828-2 TRANSITIONAL MEDICAID ELIGIBILITY
The eligibility period for Transitional Medicaid continues for twelve months if:
1) The household continues to reside in the state;
2) The household continues to include a dependent child; and
3) The parent/caretaker relative continues to cooperate with the Child Support Services Division (CSSD) and TPR recovery.
Note:
Only the caretaker relative may be ineligible for Medicaid for failure to cooperate with CSSD or TPR recovery.
828-2 B. DETERMINING THE FIRST MONTH OF TRANSITIONAL MEDICAID
Transitional Medicaid starts the first month after Medicaid is closed or should have closed had the household reported increased earnings timely. Regardless of when the adverse action notice is sent to the household, Transitional Medicaid begins the first month after the Medicaid case closes or should have closed.
For a timely report of change, apply the adverse action notice rules when determining the start date of Transitional Medicaid. See section 802-2.
For an untimely report of change, ETs should only use timely notice in order to prevent the late reporting recipient from receiving an extra month of Transitional Medicaid benefits. Although we keep adverse action time-frames in mind when calculating the start date, adverse action is not required before starting Transitional Medicaid for a household that does not report the income change timely.
If there is a month in which the benefits were paid under MAGI Medicaid because of the recipient’s untimely reporting, the ET must backdate the start month to show the correct month Transitional Medicaid should have started to ensure only 12 months of Transitional Medicaid are authorized.
Example 1: The household reports their increased earnings timely (within 10 days) and we act on that change within 10 days, Transitional Medicaid starts the first of the month after adverse action notice is sent to the household.
Franco reports on 4/29/15 that he started a new job on 4/20/15. This is a timely report of change. We act on this change 5/8/15. The household is over the income limit for Medicaid starting 6/15 and there enough time to provide adverse action notice to the household. Transitional Medicaid starts 6/1/15.
Example 2: If the household reports their increased earnings timely and we do not act on the change within 10 days, Transitional Medicaid starts back when it should have started had DPA acted on it timely. We look at the date the client reported the change and the date we should have acted on this report (10 days later). Start the Transitional Medicaid when it should have started if DPA had acted on the change timely. The notice to the client goes out the next business day.
Mae reports on 4/29/15 that she started a new job on 4/20/15. This is a timely report of change. DPA acts on this change 5/28/15. DPA should have acted on this change by 5/11/15. If DPA had acted on this change by 5/11/15, DPA would have had adverse action to end their Medicaid 5/31/15 so Transitional Medicaid should start 6/1/15.
Example 3: If the household does not report their increased earnings timely, Transitional Medicaid goes back to when it should have started had they reported it timely and DPA acted on the report immediately. The ET determines the date the household should have reported (10 days after they had the increase in earnings) and look to see when the Transitional Medicaid should have started based on adverse action requirements.
Conchita started a job on 1/5/15 and never reported this to DPA. This is not a timely report of change. She should have reported this job by 1/16/15 and on 1/16/15 DPA would have had adverse action to end the Medicaid 1/31/15. Transitional Medicaid should start 2/1/15.
Verification is required to confirm that the loss of MAGI Medicaid is due to increased earnings before eligibility for Transitional Medicaid can be established. The ET must receive verification of employment (i.e. start date, hours per week, rate of pay, and pay dates) earnings, before authorizing Transitional Medicaid. If verification of when the household lost Medicaid eligibility due to increased earnings cannot be obtained, eligibility for Transitional Medicaid cannot be determined and Transitional Medicaid cannot be approved.
828-2 D. REPORTING REQUIREMENTS
The household is required to report, within ten days, changes which would result in the loss of eligibility for Transitional Medicaid. See section 828-2 (A).
828-2 E. AGENCY NOTIFICATION REQUIREMENTS
At the time MAGI Medicaid is terminated and Transitional Medicaid approved, the agency must notify the household of the family's reporting obligations, and reasons Transitional Medicaid eligibility could end.
828-2 F. ADDING HOUSEHOLD MEMBERS TO THE TRANSITIONAL MEDICAID CASE
Anyone can be added to the Transitional Medicaid household whose needs and income you would consider if you were determining eligibility for the household for the first time, even if the individual being added did not receive MAGI Medicaid in three of the last six months. This is because Transitional Medicaid eligibility is available to households who lose MAGI Medicaid due to an increase in wages.
Example 1:
Mom and her three children have been on MAGI Medicaid for six months. Dad is also in the household, but does not receive MAGI Medicaid because he receives Disabled Medicaid due to receipt of SSI. Mom gets a full time job in April. A Transitional Medicaid case is opened for Mom and the children. Due to the increased earnings, Dad is now over income for SSI and his Disabled Medicaid case closes. Dad can be added to the Transitional Medicaid case because, if this household were applying for MAGI Medicaid in the current month, Dad’s needs and income would be considered since he is no longer receiving Disabled Medicaid.
