DEPARTMENT OF HEALTH & HUMAN SERVICES 
Centers for Medicare & Medicaid Services 
7500 Security Boulevard, Mail Stop S2-26-12 
Baltimore, Maryland   21244-1850 
CMCS Informational Bulletin 
DATE:  July 3, 2019 
FROM:  Calder Lynch, Acting Director 
Center for Medicaid and CHIP Services 
SUBJECT:  Temporary Census Income and Medicaid and CHIP Eligibility 
Preparations for the nationwide 2020 Decennial Census are underway, calling for the recruitment 
and hiring of thousands of individuals, many of whom are low-income.  Concern about 
temporary earned income affecting eligibility for health coverage and other benefits has been a 
challenge to robust recruitment of census workers.  In order to minimize concerns and 
incentivize census employment, the Administration is encouraging public benefit programs, to 
the extent permitted under the law, to exclude temporary income from census employment when 
determining eligibility for these programs.  The Center for Medicaid and CHIP Services (CMCS) 
is issuing this Informational Bulletin (CIB) to describe existing authorities states may use to 
exclude, or minimize the impact of, income from temporary Census Bureau employment 
(temporary census income) on Medicaid and Childrens Health Insurance Program (CHIP) 
eligibility for census workers and their families. 
Background 
The Census provides low-income individuals, many of whom are eligible for Medicaid or in a 
household with Medicaid or CHIP eligible individuals, with a unique opportunity for 
employment and valuable training in work skills.  These skills can provide an important 
foundation for entering the work force or advancing within the work force.  The Census Bureau 
is working hard to recruit low-income individuals for census work, and one of the elements of a 
successful recruiting effort is ensuring the continued availability of Medicaid and CHIP coverage 
for workers and their families.  During past censuses, state Medicaid and CHIP agencies have 
been encouraged to ensure that temporary census workers and their families do not lose 
eligibility due to temporary census income.  This is consistent with the Administrations 
priorities to incentivize work opportunities where possible among individuals enrolled in means-
tested public benefits programs. 
In past censuses, states were able to disregard temporary census income for all Medicaid and 
CHIP eligibility groups.  The move to the use of modified adjusted gross income (MAGI)-based 
methodology, which no longer permits the use of income disregards, changes the flexibilities 
available for many Medicaid eligibility groups and CHIP.  Below we describe existing 
authorities states may use to exclude, or minimize the impact of, income from temporary Census 
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Existing Flexibilities under the State Plan  
Non-MAGI Eligibility Groups 
 
States continue to have flexibility under section 1902(r)(2) of the Social Security Act (the Act) 
to apply income and resource disregards in determining financial eligibility for individuals who 
are exempt from the use of MAGI-based methodologies (non-MAGI groups).  As described at 
section 1902(e)(14)(D) of the Act, and implemented in regulation at 42 C.F.R. 435.603(j), non-
MAGI methodologies are used to determine eligibility for individuals: who seek Medicaid on the 
basis of being age 65 or older or having blindness or disability; who request Medicaid coverage 
for certain long-term services and supports; who are being evaluated for one of the Medicare 
Savings Program (MSP groups); and who are medically needy.  For these non-MAGI 
populations, states may disregard, in whole or in part, temporary census income.  As discussed 
further below, a census income disregard can no longer be applied to an eligibility group that 
uses MAGI-based methodologies (such as Parents and Other Caretaker Relatives or Pregnant 
Women eligibility groups).  
 
Many states have already elected to disregard temporary census income under the authority of 
section 1902(r)(2) of the Act for multiple eligibility groups in their state plan.  We note that 
existing state plan disregards may have been time-limited, applying only to a specific Decennial 
Census.  States should consult their state plans to determine whether census income disregards 
need modification/or to be updated.  States that wish to apply disregards of temporary census 
income for non-MAGI groups for the first time or that wish to add or modify the non-MAGI 
groups affected need to submit a state plan amendment (SPA) to CMS.  Such a SPA is submitted 
in the MACPro system.  The SPA package will include each eligibility group to which the 
1902(r)(2) disregard applies; and within each eligibility group the SPA effectuates the addition 
or modification of the disregard. 
  
States with approved state plan disregards including eligibility groups that are now considered 
MAGI-based groups need not take further action.  A SPA is not needed to delete the MAGI-
based groups from the state plan page because the MAGI-based methodologies themselves 
prohibit application of specific income disregards.  CMCS staff are available to provide technical 
assistance on existing state plan elections and potential SPAs. 
  
