828             TRANSITIONAL MEDICAID

Transitional Medicaid is designed to encourage households to take advantage of better employment opportunities, even when it means the household will make too much money to qualify for MAGIModified Adjusted Gross Income Medicaid. When a household with an individual receiving Parent/Caretaker Relative Medicaid loses eligibility because that individual’s earnings has increased, the household may qualify for Transitional Medicaid eligibility for up to 12 months.

Note:

Transitional Medicaid is not a Medicaid category, it is extended Medicaid coverage for Parent/Caretaker Relatives required by the Social Security Act.

828 A.   CAUSATIVE EFFECT

To be eligible for Transitional Medicaid a household must have:

1.  been both eligible for and in receipt of Parent/Caretaker Relative or Pregnant Women MAGIModified Adjusted Gross Income Medicaid coverage in any three of the six months immediately preceding the month in which the household became ineligible for MAGIModified Adjusted Gross Income Medicaid; and

2.  lost MAGIModified Adjusted Gross Income Medicaid eligibility solely because of an increase in the earnings of a parent caretaker relative, either from a new job or higher pay.

Transitional Medicaid is not available for the household who loses MAGIModified Adjusted Gross Income Medicaid for any other reason, including changes in the household size or the return of an absent parent.

When two factors of eligibility change and either one could cause ineligibility, give preference to the increased earnings so that the household will qualify for Transitional Medicaid.

Note:

If increased earned income closes Parent/Caretaker Relative Medicaid, and the individual does not qualify for Expansion Medicaid, the individual should be eligible for Transitional Medicaid.

If increased spousal support closes Parent/Caretaker Relative Medicaid, and the individual does not qualify for Expansion Medicaid, the individual should be eligible for Post Medicaid (MAGI MS 832).

Example 1:

An individual is eligible in the Parent/Caretaker Relative category for 8/15 and 9/15 and then loses eligibility in this category as the individual no longer has custody of the child. The individual is moved to the Expansion Group category starting 10/1/15. The individual reports new employment 10/5/15 that puts them over the income limit for the Expansion Group. This individual is not eligible for Transitional Medicaid as they did not receive Medicaid in an eligible category 3 of the last 6 months.

Example 2:

Medicaid household consists of 2 children who are MAGIModified Adjusted Gross Income Medicaid recipients. Their parent/caretaker relative is not receiving MAGIModified Adjusted Gross Income Medicaid. The household reports a new job that makes the children over income for MAGIModified Adjusted Gross Income Medicaid. The children are not eligible for Transitional Medicaid as there is no parent/caretaker relative recipient. The children will receive the remaining continuous eligibility period. 

Example 3: 

The MAGIModified Adjusted Gross Income Medicaid household consists of Mom and her two children. The household has been on MAGIModified Adjusted Gross Income Medicaid for the last four months. Mom has been working those four months at a constant rate of pay. In January, Mom receives a raise in her hourly wage that puts her household over income for MAGIModified Adjusted Gross Income Medicaid in February. Since the reason the household lost MAGIModified Adjusted Gross Income eligibility is the increased earnings of a caretaker relative, the household is eligible for Transitional Medicaid.

Example 4: 

The MAGIModified Adjusted Gross Income Medicaid household consists of Mom and her two children. The household has been on MAGIModified Adjusted Gross Income Medicaid for three of the last six months. Mom has been unemployed the whole time. In September, Mom’s grandfather dies and leaves her a small investment that will pay her $100 per month. Also in that month, Mom gets a job. The countable income from her job alone is just below the household Medicaid need standard, but when combined with the $100 income from her grandfather’s investment, the household is over income. Even though her increased earnings alone were not enough to cause ineligibility for MAGIModified Adjusted Gross Income Medicaid , when combined with the $100, her increased wages still had a ”causative effect” on the loss of MAGIModified Adjusted Gross Income Medicaid; therefore, the household is eligible for Transitional Medicaid.  

Example 5:

Toua and May, who are married and have 2 children, applied for and were approved for MAGIModified Adjusted Gross Income Medicaid in January. They also were also approved for Retroactive Medicaid for November and December. Toua started a new job in February and the new wages put them and their children over the income limits. As the household was eligible for MAGIModified Adjusted Gross Income Medicaid for the past 3 of the 6 months, they are eligible for Transitional Medicaid.