MAP/MAP BASIC QHP Tagging Guidelines

MAP BASIC QHP tagged clients  may be given up to 12 month coverage.

MAP

QHP “YES” tags should be added to the following clients when they receive MAP coverage (do not add tags for denied or pended clients).

Clients that attend their Foundation Communities ACA appointment and found ineligible for tax credits are eligible to apply for MAP. Clients will be QHP tagged again for the next open enrollment.

• LPRs who are::
  • Below 100% of the FPL
  • Within 5 years of their entry date
    • EXCEPT FOR
      • Those who will reach their 5 years of residency before the next open enrollment period or within the first five months of the next coverage year (1/1 – 5/31)
      • Those found in the ineligible codes list

• Individuals receiving disability through the Social Security Administration who are:
  • Over 100% of the FPL
    • EXCEPT FOR
      • Those who’s Medicare will effectuate before the next open enrollment period or within the first three months of the next coverage year (1/1 – 3/31)

MAP BASIC

• If client is QHP eligible and MAP Eligible determine if the client was previously tagged QHP as indicated by a:
  • note on the client record
  • note on previous tracks
  • QHP tagged yes on previous track
  • CH CHAP track at filing submitted status
• If yes to any of the above issue MAP BASIC and tag QHP “Yes”