MAGI-based Eligibility Groups 
 
MAGI-based methodologies are generally based on federal income tax rules for countable 
income.  Because temporary census income is taxable as employment income, it is counted in 
financial eligibility determinations for MAGI-based Medicaid eligibility groups and CHIP.  
Section 1902(e)(14)(B) of the Act prohibits the use of income disregards in MAGI-based 
methodologies, so states that previously excluded or disregarded temporary census income for 
eligibility in their Medicaid or CHIP state plans may no longer exclude such income for these 
groups.  We note that under section 1902(e)(14)(F), the provisions of MAGI-based 
methodologies cannot be waived. 
  
However, states do have some flexibility under the rules for MAGI-based methodologies to 
mitigate the impact of temporary census employment.  Under the regulations at 42 C.F.R. 
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435.603(h)(3), states may elect to have a reasonable method to include a prorated portion of 
reasonably predictable future income in the state plan.  This option to apply a reasonably 
predictable changes (RPC) methodology enables states to prorate, or spread out, expected future 
changes over a longer period of time, up to 12 months.  Many states have elected RPC 
methodologies for MAGI-based eligibility determinations under their state plan.  Most often, 
states use this RPC methodology for fluctuating income, such as from seasonal work or self-
employment.  A state that has an approved RPC methodology for seasonal work may include 
temporary census income within its scope such that a new SPA submission would not be 
necessary.  States that do not have existing state plan authority to implement an RPC 
methodology may elect such a methodology through a MAGI-Based Methodologies SPA 
submitted through the MACPro system.   An RPC methodology cannot be limited only to 
temporary census income. 
  
How RPC Works 
 
If an individual expects to earn an additional $1,200 over two months working for the 
Census Bureau, the individual may be determined financially ineligible based on current 
monthly income, but a reasonably predictable changes methodology can prorate the 
temporary income over 12 months (or some lesser number of months elected by the 
state), or $100 per month. 
 
Use of such a methodology can ensure that many individuals maintain financial eligibility 
despite the increased income, but it will not protect all individuals in MAGI-based 
eligibility groups.  If a persons monthly income is close to the income standard for 
eligibility, the prorated portion of the temporary income may still lead to financial 
ineligibility for the individual.  Under the previous example, if the individuals MAGI-
based household income is within $100 of the effective income standard before earning 
the temporary income, the individual would exceed financial eligibility despite the use of 
the reasonably predictable changes methodology. 
  
Transitional Medical Assistance 
 
The Parents and Other Caretaker Relatives eligibility group (implemented at 42 C.F.R. 
435.110), retains specific coverage protections due to increased earned income through 
Transitional Medical Assistance (TMA).  Under section 1925 of the Act, TMA provides up to 12 
months of continued Medicaid coverage to families who become ineligible for Medicaid due to 
earnings or hours of employment of the parent or caretaker relative.  TMA is a required 
eligibility protection that states must apply to qualifying individuals as a result of increased 
earnings, including from temporary census employment, of the parent or caretaker relative. 
  
To qualify for extended eligibility under TMA, an individual (such as a temporary Census 
Bureau worker) must have been covered under the Parents and Other Caretaker Relatives 
eligibility group for a specified number of months prior to losing eligibility (three of the previous 
six months, or fewer than three at state option); continue to live with a dependent child; and have 
earnings that cause family income to exceed the income standard for the Parent and Other 
Caretaker Relative group.  TMA is triggered by a change in circumstances resulting from income 
from, or hours of, work of a parent or caretaker relative receiving coverage under the group for 
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Parents/Caretaker relatives described in 42 C.F.R 435.110.  If temporary census income earned 
by an individual in the Parent/Caretaker Relative group triggers a transition to TMA, the 
Medicaid agency would redetermine the individuals eligibility when census employment ends.  
Unless other circumstances have changed, the individual likely would be transitioned back to the 
Parent/Caretaker Relative group at that time.  (Children in the family who are eligible for the 
mandatory group for Children under Age 19, implemented at 42 C.F.R. 435.118, may benefit 
from TMA, although it is not necessary to transition children to TMA unless they lose eligibility 
for the mandatory group.) 
  
Technical Assistance 
CMS is available to provide technical assistance on the options and requirements described in 
this CIB, including how to submit the required state plan amendments.  If you have questions or 
need technical assistance related to the state plan strategies discussed above, please contact 
Stephanie Kaminsky, Director, Division of Medicaid Eligibility Policy, at 
stephanie.kaminsky@cms.hhs.gov or (410) 786-4653.  
 
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