Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 20 - Division of County Operations › Rule 016.20.13-004 - Arkansas Private Option (Health Care Independence Act of 2013) - Form DCO-151, Application for Health Coverage (Single Adults) Form DCO-152, Application for Health Coverage (Family), Medical Services Policy Manual Sections B100-270, E100-270, F 160-164 and F 180

Current through Register Vol. 49, No. 6, June, 2024
Medical Services - Appendix I, Application
				Form Chart
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Appendix I - Application Table
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Medical Services - Appendix J, Eligibility
				Table
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Medical Services - Appendix K, PACE Service Counties
01/01/14
The PACE provider is Total Life Healthcare which is located in
				Jonesboro in Craighead county. The provider service area includes specific zip
				codes in Craighead, Cross, Greene, Lawrence, Mississippi, Poinsett and Randolph
				counties. Below is the list of the counties and the zip codes:
Craighead
Cross
Greene
Jonesboro
72401
Cherry Valley
72324
Paragould
72450
Jonesboro
72404
Wynne
72396
Bay
72411
Vanndale
72387
Black Oak
72414
Parkin
72373
Bono
72416
Brookland
72417
Cash
72421
Lawrence
Mississippi
Caraway
72419
Hoxie
72433
Blytheville
72315
Egypt
72427
Sedgwick
72465
Gosnell
72319
Lake City
72437
Walnut Ridge
72476
Manila
72442
Monette
72447
Leachville
72438
State College
72467
Poinsett
Randolph
Sharp
Harrisburg
72432
Pocahontas
72455
Lepanto
72354
Marked Tree
72365
Trumann
72472
Medical Services - Appendix L, Life Expectancy Table
MS Manual 01/01/14
Table 1: Male
Table 2: Female
Age
Average Number of Years of Life
						  Remaining
Age
Average Number of Years of Life
						  Remaining
0
75.38
0
80.43
10
66.08
10
71.04
20
56.40
20
61.20
30
47.13
30
51.50
40
37.84
40
41.91
50
28.99
50
32.69
60
20.92
60
23.97
61
20.16
61
23.14
62
19.40
62
22.31
63
18.66
63
21.49
64
17.92
64
20.69
65
17.19
65
19.89
66
16.48
66
19.10
67
15.77
67
18.32
68
15.08
68
17.55
69
14.40
69
16.79
70
13.73
70
16.05
71
13.08
71
15.32
72
12.44
72
14.61
73
11.82
73
13.91
74
11.21
74
13.22
75
10.62
75
12.55
76
10.04
76
11.90
77
9.48
77
11.26
78
8.94
78
10.63
79
8.41
79
10.03
80
7.90
80
9.43
81
7.41
81
8.86
82
6.94
82
8.31
83
6.49
83
7.77
84
6.06
84
7.26
85
5.65
85
6.77
86
5.26
86
6.31
87
4.89
87
5.87
88
4.55
88
5.45
89
4.22
89
5.06
90
3.92
90
4.69
100
2.07
100
2.39
110
1.15
110
1.22
Source: SSA, Office of the Actuary
Medical Services - Appendix M, Transitional Medicaid
MS Manual 01/01/14
The Family Support Act of 1988 ( Public Law 100-485 ), requires
				that certain AFDC families (Category 20) who lose eligibility April 1, 1990, or
				later, due to earned income must be given six (6) months of Initial
				Transitional Medicaid benefits without an application for such assistance.
				These families may also qualify for an Additional 6 Months Transitional
				Medicaid Extension.
The Personal Responsibility and Work Opportunity Reconciliation
				Act of 1996 extended this requirement to certain Medicaid families following
				replacement of the AFDC program with the TANF program. In Arkansas, families
				who lose eligibility for TEA Medicaid due to earnings are eligible for this
				extension.
Extent of Services
Individuals approved for Transitional Medicaid will be eligible
				for the full range of Medicaid services, including services under the
				Children's Health Services Program.