Example 2:
Mom and her two children have been receiving MAGI Medicaid for three months. A child moves into the household who did not have Medicaid. Mom had started a new job and now the household is over income (including the recently added child). The child who recently moved into the house would also be eligible for Transitional Medicaid.
828-2 G. COUNTING RETROACTIVE MEDICAID
Because a household can apply for Medicaid for up to three months prior to the date of application, it is possible that those three retroactive months will meet or help meet the Transitional Medicaid requirement that a household be eligible for and have received MAGI Medicaid in three of the last six months. A household will meet the Transitional Medicaid requirement even if their only months of Parent/Caretaker Relative or Pregnant Women Medicaid were the three months before the month of application in which retroactive MAGI Medicaid was issued. See section 827.
Medicaid coupons must be issued for each month(s) used even if there are no unpaid medical bills for that month.
828-2 H. MEDICAID RECIPIENTS IN OTHER CATEGORIES
Transitional Medicaid eligibility is based on a household’s eligibility for and receipt of Parent/Caretaker Relative or Pregnant Women Medicaid in any three of the last six months. If, when looking back six months, the ET finds that a household member received some other category of Medicaid, the ET should determine whether that household member could have been eligible for Parent/caretaker relative or Pregnant Women Medicaid for any of those months they received Medicaid under the other category. If that household member does meet criteria for a particular month, that month may count toward meeting the three of the last six months Transitional Medicaid requirement.
Do not count any month that benefits were:
Note:
The ET should not issue MAGI Medicaid coupons. All that is required is that MAGI Medicaid eligibility be documented.
828-2 I. REINSTATEMENT OF MAGI OR TRANSITIONAL MEDICAID
A household who again becomes eligible for MAGI Medicaid during their Transitional Medicaid benefit period is considered dually eligible for Transitional Medicaid and MAGI Medicaid. The clock on the transitional benefit period continues to run. If the household subsequently loses MAGI Medicaid, they may be eligible for either:
1) A new transitional benefit period, if they meet the all of the conditions for Transitional Medicaid eligibility, or
2) The time remaining of the original Transitional Medicaid period.
Reinstatement of Transitional Medicaid from MAGI Medicaid is undertaken when a worker receives a report of change, renewal, or application submitted that shows the household is no longer eligible for MAGI Medicaid.
In order to convert from Transitional Medicaid to MAGI Medicaid, the income needs to be verified. If the client does not provide the requested verification, we leave the case in Transitional Medicaid.
Example 1:
Mom, Dad and their two children have been on Transitional Medicaid for 4 months. Dad calls DPA and reports that his income decreased significantly. The ET re-determines eligibility for MAGI Medicaid. If eligible, new 12 month review and continuous eligibility periods are assigned. If the re-determination finds them ineligible for MAGI Medicaid, they remain on Transitional Medicaid.
Example 2:
Mom and her three children were receiving Transitional Medicaid for seven months. Mom submits a SNAP recertification that reports she lost her job. The ET determines the household is again MAGI Medicaid eligible. The household is given a 12 month certification period. Within two months, Mom reports and provides verification that she began a new job in which her earnings again exceed the MAGI Medicaid income standards. The case is then converted back to Transitional Medicaid with three months of Transitional Medicaid eligibility remaining. A new Transitional Medicaid period is not assigned because the household was not on MAGI Medicaid in three out of the last six months. Had Mom been eligible for and received MAGI Medicaid for one more month, she would qualify for a new 12 month Transitional Medicaid period.
If a household lost Transitional Medicaid coverage because they moved out of state and then returned to Alaska, that household may be reinstated for the remainder of their previous Transitional Medicaid period. The household must continue to meet all requirements of this category. If the household returns to Alaska within a year after the MAGI benefits were terminated, and were previously approved for Transitional Medicaid, the months of absence are counted as if the household had actually received Transitional Medicaid benefits
828-2 J. CONTINUOUS ELIGIBILITY AND TRANSITIONAL MEDICAID
Eligibility for Transitional Medicaid does not entitle a child to 12 months of continuous eligibility. Therefore, we keep track of any existing CEPs when Transitional Medicaid is authorized in case a child is removed from the Transitional Medicaid household and placed into a situation where they would not have Medicaid eligibility.
Example:
Sally is part of her mother’s household which is on Transitional Medicaid when it is decided that she should go and live with Dad. His income exceeds the MAGI Medicaid income standards for his household size, but he has no health insurance to offer Sally because he is self-employed and cannot afford private insurance. Sally can use the rest of her previously determined CEP.
When Transitional Medicaid eligibility ends and the original CEP has already ended, a new application must be submitted in order to redetermine eligibility for Medicaid.
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