Medical Assistance Eligibility Rules

The business rules operate against the evidence recorded in the system. For details of the evidence see the Cúram Logical Data Model diagram entitled Cúram Global Evidence.

The business rules for each coverage type are divided into two distinct categories, coverage type eligibility and financial eligibility. These can be further divided into the following:

• Coverage Type Eligibility consisting of:
  • Non financial requirements
  • Coverage type eligibility rules

• Financial Eligibility consisting of:
  • Income rules
  • Resource rules