Title 16
16000 Federal Poverty Level Related Programs
The following are factors of eligibility specific to the poverty level related program.
16220.1 Waiver of Social Security Number Requirement for Infants
A Social Security number is not required until the child turns age one.
16220.2 Age Requirement
Effective October 1, 1992, children up to age 18 may be categorically eligible. Effective July 1, 1993, individuals up to age 19 may be categorically eligible. Effective March 1, 1996, uninsured adults (age 19 and over) may be eligible under the demonstration waiver.
16220.2.1 Adult
An adult is defined as an individual age 18 or over. Individuals who are age 18 but under age 19 may be found categorically eligible under the poverty level program. Under the demonstration waiver, uninsured individuals age 19 or over may be found eligible as a noncategorical adult in the expanded Medicaid population.
16220.2.2 Minor
A minor is defined as an individual under age 18.
16220.2.3 Emancipated Minor
An emancipated minor (individual under age 18) can be determined categorically eligible under the poverty level program. Emancipation is established by court order, marriage or the establishment of a separate household. Emancipation must be documented in the case record. Examples include a copy of the court order, a copy of the marriage license, or wage stubs and rent receipts showing that the emancipated minor has established his or her own household. A minor can be emancipated within his or her parent's household if the minor is married or if the adult unmarried partner is living there and supporting the minor. In this case, obtain a written statement verifying the parents have relinquished responsibility for the minor. Once a determination of emancipation has been made, the individual is always considered emancipated.
16220.3 Pregnancy
The pregnant woman must have her pregnancy verified by a medical professional authorized under State law to make such a determination. A medical professional includes a physician, nurse, or lab technician. The pregnant woman may be single or married and may or may not have other children.
Note: Pregnant women count as at least two family members in determining the budget unit size in all cases. If a pregnant woman is diagnosed with a multiple pregnancy, this must be verified to adjust the budget size accordingly.
16220.4 Uninsured Requirement for Adult Expansion Population
This is a separate technical eligibility requirement for the noncategorically related adults age 19 or over, including those who receive General Assistance. The individual must be uninsured. An uninsured individual is defined as an individual who does not have Medicare, Military Health Insurance for Active Duty, Retired Military, and their dependents, or other comprehensive health insurance. (See DSSM 16220.4.1 ) An adult who is entitled to or eligible to enroll in Medicare or who has Military Health Insurance for Active Duty, Retired Military, and their dependents, or who has any comprehensive health insurance, cannot be eligible for Medicaid as a non categorical adult under the demonstration waiver.
16220.4.1 Definition of Comprehensive Health Insurance
A benefit package comparable in scope to the "basic" benefit package required by the State of Delaware's Small Employer Health Insurance Act at Title 18, Chapter 72 of the Delaware Code. This package covers hospital and physician services as well as laboratory and radiology services. The term "comprehensive" does not mean coverage for benefits normally referred to as "optional," e.g., prescription drugs.
16220.5 Enrollment in Managed Care - Special Requirement for Adult Expansion Population
Enrollment in a Diamond State Health Plan or Diamond State Partners MCO is a separate technical eligibility requirement for the non categorically related adults including adults who are receiving General Assistance. The adult must join a MCO in order for Medicaid coverage to begin. The adult, if otherwise eligible, cannot receive Medicaid coverage until he or she is enrolled in a Diamond State Health Plan or Diamond State Partners MCO.
