paragraph (4), the individual shall remain enrolled with the
same plan for one year.
(2) After an individual eligible for medical assistance
under this section enrolls in a plan approved by the department
under the Commonwealth's approved Title XIX State Plan, the
individual shall remain enrolled in the individual plan until
the individual's redetermination period, but for at least 12
months unless the individual qualifies for an exemption under
paragraph (4), or until such time as the individual is no longer
eligible for medical assistance.
(3) The department shall notify the individual eligible for
medical assistance under this section about the ability at the
time of redetermination to change the plan in which the
individual is enrolled for services offered under the
Commonwealth's approved Title XIX State Plan.
(4) The department may grant an exemption to the limitation
on changing plans under this section only if the exemption
matches standard practices for health insurance plans approved
by the Insurance Department under the insurance laws of this
Commonwealth, including, but not limited to:
(i) a qualifying life event;
(ii) a relocation of the individual to a region which is not
served by the selected Medicaid managed care organization; or
(iii) a verified health condition which requires treatment
by a provider not currently participating in the Medicaid
managed care organization.
(5) The department shall approve the exemption for an
individual based on applicable Federal regulations regarding
enrollment or on the approved State plan.
(6) Nothing in this section shall be construed to remove an
20210HB0665PN0627 - 2 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30