MAP Length of Issuance Policy

Length of Issuance Policy

Purpose: To assist Program Representatives in determining the length of issuance for MAP/CAP.

I.  Definition of Issuance

Length of issuance refers to the specific time period a client may have MAP/CAP coverage. A client may be eligible for coverage up to 24 months.

II.  Length of Issuance by Status

A client should be considered for the appropriate length of issuance based on their status as determined during the eligibility interview. MAP/CAP coverage should be issued based on the following criteria:

A.     General Public

1.  All individuals, including those whom receive Workers’ Compensation or unemployment benefits or those who report no income, will be issued MAP/CAP coverage for 6 months. The criterion does not apply to individuals who fit the guidelines listed in Section II B through F of this policy.

2.  If the family previously had 2 consecutive MAP coverage periods without changes in family status and do not have minors over the age of 15 in the household, they may be eligible for a 1 year issuance. Program representatives should also check if these individuals fit the criteria listed under Sections II C through F of this policy prior to making a final determination on the length of issuance.

B.      Disabled and/or Elderly

1.  All family members may be eligible for a 1-year issuance if they meet all of the following criteria:

a)  They are elderly or disabled as evident by retirement or disability benefits (other than Social Security), and

b)  They will not be eligible for other benefits (i.e., Medicare, Medicaid or Health Insurance Marketplace) within the 1-year issuance.

C.  Individuals Ages 65 Years and Older

1.  Family MAP/CAP issuances should be terminated on the last day of the month prior to a family member’s 65th birthday because the family member may qualify for Medicaid or Medicare coverage. The family may re-apply for coverage to reassess their benefit level.

D.     Homeless Individuals

1. Individuals who meet the definition of homeless may be issued coverage not to exceed 6 months.

E. Individuals receiving Social Security Disability Insurance (SSDI)/ Retirement Survivors Disability Insurance (RSDI) below 100% of the FPL

1. Family MAP/CAP issuances that include individuals whose sole income is SSDI or RSDI for a disability should be terminated on the last day of the month prior to their Medicare eligibility date. This guideline does not apply to families with minors over the age of 15 in the household. In these cases, refer to Section II A of this policy.

F. Individuals eligible for a Qualified Health Plan (QHP) through the Health Insurance Marketplace

1. Individuals potentially eligible for subsidies for any QHP through the Health Insurance Marketplace that apply for MAP when the Marketplace is closed for enrollment, is not eligible due to a qualifying event and has not been previously referred should have coverage terminated no later than December 31 of the current year.

III. Other Factors Affecting Length of Issuance

There may be multiple factors that may affect a client’s eligibility for MAP/CAP coverage. These factors include, but are not limited to:

1. Moving outside the Travis County limits (coverage should expire the day of the expected change).

2. Changes in family size (coverage should expire the day prior to the expected change of status).

3. Changes in income or medical coverage (coverage should expire the day prior to the expected change of status. If Medicare effective date is unknown issue 2 months of coverage).