poverty
				  level for a household of applicable size. An income disregard of five per cent
				  of the applicable federal poverty level is added to the highest income standard
				  for an individual using MAGI-based methodology under the applicable title of
				  the Social Security Act.
(c) An
				  individual who is determined ineligible under this chapter shall have
				  eligibility determined for other applicable eligibility groups.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1718 - ADULTS GROUP › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1718-13 - Eligibility review requirements

Current through June, 2024
(a) An eligible
				  individual shall receive an annual eligibility review every twelve
				  months.
(b) Eligibility shall be
				  redetermined in accordance with chapter 17-1712.1 and subchapter
				  5 of chapter 17-1714.1.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1718 - ADULTS GROUP › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1718-19 - Purpose

Current through June, 2024
This subchapter addresses and refers to the provisions of
					 freedom of choice, enrollment, benefits and disenrollment for an individual who
					 is eligible in accordance with this chapter.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1718 - ADULTS GROUP › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1718-20 - Freedom of choice

Current through June, 2024
(a) An individual
				  eligible in accordance with this chapter, with the exception of an individual
				  identified in section
				  17-1735.1-2(a),
				  shall be provided a choice of a health plan and a provider as described in
				  chapter 17-1720.1.
(b) An
				  individual identified in section
				  17-1735.1-2(a)
				  shall choose a department approved provider as described in section
				  17-1736-3.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1718 - ADULTS GROUP › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1718-21 - Enrollment into a participating health plan

Current through June, 2024
(a) An
				  individual eligible in accordance with this chapter, with the exception of an
				  individual identified in section
				  17-1735.1-2(a),
				  shall be enrolled in a health plan as described in chapter 17-1720.1.
(b) An individual identified in section
				  17-1735.1-2(a)
				  shall not be enrolled into a health plan and their healthcare services shall be
				  provided on a fee-for-service basis.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1718 - ADULTS GROUP › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1718-22 - Benefits

Current through June, 2024
(a) An individual eligible in accordance with
				  this chapter who is enrolled in a health plan shall be provided a standard
				  benefits package by a participating health plan and other services when
				  appropriate as described in chapter 17-1720.
(b) An individual identified in section
				  17-1735.1-2(a)
				  shall be provided coverage under the fee-for-service provisions as described in
				  chapter 17-1737.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1718 - ADULTS GROUP › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1718-23 - Disenrollment from a health plan

Current through June, 2024
An enrollee shall be disenrolled from a health plan under
					 the provisions as described in chapter 17-1720.1.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719 - AGED, BLIND, AND DISABLED GROUP › Subchapter 1 - GENERAL PROVISIONS › Section 17-1719-1 - Purpose

Current through June, 2024
This chapter establishes the Aged, Blind, and Disabled
					 Group. The Aged, Blind, and Disabled Group provides Medicaid eligibility for an
					 aged, blind, or disabled individual under the provisions of Title XIX of the
					 Social Security Act.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719 - AGED, BLIND, AND DISABLED GROUP › Subchapter 1 - GENERAL PROVISIONS › Section 17-1719-2 - General requirements

Current through June, 2024
The confidentiality, administrative appeal, fraud, medical
					 assistance recovery, application processing, eligibility review, and adverse
					 action provisions described in subtitle 12 shall pertain to an aged, blind, or
					 disabled individual who applies or is eligible under this
					 chapter.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719 - AGED, BLIND, AND DISABLED GROUP › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1719-8 - Purpose

Current through June, 2024
This subchapter describes the basic, categorical, and
					 financial eligibility requirements for participation in the Aged, Blind, and
					 Disabled Group.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719 - AGED, BLIND, AND DISABLED GROUP › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1719-9 - Basic requirements

Current through June, 2024
An individual whose eligibility is being determined under
					 this chapter shall meet the basic eligibility requirements which include, but
					 are not limited to, citizenship, qualified non-citizen or a lawfully present
					 non-citizen status, State residency, verification of identity, not residing in
					 a public institution, and the provision of a social security number, as
					 described in chapter 17-1714.1.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719 - AGED, BLIND, AND DISABLED GROUP › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1719-10 - Categorical requirements for an aged individual

Current through June, 2024
(a) To be
				  eligible under the Aged, Blind, and Disabled Group, an aged individual shall be
				  at least sixty-five years of age in the month of eligibility.
(b) Proof of age shall be required, and
				  includes, but is not limited to:
(1) Birth
				  verification, legal documents, or church records; or
(2) Eligibility for or receipt of SSI or RSDI
				  benefits on the basis of being aged.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719 - AGED, BLIND, AND DISABLED GROUP › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1719-10.1 - Categorical requirements for a blind individual