Eligibility Requirements
In addition to the standard Medicaid eligibility requirements
				of citizenship, enumeration and child support enforcement, the following
				requirements must be met in determining eligibility for the Initial 6 Months TM
				Extension period:
1. The family must
			 have become ineligible for TEA Medicaid due to increased wages or increased
			 hours of employment (Re. MS Appendix M).
2. The family must have received TEA Medicaid
			 in at least 3 of the 6 months immediate preceding the first month of TEA
			 Medicaid ineligibility. Retroactive months count for this purpose (Re. MS
			 Appendix M).
3. The family members
			 must have been residents of Arkansas in the last month of TEA Medicaid
			 eligibility, and must continue to reside in Arkansas.
4. There must be a dependent child under age
			 18 in the home (Re. MS Appendix M).
In addition to the eligibility criteria stated above, the
				following eligibility requirements must also be met in the Additional 6 months
				TM extension period:
1. The family
			 must have received TM in each month of the Initial 6 Months TM extension
			 period.
2. There must continue to
			 be a dependent child under age 18 in the home.
3. The parent (or non-parent specified
			 relative) must have met the reporting requirements in the 1st and 4th months of
			 the Additional TM Extension period (Re. MS 2061.7 and MS 2062.1).
4. The parent (or non-parent specified
			 relative) must continue to be employed and receive earnings in each month
			 preceding the 2nd and 3rd report periods of the additional TM extension period,
			 unless good cause exists.
The average monthly gross earnings of the eligible members
				(less paid child care costs) cannot exceed 185% of the Federal Poverty Level
				(Re.
FPL
				Chart at Appendix F)
.
Resources, deprivation, and unearned income are not eligibility
				factors for TM. A re-referral to OCSE is not required.
TEA Medicaid Case Closure - Due to Earnings
The Tea Medicaid case closure must be due solely to increased
				wages or increased hours of employment. If a TEA Medicaid family becomes
				ineligible due to earnings and for another reason in the same month, the family
				will be ineligible for Transitional Medicaid. For example, if the absent parent
				of all the TEA Medicaid children returns home and the caretaker parent becomes
				employed in the same month, the family will not be eligible for TM since earned
				income is not the sole reason for ineligibility. If, however, the TEA Medicaid
				family began receiving unearned income and earned income (of the caretaker
				parent) in the same month, a budget will be worked without the earned income.
				If the TEA Medicaid case remains eligible without the earned income and the
				inclusion of the earned income is the sole reason for TEA Medicaid closure,
				this requirement for TM has been met.
The increased earnings must be of the child's parent (or
				non-parent specified relative) who was included in the TEA Medicaid case as an
				eligible member in the last month of eligibility. The client's declaration of
				earnings will be accepted to determine continued Medicaid eligibility when the
				TEA cash assistance case closes due to employment. If at the first quarterly
				report the caseworker determines that the family should have remained in the
				TEA Medicaid, the case will be converted back to TEA Medicaid.
When it is determined that the family is ineligible for TEA
				Medicaid, and eligible for the Initial 6 Months Transitional Medicaid
				Extension, the caseworker will manually issue Form DCO-123 to notify the family
				of their TEA cash case closure; and to inform them of their eligibility for
				Transitional Medicaid and of the reporting requirement in the Initial 6 Months
				Transitional Medicaid Extension Period.
The TEA Medicaid case will be closed using "Convert to TM" and
				the appropriate reason will be entered in ANSWER. The earnings that resulted in
				TEA Medicaid ineligibility will be entered in ANSWER. The Transitional Medicaid
				case will be keyed to the WATM screen, using Form DCO-125, and the TEA Medicaid
				case number.
The Initial 6 Months TM Extension will begin with the first
				month following the last month of TEA Medicaid eligibility. The begin date will
				be entered in the Transitional Medicaid Begin Date on WATM. Individuals
				included in the budget group in the last month of TEA Medicaid eligibility will
				be entitled to the Initial 6 Months TM Medicaid Extension. Night Edit will
				convert the case to Category 25 for all open members if the income keyed, when
				calculated by the system, shows the case to be ineligible for TEA
				Medicaid.
