Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 332 - MAINECARE ELIGIBILITY MANUAL › Part 3.5 - ELIGIBILITY GROUPS REQUIREMENTS › Section 144-332-3.5-4 - Transitional Medicaid

Current through 2024-29, July 17, 2024
When eligibility within either a parent/caretaker relative
					 or child under age 21 eligibility group for which MAGI-based methodology
					 applies ceases because of hours of, or income from, employment of the
					 parent/caretaker relative or because of receipt of alimony, Transitional
					 Medicaid may be available.
Section 4.1: Definitions
Family
- a family consists of individuals
					 whose needs and income were included in determining eligibility in a coverage
					 group for which MAGI-based methodology applies at the time this coverage ended.
					 It also includes those individuals whose needs and income would be taken into
					 consideration in determining eligibility for a coverage group for which
					 MAGI-based methodology applies if the family were applying in the current
					 month.
Included in the definition is:
a parent/caretaker relative who returns home, who is
						included in an eligibility group for which MAGI-based methodology applies and
						whose earnings, either alone or added to other income of the household, result
						in the family losing coverage under an eligibility group for which MAGI-based
						methodology applies;
										a child or parent/caretaker relative who moves into
						the home after TM has started; or
										 a child who is born after TM has started.
Section 4.2: Eligibility for Transitional Medicaid:
					 Individuals Who Become Ineligible for Coverage under MAGI-Based Coverage Due to
					 Increased Earnings
Section 4.2.1: Computation of Transition
					 Period
Individuals who lose eligibility in a coverage group for
					 which MAGI-based methodology applies due to the earnings of a parent/caretaker
					 relative may remain eligible for Medicaid for up to a year. The scope of
					 services will be the same as those provided to those eligible under an
					 eligibility group for which MAGI-based methodology applies.
These individuals may receive up to twelve additional
					 months of medical coverage known as Transitional Medicaid (TM). The twelve
					 months are divided into two separate eligibility periods, each consisting of
					 six months. There are different requirements for each extension. Individuals
					 receiving TM must continue to assign their rights to payment for medical care
					 from any third party. The custodial parent is not required to cooperate in
					 obtaining medical support or payments from the non-custodial parent (See Part
					 2, Sections 6 and 7 ).
The twelve month count starts with the first month of
					 ineligibility, which may not necessarily be the effective month of the loss of
					 coverage under an eligibility group for which MAGI-based methodology
					 applies.
Example:
A family reports an increase in the parent's earnings on
					 April 5th. The parent is now ineligible in April.
					 The first month for TM is April, the first month of ineligibility, and not May,
					 which would be the effective month for the closing under an eligibility group
					 for which MAGI-based methodology applies.
Section 4.2.1.1: Initial Six Month Extension (Months
					 One - Six):
A.
Conditions of Eligibility
At least one member must have been eligible for and
					 receiving coverage under an eligibility group for which MAGI-based methodology
					 applies in one of the prior three months immediately preceding ineligibility.
					 Retroactive coverage under an eligibility group for which MAGI-based
					 methodology applies will be counted for this purpose even if there is only one
					 month of retroactive coverage and no current eligibility under an eligibility
					 group for which MAGI-based methodology applies.
For example, the family applies in July. Eligibility exists
					 only for June. The family gets coverage under an eligibility group for which
					 MAGI-based methodology applies for June and TM starting in July.
Exception
(1) An individual is not eligible for the
				  initial six month extension of Transitional Medicaid if the individual is a
				  member of a family which has received Medicaid, if the State makes a finding
				  that, at any time during the last 6 months in which the family was receiving
				  such aid, before otherwise being provided extended eligibility under this
				  section, the individual was ineligible for Medicaid because of fraud.
(2) The closing of coverage in an eligibility
				  group for which MAGI-based methodology applies must be due to the earnings of a
				  specified relative as defined by Section 2 above.
Examples
(a) Mother and one child are covered under an
				  eligibility group for which MAGI-based methodology applies. Father or
				  stepfather returns to the home. When eligibility is determined including the
				  father or stepfather and his earnings, the mother and father or stepfather is
				  over income for eligibility in a coverage group for which MAGI-based
				  methodology applies. The mother and father or stepfather are eligible for
				  TM.
(b) Mother, father and two
				  children are covered under an eligibility group for which MAGI-based
				  methodology applies. Mother and father have earnings. One child leaves the home
				  or turns age 18 resulting the family being over income for an eligibility group
				  for which MAGI-based methodology applies. Mother, father, and child under age
				  18 are eligible for TM.
(c) Mother
				  and two children are covered under an eligibility group for which MAGI-based
				  methodology applies. The 17 year old (not attending school) has countable
				  earnings, which result in the mother being over income under an eligibility
				  group for which MAGI-based methodology applies. The mother is not eligible for
				  TM because it is not the earnings of the parent/caretaker relative that
				  resulted in ineligibility for a coverage group for which MAGI-based methodology
				  applies.
(d) A family of four is
				  covered under an eligibility group for which MAGI-based methodology applies.
				  Mother has earnings and father, who was employed, starts to get unemployment
				  benefits putting the mother and father over the income limits for an
				  eligibility group for which MAGI-based methodology applies. The mother and
				  father are not eligible for TM since it was the change in Unemployment
				  Insurance Benefits (UIB) that resulted in being over the income limits for an
				  eligibility group for which MAGI-based methodology applies.
It is not a condition of eligibility that the specified
					 parent/caretaker relative remain employed during the first six months of the
					 initial extension or that included individuals cooperate in establishing
					 paternity or in obtaining medical support and payments. Individuals in the
					 household must comply with rules on assigning rights to medical support
					 (through Third Party Liability (TPL), see Part 2, Section 6).
There is no income test for the initial six month
					 extension.
Failure to file the income and child care report required
					 in the fourth month does not affect the coverage provided in the initial
					 extension.
The coverage group must include a child, who resides in the
					 household. This child must be under the age of eighteen or between the ages of
					 18 and 19 and a student regularly attending a secondary school on a full-time
					 basis (or in the equivalent level of vocational or technical training at the
					 high school level) and reasonably expected to complete the program prior to his
					 or her 19th birthday.