Current through June, 2024
(a) To be
				  eligible under the Aged, Blind, and Disabled Group, a blind individual shall
				  have central visual acuity of 2 0/2 0 0 or worse in the better eye with
				  correcting lens, or the widest field of vision subtends an angle no greater
				  than twenty degrees (tunnel vision).
(b) Proof of blindness shall be required, and
				  includes, but is not limited to:
(1)
				  Eligibility for or receipt of SSI or RSDI benefits based on
				  blindness.
(2) Certification of
				  blindness by the department's division of vocational rehabilitation, Ho' opono,
				  if the requirement of paragraph (1) is not met.
(A) Recertification of blindness is not
				  required if the department's division of vocational rehabilitation, Ho' opono,
				  certified the blind individual's condition to be permanent with little chance
				  of improvement and, therefore, specifies that reevaluation is not necessary or
				  warranted.
(B) Recertification of
				  blindness is required if the individual's condition is not permanent, there is
				  a possibility of improvement, or reevaluation is recommended by the
				  department's division of vocational rehabilitation, Ho' opono.
(i) Reevaluation of blindness shall be
				  scheduled as recommended by the department's division of vocational
				  rehabilitation, Ho' opono.
(ii) If
				  no evaluation date is indicated, recertification will be scheduled on an annual
				  basis.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719 - AGED, BLIND, AND DISABLED GROUP › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1719-10.2 - Categorical requirements for a disabled individual

Current through June, 2024
(a)
				  To be eligible under the Aged, Blind, and Disabled Group, a disabled individual
				  shall be unable to engage in substantial gainful activity because of a
				  medically determinable physical or mental impairment which has lasted or is
				  expected to last for a continuous period of not less than twelve months or
				  which is expected to result in death.
(b) Proof of disability shall be required,
				  and includes, but is not limited to:
(1)
				  Eligibility for or receipt of SSI or RSDI benefits based on
				  disability.
(2) Certification of
				  disability by the department's aid to the disabled review committee (ADRC) if
				  the requirement of paragraph (1) is not met.
(A) Recertification of disability is not
				  required if the department's ADRC certifies the individual's condition to be
				  permanent with little chance of significant improvement and therefore specifies
				  that reevaluation is not necessary or warranted.
(B) Recertification of disability is required
				  if the individual's condition is not permanent, there is a possibility of
				  improvement, or reevaluation is recommended by the department's ADRC.
(i) Reevaluation shall be scheduled as
				  recommended by the department's ADRC.
(ii) If no evaluation date is indicated,
				  recertification will be scheduled on an annual basis.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719 - AGED, BLIND, AND DISABLED GROUP › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1719-11 - Income requirements

Current through June, 2024
(a) The income
				  standards for participation in the Aged, Blind, and Disabled Group, are the
				  standards of assistance as designated under this subchapter.
(b) An individual who meets the requirements
				  of more than one standard of assistance shall have eligibility determined based
				  on the standard of assistance that would be most beneficial to the
				  individual.
(c) Countable income,
				  as referred to in chapter 17-1724.1, after allowable disregards and exemptions,
				  shall be compared to the standards of assistance which are established for the
				  different coverage groups under the State Plan.
(d) An individual applying for medical
				  assistance shall not be required to apply for or receive SSI.
(e) If income exceeds the applicable
				  standards of assistance under section 17-1719-11.1, the provisions relating to
				  an individual with excess income described in chapter 1730.1 shall
				  apply.
(f) The provisions of
				  subchapter 8 of chapter 17-1724.1 shall apply to an individual who is
				  requesting or receiving coverage of long-term care services.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719 - AGED, BLIND, AND DISABLED GROUP › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1719-11.1 - Standards of assistance

