2005 Arizona Revised Statutes - Revised Statutes §36-2930  Temporary medical coverage program; qualifications; fund; program termination

A. The temporary medical coverage program is established. Beginning October 1, 2006, the administration shall establish eligibility for the program for any uninsured person who meets the following requirements:

1. Is a resident of this state.

2. Is a citizen of the United States or a legal resident that meets the requirements of section 36-2903, subsection B or C.

3. Submits an application as prescribed by the administration.

4. Has been eligible for services pursuant to section 36-2901, paragraph 6 or section 36-2931, paragraph 5 and enrolled in the system, excluding persons who are receiving services pursuant to section 36-2912, at any time within twenty-four months before the person submits an application pursuant to paragraph 3 of this subsection.

5. Is receiving benefits pursuant to 42 United States Code section 423.

6. Is not eligible for medicare benefits pursuant to 42 United States Code section 426(b) or section 426-1.

B. The director may adopt rules to implement the program and the requirements of this section and to prescribe the following:

1. The application process.

2. Actuarially sound capitation rates.

3. The collection of monthly premiums from program enrollees. Monthly premiums shall not exceed the capitation rate paid to health plans for the enrollee and shall be based on the enrollee's gross household income with tiered premiums for any enrollee whose income is:

(a) More than one hundred but not more than one hundred fifty per cent of the federal poverty guidelines.

(b) More than one hundred fifty but not more than two hundred per cent of the federal poverty guidelines.

(c) More than two hundred but not more than two hundred fifty per cent of the federal poverty guidelines.

(d) More than two hundred fifty but not more than three hundred per cent of the federal poverty guidelines.

(e) More than three hundred per cent of the federal poverty guidelines.

C. All covered services shall be provided by health plans that have contracts with the administration pursuant to section 36-2906.

D. Unless otherwise required by the administration, the health plans shall provide medically necessary health and medical services as required by section 36-2907.

E. A person who is enrolled in the program must notify the administration when the person becomes eligible for medicare benefits through 42 United States Code section 426(b) or section 426-1. A person who is enrolled in the program and who becomes eligible for medicare benefits is ineligible for the program.

F. If the director determines that monies may be insufficient for the program, the administration may stop processing applications until the administration is able to verify that funding is sufficient to fund the program.

G. The temporary medical coverage fund is established consisting of premiums collected from enrollees pursuant to subsection B of this section, legislative appropriations, gifts, grants and donations received by the administration to operate the program. The administration shall use fund monies to pay for the services and costs associated with persons who are eligible pursuant to this section. On notice from the administration, the state treasurer shall invest and divest monies in the fund as provided by section 35-313, and monies earned from investment shall be credited to the fund. Monies in the fund are subject to legislative appropriation.

H. The program established by this section ends on July 1, 2016 pursuant to section 41-3102.