828-1        TRANSITIONAL MEDICAID HOUSEHOLDS

Follow MAGIModified Adjusted Gross Income Medicaid household composition and income counting rules to determine Transitional Medicaid eligibility. Using tax filing rules means that there may be multiple Transitional Medicaid cases with different certification dates for the same household. Only move the household member(s) into Transitional Medicaid who are over income for MAGIModified Adjusted Gross Income Medicaid and meet all Transitional Medicaid requirements.

If the parent/caretaker relative has an increase in earnings that causes the parent/caretaker relative to go over income standard but the child is still eligible for MAGIModified Adjusted Gross Income Medicaid, only the parent/caretaker is moved to Transitional Medicaid. The child continues to receive MAGIModified Adjusted Gross Income Medicaid in the Child Under 19 category. If the parent/caretaker reports another change in income that causes the child to go over the income limit for MAGIModified Adjusted Gross Income Medicaid, the child is added onto Transitional Medicaid with the parent/caretaker relative. If both parents in a household have different Transitional Medicaid certification periods, the child is added on the Transitional Medicaid case that has the most months left on the Transitional Medicaid period. The child does not receive an additional 12 months

Example:

Mom and children are receiving Medicaid benefits starting 1/1/24. Mom reports a new job 4/10/24 that puts her over the income limit for the parent/caretaker category but the children are still eligible for MAGIModified Adjusted Gross Income Medicaid. Mom is moved to Transitional Medicaid 5/1/24 and is certified through 4/25. The mom reports an increase in income 8/16/24 that causes the children to go over the income limit. The children are moved to Transitional Medicaid and are certified through 4/25 with mom.

If an individual is receiving Newborn Medicaid or Pregnant Women Medicaid, the individual  should continue the approved certification period rather than be moved to Transitional Medicaid. These types of Medicaid have categorical eligibility meaning once eligible, the individual remains eligible despite changes in household income or size. At the end of the certification period, redetermine Medicaid to see if the individual is eligible for regular Medicaid. If not, the individual should be added to the Transitional Medicaid case with the household. The individual does not receive an additional 12 months.

Example:

Mom, Dad, and child are receiving Medicaid benefits starting 1/1/24. Mom reports a pregnancy and is moved to Pregnant Women Medicaid 3/1/24. Dad reports a new job that puts the household over the income limit for Medicaid on 11/10/24 (both the Parent/caretaker relative category and the Children Under Age 19 category). Dad and child are moved to Transitional Medicaid 12/1/24 and is certified through 11/25. Mom continues to receive the Pregnant Women Medicaid through her pregnancy due date as changes in her household income does not affect her eligibility for this category. Mom reports the birth of her newborn 8/25/24. The mom receives postpartum benefits for 12 months through 9/25. The case is reviewed to see if adding this newborn makes any household member eligible for regular Medicaid again. In this case, it does not. The mom continues to receive postpartum Medicaid until 9/25 and then added onto Transitional Medicaid 10/25 with the rest of the household and is certified through 11/25.