Received TEA Medicaid in 3 of the last 6
				Months
The family must have received TEA Medicaid in at least 3 of the
				6 months immediately preceding the first month of TEA Medicaid ineligibility in
				order to qualify for TM. Eligibility for retroactive TEA Medicaid can count
				toward the 3 months. This requirement must always be met. For example, after
				receiving TM for 4 months or longer, if the parent (or non-parent specified
				relative) loses employment, receives TEA Medicaid for two months, than loses
				TEA Medicaid eligibility again due to employment, the family will not be
				eligible for TM, as they did not receive TEA Medicaid in 3 of the last 6 months
				immediately preceding the first month of TEA Medicaid ineligibility.
If a family received TEA in another state at any time during
				the 6 months immediately preceding the first month of TEA ineligibility, this
				period can be used to determine eligibility for TM.
The family will not be eligible for Transitional Medicaid if it
				is determined that the family was ineligible for TEA Medicaid at any time
				during the 6 months immediately preceding TEA Medicaid ineligibility due to
				fraud (under current policy, only a court can make a determination of
				fraud).
Residence
The family members must be residents of Arkansas at the time
				they became ineligible for TEA Medicaid, and must continue to reside in
				Arkansas throughout the Transitional Medicaid period. Residence is not affected
				by temporary absence from the state (e.g., on vacation). The TM case will be
				closed if the family moves out of Arkansas. Subsequently, if the family returns
				to Arkansas after the TM case has been closed, the TM case cannot be reopened.
				The family will have to make an application, and eligibility will be determined
				in another category.
Dependent Child
"Dependent Child" is defined, for TM purposes, as a child who
				is under age 18 who was living in the home in the last month of TEA Medicaid
				eligibility, and whose presence in the home helped establish TEA Medicaid
				eligibility. As a condition of TM eligibility, there must be a dependent child
				in the home in each month of TM. Eligibility for TM will terminate at the end
				of the first month in which the family ceases to include a dependent child. If
				the only dependent child leaves home and later returns after the TM case has
				been closed, the TM case may not be reopened, even if a portion of the 12 month
				TM period remains.
Reporting Requirements in the Initial 6 Months
				Transitional Medicaid Extension Period (First Six Months)
First Report
On the 6th workday from the end of the 3rd month of the Initial
				6 Months Extension Period, the system will generate a notice and report form,
				DCO-124, to the family to be returned to the County Office by the 5th day of
				the 4th month. The parent (or non-parent specified relative) must report the
				household composition, the amount of gross earnings received, the amount of
				child care paid, and other circumstances which existed in the first 3 months of
				the Initial 6 Months TM Period. The DCO-124 will inform the family of its
				option for an additional 6 months period of TM which will be, in part,
				dependent upon the return of the DCO-124 report form in the 4th month of the
				Initial 6 Months TM Extension Period.
Upon receipt of a complete DCO-124, the County will key a "Y"
				in the "Report Received by County" field on WATM and will enter the date the
				report was received. This must be keyed to WATM no later than the 7th workday
				from the end of the 4th month. The earnings will be keyed into the income
				section in ANSWER, but continuing eligibility is not based on the amount of
				earnings received in the first 3 months of the Initial Extension Period. If
				there is any unearned income in the budget fields, it should be removed with
				zeros (00s). Zeros should also be entered in the deduction fields. The only
				entries needed in the budget fields are gross earned income and child care. The
				system will compute the net earned income.
If the DCO-124 has not been received in the County Office by
				the 5th day of the report month (or the following workday if the 5th falls on a
				non-workday) or, if an incomplete DCO-124 is received, the following procedures
				will be used:
1. Notice DCO-126 and
			 Form DCO-124 will be manually issued to the parent (or non-parent specified
			 relative) no later than the 1st workday following the 5th day of the report
			 month. The DCO-126 will advise the parent (or non-parent specified relative)
			 that the DCO-124 must be returned in 10 days, or eligibility will not be
			 granted for the Additional 6 months TM Extension period.
2. If the client returns an incomplete
			 DCO-124, the caseworker will mail the incomplete form back with the DCO-126 and
			 advise the client in the space provided on the DCO-126 which questions must be
			 completed or what verification is required. The client will also be advised
			 that failure to return the completed DCO-124 in 10 days will result in
			 ineligibility for the Additional 6 Months TM Period.
