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

VII. AUTOMATED TRANSITIONAL BENEFIT REPORTING

A. Requirements

1. Recipients of Transitional Medicaid must complete Transitional Benefit Reports, DMA-5082, for the first nine months during the twelve month transitional period.

2. EIS generates Transitional Benefit Reports (TBRs) for cases in TMA months 3, 6 and 9. The report shows which months the recipient is required to report and the deadline for the reports to be returned.

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(VII.A.)

3. Initial Reports

Cases are selected for reporting at the end of the first quarter of Transitional Medicaid.

EXAMPLE: Case transferred to Transitional Medicaid on October 15^th. The effective date of transfer is November 1^st. The first quarter is November, December and January. EIS generates the first TBR on pull night in January for the 1^st quarter report. Deadline for return of this report is in February, the 4^th month.

4. Second Reports

If the first Transitional Benefit Report is not returned and the Work First Transitional Quarterly Reporting Screen updated by the first Transitional Quarterly Reporting deadline, EIS will generate:

a. A second report, and

b. A good cause informational insert, (the DMA-5084, Transitional Benefits Good Cause).

The deadlines for returning the first and second reports are in the Work First Transitional Reporting Schedule.

B. What Is A Complete Transitional Benefit Report

Review the TBR for changes and completion when you receive it. A complete report is one that:

1. Is signed and dated by the recipient, and

2. Has reported income, and

a. The recipient who is working must report his gross income for the three months. The recipient is not required to provide verification of income unless the recipient reports a change.

b. If there is a change in income, request verification. Refer to MA-3300, Income, for definition of change and what is considered adequate income verification.

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(VII.B.2.)

c. If the recipient who is working does not provide income information for all three months, the report is incomplete. If you determine that the report is incomplete, circle the incomplete items in red ink and return it to the recipient. Retain a copy of the report in the case record.

d. If the recipient reports he is not working, follow instructions in V.A. above.

3. Reports whether child care expenses were incurred.

a. If there is someone in the assistance unit who is working and has child care expenses, the recipient must report child care expense for each of the three months. The TBR must be signed by the child care provider.

b. If the recipient who is working did not have child care expenses, box 4 of the TBR report must be marked “no”.

c. If the recipient who is working does not provide child care information or if the child care information is incomplete, the report is incomplete. If you determine that the report is incomplete, circle the incomplete items in red ink and return it to the recipient. Retain a copy of the report in the case record.

4. Notify the recipient that the report is incomplete.

a. Advise the recipient to complete the circled items and to return the completed report by the second quarterly deadline.

b. Notify the recipient that if the information is not completed and returned benefits may be terminated.

c. If by the second deadline, the recipient does not provide the requested information, and you do not find good cause, conduct an ex parte review to determine continuing eligibility. Refer to VII.F. for processing instructions for the first quarterly report.

C. Determination of Good Cause

Determine good cause when:

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(VII.C.)

1. The quarterly report is not returned by the 1st deadline in the 1st, 2nd, and 3rd quarters of TMA. The parent/specified relative has until the 2nd deadline to prove good cause. Refer to the DMA-5084, Transitional Benefits Good Cause, for what is considered good cause. The recipient’s statement of good cause is acceptable. Verification of good cause is required only if the recipient’s statement is questionable.

2. The parent/specified relative had no earnings in one or more months in the 2nd or 3rd quarter. Refer to the DMA-5084, Transitional Benefits Good Cause, for what is considered good cause. Acceptable evidence of good cause includes but is not limited to a statement from the employer, bill from the hospital, statement from a doctor, newspaper clipping, or a written collateral statement.

D. Updating The On-line Quarterly Reporting Screen In EIS

EIS automatically tracks Transitional Medicaid cases.

