(1) An individual is eligible for covered services under the MHS plan if:

(a) the individual is a youth 17 years of age and younger with a serious emotional disturbance in accordance with ARM 37.87.303;

(b) the family of which the individual is a member has a total family income, without regard to other family resources, at or below 160% of the most recently published federal poverty level (FPL); and

(c) the youth is not eligible for Medicaid or the Children's Health Insurance Plan (CHIP).

(2) If a youth who is determined eligible for the MHS plan based upon a pending Medicaid application is later determined to be eligible for Medicaid:

(a) any payment received by the provider under the MHS plan for services provided during the effective period of Medicaid eligibility must be refunded to the department; and

(b) all services provided to the youth during the effective period of Medicaid eligibility may be billed to Medicaid according to applicable Medicaid requirements.

(3) For purposes of determining financial eligibility under (1), the department references the criteria outlined in ARM 37.79.201, 37.79.206, and 37.79.209 except for:

(a) the annual family income without regard to other family resources is at or below 160% of FPL;

(b) the applicant's family member may be employed by the state of Montana; and

(c) the applicant's family does not have to meet the requirement of having had creditable health insurance coverage prior to becoming eligible.