A "complete" DCO-124 is defined as one in which each "Yes or
				No" question is answered, the explanations related to a "Yes" response are
				completed, and required verification is attached. Part I, Household
				Information, will be considered complete if sufficient information is shown to
				determine household composition.
If the county has not keyed a "Y" to WATM by the 7th workday
				from the end of the month, the system will close the case with a Medicaid end
				date effective the last day of the 6th month and will send a closure notice to
				the family. If the client returns a complete report form after the 7th workday
				from the end of the 4th month and good cause for an untimely report is
				established, or the County failed to key a "Y" by the 7th workday from the end
				of the month, the County will reinstate the case in ANSWER and key "Y" in the
				Override Indicator" field on WATM and the date the report was received. The
				original Med Begin Date will be rekeyed and the Med End Date zeroed out. When
				the County reopens a case in this situation, it will not be necessary to
				register a new application.
T
Note:
Good
				Cause for untimely reports (DCO-124):
An untimely DCO-124 is one
				which is received after the 10 day notice period specified on the DCO-126. The
				client must establish good cause for an untimely report in order for the report
				requirement to be met. The determination as to whether good cause exists for
				returning an "untimely" report will be left to the judgment of the caseworker,
				with approval by the Supervisor or his/her designated representative. Some
				examples of situations which might result in good cause are hospitalization,
				client is out of town, client's new address had not been keyed by County which
				resulted in the client not receiving the report form, etc.
D
etermining Initial Eligibility When There
				Was an Untimely Report of Earnings
In the event the County Office is not informed by a TEA
				Medicaid recipient of increased earnings in a "timely" manner, eligibility for
				Transitional Medicaid will be determined from the month the family actually
				became ineligible for TEA Medicaid.
If the County Office is informed of a TEA Medicaid family's
				increase in earnings as late as the 5th day of the 4th month of TEA Medicaid
				ineligibility, eligibility will be determined for TM in each of the months
				succeeding the last month of TEA Medicaid eligibility. If the eligibility
				requirements in the Initial 4 Months TM Extension period (MS Appendix M) are
				not met, no additional benefits will be authorized. If the eligibility
				requirements in the Initial 4 Months Extension period (MS Appendix M) are met,
				continuing TM benefits will be authorized. The County will manually issue Form
				DCO-124 to the family, if it is later than the 3rd month of TEA Medicaid
				ineligibility. This report must be returned to the County by the last day of
				the 4th month of the Initial TM Extension Period in order for the family to
				qualify for the Additional 6 Months TM Extension period.
If the earned income is reported or discovered after the 5th
				day of the 4th month of TEA Medicaid ineligibility, eligibility for the Initial
				TM period will be determined (for purposes of an overpayment only) but the
				family will not be entitled to receive any Additional TM benefits.
Determining Initial Eligibility When There Was an
				Untimely Report of Earnings
In the event the County Office is not informed by a TEA
				Medicaid recipient of increased earnings in a "timely" manner, eligibility for
				Transitional Medicaid will be determined from the month the family actually
				became ineligible for TEA Medicaid.
If the county Office is informed of a TEA Medicaid family's
				increase in earnings as late as the 5th day of the
				4th month of TEA Medicaid ineligibility, eligibility
				will be determined for TM in each of the months succeeding the last month of
				TEA Medicaid eligibility. If the eligibility requirements in the Initial 4
				Months TM Extension period (MS Appendix M) are not met, no additional benefits
				will be authorized. If the eligibility requirements in the Initial 4 Months
				Extension period (MS Appendix M) are met, continuing TM benefits will be
				authorized. The County will manually issue Form DCO-124 to the family, if it is
				later than the 3rd month of TEA Medicaid
				ineligibility. This report must be returned to the County by the last day of
				the 4th month of Initial TM Extension Period in
				order for the family to qualify for the Additional 6 Months TM Extension
				period.
If the earned income is report or discovered after the
				5th day of the 4th month
				of TEA Medicaid ineligibility, eligibility for the Initial TM period will be
				determined (for purposes of an overpayment only) but the family will not be
				entitled to receive any Additional TM benefits.
