533 B.     TEFRA CONVERSIONS

When a child is eligible for another category of Medicaid, such as SSISupplemental Security Income or MAGIModified Adjusted Gross Income, and has been determined to meet on of the three LOCLevel of Care categories, the case is referred to as a deferred TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248case. It is important that parents are given a choice of the category of Medicaid they wish their child to receive. Take the following steps for a potential deferred TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 case and current cases:

1. SSI Children

1. When SSISupplemental Security Income starts, the case must be converted to an SSISupplemental Security Income Medicaid case with the DC-54 MERE coding.

2. Comagine Health must be notified that the TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 case has been changed to an SSISupplemental Security Income Medicaid case and advised to close the Comagine Health case. Comagine Health can be emailed at AKTefra-Waiver@Qualishelath.org.

3. Document the LOCLevel of Care renewal date and set an alert that this was a former TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 child.

4. The SSISupplemental Security Income case is then transferred to the appropriate local office.

If the child's SSISupplemental Security Income benefit stops, the caseworker must evaluate the child's eligibility for MAGIModified Adjusted Gross Income Medicaid, TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248, and a Continuous Eligibility Period (CEP).

• If there is no MAGIModified Adjusted Gross Income Medicaid, TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248, or a CEPcontinuous eligibility period, the case must be closed and a new application is required.

• If there is eligibility for MAGIModified Adjusted Gross Income Medicaid but not TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248, open the MAGIModified Adjusted Gross Income Medicaid case and let the parents know that they can pursue TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 if they wish.

• If there is no eligibility for MAGIModified Adjusted Gross Income or TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 but the child has a CEPcontinuous eligibility period, the Medicaid case will continue until the CEPcontinuous eligibility period ends. The case should be referred to the LTCLong Term Care unit to determine TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 eligibility. In order for a TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 case to be opened, the case must meet the LOCLevel of Care and disability diary date requirements. The LTCLong Term Care unit will work with the parents and Comagine Health. The LTCLong Term Care unit will check the LOCLevel of Care and email Comagine Health at AKTefra-Waiver@Qualishealth.org to reopen the LOCLevel of Care case if there is a current LOCLevel of Care in place. If there is no LOCLevel of Care, the TEFRATax Equity and Fiscal Responsibility Act, P.L. 97-248 case will be pended for LOCLevel of Care to be determined. The LTCLong Term Care unit will check the disability diary date. If there is no disability diary date, the case must be pended for a disability determination.

2. TEFRA and MAGI

With every TEFRA application, the TEFRA caseworker must screen for potential MAGI Medicaid eligibility. If there appears to be MAGI eligibility, the family should be notified of this and be allowed to pursue this coverage. The family should be advised that there may be a lapse in coverage after MAGI ends while pursuing TEFRA eligibility. Parents should be offered the opportunity to pursue TEFRA and maintain TEFRA eligibility as a backup. If the parent chooses to pursue TEFRA:

1. Register a new case with the child as PI,

2. Pursue a disability determination,

3. Refer the child for a LOC determination by Comagine Health, and

4. Transfer the MAGI case to the LTC unit.

If LOC and disability are approved, the parent must be contacted and given the choice of having the TEFRA case opened or maintaining the child's Medicaid eligibility within MAGI. If the parent opts to continue eligibility with MAGI, the TEFRA caseworker will close the TEFRA case and document eligibility via MAGI.

If MAGI closed for earned income or failure to renew, the MAGI caseworker should notify the LTC unit to review TEFRA eligibility and take the following actions:

• Review case for LOC status and DDS status.

• If both LOC and disability status are current, open the TEFRA case and notify Comagine Health that the case is now open and to reactivate the case in the Comagine system.

• If LOC or disability status has lapsed, pend the TEFRA case for current disability approval and LOC.

The EIS case notes and alert system must clearly indicate which child is the TEFRA eligible child in the home.

3. Institutionalized Children

Children may go between their home and inpatient treatment. This happens most often with the IPH-LOC.

TEFRA Recipients

If a TEFRA child enters an inpatient facility, the caseworker must contact the family to determine the anticipated length of stay. If the stay will be for more than six months, Comagine Health must be notified to close the LOC case.

If the say is expected to be more than 30 days, convert the case to a child only MAGI case and transfer the case to the appropriate local office.

When the child is ready to return home, the MAGI caseworker must notify the LTC unit. The LTC unit must review LOC and disability status for TEFRA eligibility. If disability and LOC are not current, the LTC unit must initiate the process for both.

New Applications and Institutionalized Children

A TEFRA application may be received at the same time that the family is pursuing inpatient care for their child. If the child is institutionalized prior to TEFRA eligibility being established and the stay is anticipated to be greater than 30 days, take the following actions:

1. Open a child only MAGI case and transfer the case to the appropriate local office,

2. Set an alert and case note alerting the MAGI worker that this is a potential TEFRA child, and 

3. Notify the family to contact their case coordinator, the LTC unit, and Comagine Health when a discharge date is determined so the TEFRA process can be initiated prior to the child's return.

Note:

A new application is not needed to go between one category of Medicaid and another. Caseworkers must use the alert and case note system to identify these children and make appropriate referrals to maintain coverage and ensure there are no breaks in service.