(1) An applicant must be eligible and enrolled in the program to receive premium assistance.

(2) To qualify the applicant must:

(a) be a resident of the state of Montana; and

(b) have a family income at or below 200% FPL.

(3) An applicant who meets the eligibility requirements for Social Security Extra Help as outlined in 42 CFR 423.773 (2007), which is adopted and incorporated by reference, must provide a determination from Social Security Extra Help.

(4) An individual who is receiving benefits for Medicaid is not eligible for the Big Sky Rx Program.

(5) An individual in a LIS program with full premium subsidy is not eligible.

(6) Eligibility determinations shall be effective for 12 months from the date of determination regardless of change in income or household size. This also applies to an applicant on the waiting list as provided in ARM 37.81.326.

(7) Enrollees in the program must comply with procedures specified by the PDP, the department, Extra Help, and Social Security (if applicable) to receive premium assistance.

(8) Program enrollment and eligibility will terminate at the end of the month in which any of the following events occur:

(a) the enrollee becomes Medicaid eligible;

(b) by income verification, the enrollee's income is found to exceed 200% of the FPL;

(c) the enrollee is no longer enrolled in a PDP;

(d) the enrollee did not provide an Extra Help determination, if appropriate, or reapply for Extra Help;

(e) the enrollee dies;

(f) the enrollee is incarcerated; or

(g) the enrollee fails to provide information requested by the department.

(9) Termination of the benefit amount will be effective at the end of the month and a notice of termination will be mailed to the enrollee.

(10) Big Sky Rx eligibility and benefits are not an entitlement. If funding is insufficient, the department may reduce enrollment numbers or enrollment criteria to limit the number of individuals who are eligible to participate.

History: 53-2-201, 53-6-1004, MCA; IMP, 53-2-201, 53-6-1001, 53-6-1004, 53-6-1005, MCA; NEW, 2006 MAR p. 336, Eff. 2/10/06; AMD, 2008 MAR p. 954, Eff. 5/9/08.