Six Months TM Extension Period (Second Six
				Months)
In addition to continuing to meet each eligibility factor
				listed in MS Appendix M, the eligibility criteria specified in MS Appendix M
				must also be met for the Additional 6 Months of TM.
The family must have received TM in each of the 6 months of the
				Initial Transitional Medicaid Extension Period. If the TM case is closed at any
				point during the Initial 6 months Transitional Medicaid Extension period (e.g.,
				no eligible child in the home or moved out of Arkansas
R
eporting Requirements in the Additional 6
				months Extension Period (Second Six Months)
Second Report
On the 6th workday from the end of the 6th month of the Initial
				6 Months Extension Period, the system will generate a notice and report form,
				DCO-124; to those families who met the eligibility factors in the Initial 6
				months Extension Period. This report should be returned to the County Office by
				the 5th day of the 1st month of the Additional 6 Months TM Extension Period
				(the 7th month). The parent (or non-parent specified relative) must again
				report the household composition, the amount of gross earnings received, the
				amount of child care paid, and other circumstances which existed in the last 3
				months of the Initial TM Extension Period.
Upon receipt of a complete DCO-124, the caseworker will
				determine the client's continued eligibility for TM and, if eligible, the
				County will document the case.
If a complete report form, DCO-124 is not returned by the 5th
				day of the 1st month of the Additional 6 Months Extension Period (the 7th
				month), or the following workday if the 5th falls on a non-workday or, an
				incomplete DCO-124 is received, the following procedures will be used:
1. Notice DCO-126 and Form DCO-124 will be
			 manually issued to the parent (or non-parent specified relative) no later than
			 the 1st working day following the
			 5th day of the month. The DCO-126 will advise the
			 client that the DCO-124 must be returned in 10 days or the case will be
			 closed.
2. If the client returned
			 an incomplete DCO-124, the caseworker will mail the incomplete form back with
			 the DCO-126 and advise the client, in the space provided on the DCO-126, which
			 questions must be completed and what verification is required. The client will
			 be advised that failure to return the DCO-124 in 10 days will result in case
			 closure.
If a complete DCO-124 is not received by the 7th workday from
				the end of the 1st month of the Additional 6 Months Extension Period (the 7th
				month), the caseworker will close the case on WATM and in ANSWER with a
				Medicaid End Date effective the last day of that month. If the client returns
				the report form after the 7th workday from the end of the month, the case has
				been closed, and good cause is established, the caseworker will reopen in
				ANSWER, and WATM ("Convert to TM" and use the appropriate Action Reason, no new
				application necessary). The original Med. Begin Date will be entered, and the
				End Date will be zeroed out.
Third Report
On the 6th workday from the end of the 3rd month of the
				Additional 6 Months Extension Period (9th month), if the case remains open, the
				system will generate a notice and report form, DCO-124, to the family to be
				returned by the 5th day of the 4th month of the Additional Extension Period
				(10th month).
Upon receipt of a complete DCO-124, the caseworker will
				determine the client's continued eligibility for TM and, if eligible, the
				County will document the case.
If a complete report form, DCO-124 is not returned by the 5th
				day of the 4th month of the Additional 6 Months Extension Period (the 10th
				month) (or the following workday if the 5th falls on a non-workday) or an
				incomplete DCO-124 is received, the following procedures will be used:
1. Notice DCO-126 and Form DCO-124 will be
			 manually issued to the parent (or non-parent specified relative) no later than
			 the 1st working day following the
			 5th day of the month. The DCO-126 will advise the
			 client that the DCO-124 must be returned in 10 days or the case will be
			 closed.
2. If the client returns an
			 incomplete DCO-124, the caseworker will mail the incomplete form back with the
			 DCO-126 and advise the client, in the space provided on the DCO-126, which
			 questions must be completed and what verification is required. The client will
			 be advised that failure to return the DCO-124 in 10 days will result in the
			 case closure.