Current through June, 2024
(a) In addition to
				  meeting the categorical requirements for an aged, blind, or disabled individual
				  under this chapter, the individual must be eligible for one of the following
				  categorically needy groups:
(1) Mandatory
				  Categorically Needy (MCN) for an individual or couple, as applicable, eligible
				  for or in receipt of SSI payments or SSP payments, or both, and the standard of
				  assistance shall be equal to the SSI standard.
(2) Medically Needy (MN) for an individual
				  financially ineligible for SSI benefits, but whose income is insufficient to
				  meet medical expenses, and the standard of assistance shall be equal to fifty
				  per cent of the 2006 federal poverty level for a household of applicable
				  size.
(3) Optional Categorically
				  Needy (OCN) for an individual who is sixty-five years of age or older or whose
				  eligibility is being determined on the basis of being disabled, and the
				  standard of assistance shall be equal to one hundred per cent of the federal
				  poverty level for a household of applicable size.
(4) Optional Categorically Needy (OCN) for an
				  individual in a licensed domiciliary care facility, both residential care
				  facility and community care foster family home; and the standard of assistance
				  shall be equal to the rate of payment of the SSI program and SSP for:
(i) A Type I domiciliary care facility has
				  not more than five residents; or
(ii) A Type II domiciliary care facility has
				  six or more residents,
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719 - AGED, BLIND, AND DISABLED GROUP › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1719-12 - Asset requirements

Current through June, 2024
(a) The personal
				  reserve standard is the maximum amount of countable assets that may be held by
				  an individual or household while establishing or maintaining eligibility for
				  medical assistance under this chapter. The personal reserve standards for an
				  individual or two-member household shall be equal to the resource limits
				  employed by the SSI program.
(b)
				  For each household member in households greater than two, $250 shall be added
				  to the SSI personal reserve standard for two and the resultant amount is the
				  personal reserve standard for a household of applicable size.
(c) An individual or household whose equity
				  in non-exempt assets as determined in chapter 17-1725.1 exceeds the personal
				  reserve standard for medical assistance for a household of applicable size
				  shall be ineligible for medical assistance.
(d) An individual who is requesting or
				  receiving coverage of long-term care services must meet the requirements of
				  subchapter 7 of chapter 17-1725.1.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719 - AGED, BLIND, AND DISABLED GROUP › Subchapter 2 - ELIGIBILITY REQUIREMENTS › Section 17-1719-13 - Eligibility review requirements

Current through June, 2024
(a) An eligible
				  individual shall receive an eligibility review every twelve months.
(b) Eligibility shall be redetermined in
				  accordance with chapter 17-1712.1 and subchapter
				  5 of chapter 17-1714.1.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719 - AGED, BLIND, AND DISABLED GROUP › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1719-19 - Purpose

Current through June, 2024
This subchapter addresses and refers to the provisions of
					 freedom of choice, enrollment, benefits and disenrollment for an aged, blind,
					 or disabled individual who is eligible in accordance with this
					 chapter.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719 - AGED, BLIND, AND DISABLED GROUP › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1719-20 - Freedom of choice

Current through June, 2024
(a) An aged, blind
				  or disabled individual eligible in accordance with this chapter, with the
				  exception of an individual identified in section
				  17-1735.1-2(a),
				  shall be provided a choice of a health plan and a provider as described in
				  chapter 17-1720.1.
(b) An aged,
				  blind or disabled individual identified in section
				  17-1735.1-2(a)
				  shall choose a department approved provider as described in section
				  17-1736-3.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719 - AGED, BLIND, AND DISABLED GROUP › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1719-21 - Enrollment into a participating health plan

Current through June, 2024
(a) An aged,
				  blind or disabled individual eligible in accordance with this chapter, with the
				  exception of an individual identified in section
				  17-1735.1-2(a),
				  shall be enrolled in a health plan as described in chapter 17-1720.1.
(b) An aged, blind or disabled individual
				  identified in section
				  17-1735.1-2(a)
				  shall not be enrolled into a plan and services shall be provided on a
				  fee-for-service basis.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719 - AGED, BLIND, AND DISABLED GROUP › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1719-22 - Benefits

Current through June, 2024
(a) An aged, blind or disabled individual who
				  is enrolled in a health plan shall be provided a standard benefits package by a
				  participating health plan and other services when appropriate as described in
				  chapter 17-1720.
(b) An aged, blind
				  or disabled individual identified in section
				  17-1735.1-2(a)
				  shall be provided coverage under the fee-for-service provisions as described in
				  chapter 17-1737.
Hawaii Administrative Rules › Title 17 - DEPARTMENT OF HUMAN SERVICES › Department of Human Services › Chapter 1719 - AGED, BLIND, AND DISABLED GROUP › Subchapter 3 - FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND DISENROLLMENT › Section 17-1719-23 - Disenrollment from a health plan

Current through June, 2024
An enrollee shall be disenrolled from a health plan under
					 the provisions as described in chapter 17-1720.1.