Family and Children's Medicaid MA-3405 TWELVE MONTHS TRANSITIONAL MEDICAID

V. CHANGE IN SITUATION DURING THE TRANSITIONAL MEDICAID PERIOD

A. Parent/Specified Relative Stops Working

1. If the parent/specified relative reports he is no longer working he is ineligible for Twelve Months Transitional Medicaid. This does not include a parent/specified relative who is temporarily out of work but plans to return to work.

a. A person who is not working, but is on the company’s payroll, is considered temporarily out of work. An example is someone who works for a temporary agency but is between assignments.

b. If a parent/specified relative stops working then begins another job before the worker can take action, continue Transitional Medicaid benefits.

2. If the parent/specified relative had good cause for loss of earnings, continue Transitional Medicaid. Refer to VII.C. for determining good cause.

3. If during the Twelve Months Transitional Medicaid period, the parent/specified relative reports he stopped working without good cause , follow these steps:

REVISED 11/01/11 - CHANGE NO. 15-11

(V.A.2.)

a. Conduct an ex parte review to evaluate each assistance unit member for ongoing Medicaid in all aid program/categories. Refer to MA-3410, Termination and Deletions, for instructions on how to conduct an ex parte review.

(1) If it is during the 2nd or 3rd quarter of the Transitional Medicaid period, determine if good cause exists for not working. Refer to the DMA-5083, Notice of Transitional Benefits.

(2) Good cause does not apply in the 1st quarter of Transitional Medicaid. This would be the only time when the parent/specified relative can be unemployed and eligible for Medicaid through the 6th month. To receive Transitional Medicaid after the 6th month, the parent/specified relative must be working.

b. For a child(ren) under age 19, determine whether any months remain in their 12 month continuous Medicaid period based on the last redetermination.

c. If the assistance unit remains eligible under MAF-C, begin a new certification period. If the parent/specified relative remains in the assistance unit, the certification period is 6 months.

d. If the ex parte review determines there is no eligibility under Medicaid or North Carolina Health Choice (NCHC), send a timely notice to terminate.

e. If the assistance unit later qualifies for TMA again, begin a new 12 month TMA.

B. Termination or Deletion During The Transitional Period

Terminate a case or delete an individual from the assistance unit during the Twelve Months Transitional Medicaid when you learn:

1. The parent/specified relative/child begins to receive SSI.

a. EIS automatically deletes the adult/child from the case and authorizes as MAD.

b. If the parent receives SSI, evaluate the children under another aid program/category. For children under age 19, determine whether any months remain in their 12 month Continuous Medicaid.

REISSUED 11/01/11 - CHANGE NO. 15-11

(V.B.1.)

c. Any time a child is deleted from Twelve Months Transitional Medicaid, evaluate for other Medicaid programs including continuous Medicaid. See MA-3410, Terminations and Deletions.

or

2. If the parent/specified relative no longer has an eligible child, the parent/specified relative is no longer eligible. Evaluate the caretaker for ongoing Medicaid in any F& C, ABD, or MPW aid program/category. If a child is receiving Medicaid or NC Health Choice in another case or aid program/category, the parent still has an eligible child.

or

3. The child (ren) no longer lives with the parent/specified relative. If you know the child (ren)’s location, evaluate for 12 month continuous Medicaid or eligibility under another aid program/category, (Refer to MA-3340, County Residence if the child’s location is out of county.)

or

4. The assistance unit or individual moves out of North Carolina, or

5. You are unable to locate the assistance unit.

Document all reasonable attempts to locate the assistance unit. This includes searching all other agency records, both paper and computer records if no older than 6 months. For example, search Food Stamps, ACTS, Service Records (Child Care, etc.), ESC, SDX, SOLQ and EPICS. If the most recent address is not current, attempt to locate a telephone number to contact the family. Refer to MA-3410, Terminations and Deletions, for an explanation of what is considered a current address.

or

6. The parent/specified relative requests termination for herself and children.

a. The request must be in writing and specifically request Medicaid termination.

b. File the written request in the case record. The record must include documentation that the individual understood that he and/or the children may still be eligible for Medicaid and chose not to continue.

or

REVISED 11/01/11 - CHANGE NO. 15-11

(V.B.)

7. Recipient no longer meets the age requirement (Work First – Age 18 and Medicaid/NCHC – age 19). Delete the individual for age requirements based on the aid program/category the child was in prior to receiving Twelve Months Transitional Medicaid. Evaluate the individual for other Medicaid programs.

C. Evaluation For Other Medicaid

When a change occurs which impacts eligibility, evaluate for continued eligibility under all other aid program/categories. Complete an ex parte review. If no eligibility exists, send the recipient a timely notice to terminate/delete.

D. County Transfers During the Transitional Medicaid Period

If the assistance unit moves to another county in North Carolina any time during the Twelve Months Transitional Medicaid period, follow instructions in MA-3340, County Residence, to transfer the case to the second county. A redetermination of eligibility is not required until the end of the Transitional Medicaid period.