If a complete DCO-124 is not received by the 7th workday from
				the end of the 4th month of the Additional 6 Months Extension Period (the 10th
				month), the County will close the case on WATM and in ANSWER, with a Medicaid
				End Date effective the last day of that month. If the client returns the report
				form after the 7th workday from the end of the month, the case has been closed,
				and good cause is established, the County will reinstate the case ("Convert to
				TM" and use the appropriate action reason, no new application necessary). The
				original Med. Begin Date will be reentered, and the Med. End Date will be
				zeroed out.
T
Note:
There are no
				automatic system closures in the Additional 6 Months Extension Period, except
				at the end of the 12th month.
Employment Requirement
In order for extended benefits to continue in the second
				6-month period, the parent (or non-parent specified relative) must continue to
				be employed and receive earnings in each month preceding the 2nd and 3rd
				reports unless good cause exists.
Examples of good cause for loss of employment are illness,
				involuntary layoff, etc.
The 185% Earned Income Test and Computation of Average
				Monthly Gross Earnings
The family's average monthly gross earnings (less paid child
				care costs necessary for the parent, or non-parent specified relative, to
				maintain employment) cannot exceed 185% of the Federal Poverty Level (Re.
FPL
				Chart at Appendix F)
.
To compute average monthly gross earnings:
1. Total for each month the earning received
			 by all eligible family members in each of the 3 reporting months. Unearned
			 income will be disregarded;
2.
			 Subtract, from each month's total, the amount of child care paid in that month
			 that was necessary for the parent ( or non-parent specified relative) to
			 maintain employment (use the actual child care paid);
3. Add the net results from each of these
			 months; and
4. Divide the result by
			 3.
This figure is the family's average monthly gross
				earnings.
EXAMPLE:
A family of 4
				has earnings and paid child care for the reporting period as follows:
*
* Earnings
*
* Child Care Paid
*
* Net Income
Month #1
$1,200.00
-
$180.00
=
$1,020.00
Month #2
$ 925.00
-
$150.00
=
$ 775.00
Month #3
$1,450.00
-
$200.00
=
$1,250.00
$1,020.00 + $775.00 + $1,250.00 = $3,045.00 divided by 3 =
				$1,015 average gross monthly earnings. Compare the average gross monthly
				earnings to 185% of the Federal Poverty Level (Re.
FPL Chart at Appendix F)
.
T
Note:
The FPL is
				adjusted annually due to changes in the Consumer Price Index. For continuing
				eligibility, the average monthly gross income, as computed above, will be
				compared to the FPL in effect during the report month, if different from the
				preceding months.
If the family's average gross monthly earnings (less paid child
				care) do not exceed 185% of Federal Poverty Level, the family will remain
				eligible. The case will be documented
If the family's average gross monthly earnings (less paid child
				care) exceed 185% of the FPL, the County will send a notice of closure to the
				family, and will key a closure to the Transitional Medicaid case in ANSWER with
				a Medicaid End Date effective the last day of the report month. Earnings that
				resulted in
Transitional Medicaid closure will be entered in the budget
				section. Night Edit will convert all open members in category 25 to closed
				status.
Changes in the Transitional Medicaid Period
Minor children entering the household, who were not in the
				budget group at the time the group became TEA Medicaid ineligible, will not be
				eligible for Transitional Medicaid and will not be added to the case. If an
				excluded child has earnings, they will not be considered in computing the
				family's average gross monthly earnings. The caseworker will determine
				eligibility for this child in another category, counting only the child and the
				child's parent(s) in the unit, and considering only their income.
Minor children, who were in the home and included in the TEA
				Medicaid case during the last month of TEA Medicaid eligibility, who later
				leave the home, will be dropped (a 10 day notice will be given). If he/she
				subsequently reenters the home while the family is receiving TM, he/she will be
				added to the Transitional Medicaid case. Any earnings that this child may have
				will be considered in computing the family's average gross monthly
				earnings.
The return of an absent parent to the home during Transitional
				Medicaid is not, in itself, a reason for closure (i.e., deprivation is not an
				eligibility factor for Transitional Medicaid). The absent parent, who returns,
				if he/she was not in the budget group at the time of the TEA Medicaid case
				closure, will not be eligible for Transitional Medicaid and will not be added
				to the case. Any earnings of the returning parent, however, will be used in
				computing the family's average gross monthly earnings.
If the only child in the home becomes eligible for SSI, the
				parent(s) (or non-parent specified relative) will remain eligible for
				Transitional Medicaid as long as the SSI child is under age 18. However, the
				County will receive a Systems Action Report notifying them that the case has
				been closed. The caseworker will reopen the Transitional Medicaid case for the
				adults(s) by using "Converting to TM" and the appropriate action reason. The
				Transitional Medicaid Status on WATM will be changed to open status. The
				adult(s) must continue to meet all other eligibility requirements in order to
				remain eligible for Transitional Medicaid.
System Closures, System Reports, and County
				Responsibilities
On the first workday of each month the system will search all
				Transitional Medicaid records for children who will reach the age of 18 that
				month. If the only child in the home is reaching age 18, the system will close
				the case and send a notice of case closure to the family. If there are other
				children under 18 in the home, the system will close only the 18-year-old and
				leave the remaining individuals open.
The Counties will receive a Systems Action Report that will
				inform them of Transitional Medicaid 18 year olds and cases closed by the
				system.
When the system has closed an 18 year old, or at any time a
				member or a case is found ineligible for Transitional Medicaid, the County
				Office will make a determination and document the case record as to whether or
				not the ineligible member(s) meets the eligibility criteria in any other
				Medicaid Category
(e.g., PW, MN-SD, etc.). If it appears that a member or the
				case would be eligible in another category, an application and notice of
				potential benefits will be sent to the individual(s).
During the Additional 6 Months TM Extension Period (Second Six
				Months), a monthly report titled "Transitional Medicaid Cases" will be
				generated to the Counties to assist them in tracking the Transitional Medicaid
				cases. This report will list the Case Number, Case head Name, Worker Number,
				Transitional Medicaid Begin Date, Current Month of Transitional Medicaid and
				the next month in which a Transitional Medicaid Report (DCO-124) is due.
At the end of the 12th month, the system will send a notice and
				close all Transitional Medicaid cases which remained open throughout both
				6-month periods.
Summary of Sequence of Notices/Reports in Transitional
				Medicaid
Found TEA Medicaid ineligible prospectively. Determined
				Transitional Medicaid eligible:
* Form DCO-123 manually issued to family.
Initial 6
				months Extension Period
1st Month
* 1st month of TEA Medicaid ineligibility.
2nd Month 3rd Month
* Notice/Report Form DCO-124 system generated to case head on
				the 6th workday from the end of the month.
4th Month
* Case head must return DCO-124 with income and child care
				verification by the 5th day of the month. County completes DCO-125 and keys "Y"
				to WATM by the 7th workday from the end of the month. If the "Y" is not keyed,
				the system will generate a notice and close the case with a Medicaid End Date
				effective the last day of the 6th month.
5th Month 6th Month
* Notice/Report Form DCO-124 system generated to the case head
				on the 6th workday from the end of the month.
Additional 6 months Extension
				Period
7th Month
* Case head must return DCO-124 with income and child care
				verification by the 5th day of the month. If family eligible, County documents
				case. If family ineligible, County must key closure to ANSWER and WATM with a
				Medicaid End Date equal to the last day of the 7th month.
8th Month 9th Month
* Notice/Report Form DCO-124 system generated to the case head
				on the 6th workday from the end of the month.
10th Month
* Case head must return DCO-124 with income and child care
				verification by the 5th day of the month. If family eligible, County documents
				case. If family ineligible, County must key closure in ANSWER and WATM with a
				Medicaid End Date equal to the last day of the 10th month.
11th Month 12th Month
* System closes.
Extended Medicaid Eligibility When TEA Medicaid Case
				Closed Due to Child Support Income
Three months of extended Medicaid will be authorized when a TEA
				Medicaid case is closed due to child support income provided the case was open
				for at least three of the six months immediately preceding the first month of
				ineligibility. The three months will begin with the month following the first
				month in which the case became ineligible due to child support income. The TEA
				Medicaid ineligibility may have been caused in whole or in part by the child
				support income. Only those persons who were included in the budget in the last
				month of TEA Medicaid eligibility will be entitled to the three months of
				extended Medicaid.
Medical Services - Appendix N, Medically Needy
				Resource and income Levels
01/01/14
Medically Needy (MN) Resource Limitations for U-18 and
				Pregnant Woman (PW)
Resource eligibility for U-18 and PW is determined by computing
				countable resources as specified below in Part II and comparing them with the
				Medically Needy resource limitations. There is not applicable transfer of
				resource provision which applies to the U-18 and Pregnant Woman MN.
The following countable resource limitations are in effect for
				the Medically Needy Program U-18 and Pregnant Woman.
Resource Limits
Household Size
1/1/86-12/31/86
1/1/87-12/31/87
1/1/88-12/31/88
From 1/1/89
1
$1,700
$1,800
$1,900
$2,000
2
$2,550
$2,700
$2,850
$3,000
3
$2,650
$2,800
$2,950
$3,100
4
$2,750
$2,900
$3,050
$3,200
5
$2,850
$3,000
$3,150
$3,300
6
$2,950
$3,100
$3,250
$3,400
7
$3,050
$3,200
$3,350
$3,500
8
$3,150
$3,300
$3,450
$3,600
9
$3,250
$3,400
$3,550
$3,700
10
$3,350
$3,500
$3,650
$3,800
T
Note:
For household
				sizes above 10, add $100 for each additional member.
1.
Determination of Household
			 Size for Medically Needy Resource Consideration
Household size for MN Resource determination is made according
				to categorical consideration.
a. SSI
			 cash assistance recipients and their resources are excluded from MN cases. They
			 cannot be considered in a second eligibility determination.
b. Determination of household size for MN
			 cases is made as follows. The resources of non-SSI individuals may be
			 considered in more than one MNRL.
1)
U-18
. The eligible children and the natural/adoptive
			 parent(s) in the home will be included in the MNRL unit. However, a parent may
			 choose to exclude a child and that child's resources if inclusion of that child
			 and that child's resources would cause ineligibility. A parent's needs will
			 always be included when determining eligibility for his/her children.
PW. The pregnant woman is the only eligible, the father of the
				unborn child, if in the home, and the unborn child will be included in the
				budget unit. If there are other children in the home who meet the relationship
				requirement, they may be included in the budget, if necessary, to raise the
				need standard to a level that will allow eligibility for the PW. If inclusion
				of a child and the child's resources will result in ineligibility for the PW,
				that child and the child's resources may be excluded. However, the unborn child
				will always be counted in the need standard for the PW.
2) The resources available only to a
			 stepparent will be disregarded in the MNRL of his/her stepchild and his/her
			 spouse (the stepchild's natural/adoptive parent) if that spouse requests
			 assistance as caretaker relative of her deprived child. The stepparent will not
			 be counted in their MNRL.
3) The
			 resources available only to a grandparent, or any relative other than a parent,
			 who is not included in the assistance unit, will be disregarded.
If the grandparent, or other relative other than a parent,
				chooses to be included in the assistance unit, his/her resources will be
				included in full in determining resource eligibility for all those included in
				the MNRL.
When the grandparent or other relative chooses to be included
				and when the grandparent/other relative has a spouse in the home, the resources
				available only to that spouse will be disregarded in determining resource
				eligibility.
4) In
			 dependent child/minor parent/grandparent households, the rules in (3) above
			 will apply, i.e., if the grandparent is to be included as an eligible, the
			 grandparent's resources will be counted; and if the grandparent is not to be
			 included, the grandparent's resources will be excluded.
Note:
In MN cases, the
				resources of a parent(s) will always be counted in full in his/her child's MNRL
				and that parent(s) will be included in the MNRL, even though the parent(s) may
				be over age 18 and will not be a Medicaid eligible member(s) of the unit.
				However, in dependent child/minor parent/grandparent households, even though
				the grandparent's resources must be counted toward the minor parent, they will
				be disregarded in the resource eligibility determination of the
				grandchild.