1. Select the Work First/Transitional Quarterly Reporting screen upon receipt of a TBR for the current processing quarter. From the inquiry menu in EIS, enter M in selection. The following screen appears:

XXX *** WORK FIRST/TRANSITIONAL QUARTERLY REPORTING *** Report Month Current Date COUNTY: __ DISTRICT: ___ CASE ID: ________ LAST NAME: __________ TYPE: _ MR STATUS RPT CASE ID DIST CO CASE LAST NAME FIRST NAME MI FSIS TYPE X XXXXXXX XXX XXXXXX XXXXXXXXXXXXX XXXXXXXXXXXX X XXX X XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX ENTER = UPDATE PF7/19 KEY = PAGE BACK PF8/20 KEY = PAGE FORWARD SELECTION -- KEY

2. Use this screen to access Work First Family Assistance reporting (QR), Transitional Benefit reporting, or both. You may access:

a. A particular QR/TBR case,

b. All of the QR/TBR cases by district or last name, or

c. All of the QR/TBR cases in a particular county.

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(VII.D.)

3. Enter the following information:

a. COUNTY - Enter the county number for your county.

b. DISTRICT - Enter the district number to view/update all QR/TBR cases in a particular district.

c. CASE ID - Enter the case ID number of a particular case you want to view/update.

d. LAST NAME – Use this field with the district number field. Enter the last name of the payee to view/update all QR/TBR cases with the same last name in a particular district.

e. TYPE - Enter A for Work First Family Assistance cases, T for transitional cases, or leave blank for both Work First Family Assistance and transitional cases.

4. Press ENTER. EIS displays cases based on the selection above.

a. Update the STATUS field as follows:

(1) S - This indicator is entered by EIS when a QR/TBR is generated for issuance.

(2) C - Enter this indicator when a complete QR/TBR is received.

(3) I - Enter this indicator when an incomplete QR/TBR is received.

(4) G - Enter this indicator when the recipient has good cause for not submitting the TBR on a timely basis.

b. You may update more than one record at a time. After entering the appropriate code(s) in the STATUS field, press ENTER. This updates the QR/TBR database. This is an on-line update. From this information, EIS either generates a second report or transfers the case to MAF-C.

c. If the recipient has reported any changes that affect eligibility for Transitional Medicaid, conduct an ex parte review to determine ongoing eligibility in other aid/program categories.

(VII.)

E. Transitional Benefits Report Tracking

EIS uses information keyed on the Work First/Quarterly Reporting Screen to update the Transitional Benefits Reports (TBR) Screen. If you did not update the Work First/Transitional Quarterly Reporting screen because the 1^st quarterly report was not returned, you will need to update the TBR screen if the recipient returns the report or good cause is established by Work First Regular Run in the 6^th month.

Use the TBR tracking screen to indicate that a quarterly report is returned complete or incomplete or to indicate that the recipient has good cause for not returning the report.

1. From the inquiry menu in EIS, choose selection TR, followed by the Case ID number for the affected case. The following screen appears:

EJAXXX XX EIS TRANSITIONAL BENEFITS REPORTS TRACKING CASE-ID XXXXXXX CO XX CO-CASE XXXXX DIST XXX WORKER XXX PAY TYPE X CASEHEAD/PAYEE XXXXXXX X XXXXXXXXXX XXX PHONE NUMBER XXXXXXX ADDRESS LINE 1 XXXXXXXXXX ADDRESS LINE 2 XXXXXXXXXX CITY XXXXXXXXXX STATE XX ZIP CODE XXXXXXXXXX TRANSITIONAL REPORT REPORT MONTH MONTH RESPONSE 01 05/01 ___ 02 06/01 ___ 03 07/01 ___ 04 08/01 ___ 05 09/01 ___ 06 10/01 ___ 07 11/01 ___ 08 12/01 ___ 09 01/02 ___ 10 02/02 ___ 11 03/02 ___ 12 04/02 ___ ENTER = UPDATE PF2/PF14 = INQUIRY MENU SELECTION -- KEY ----------

2. The REPORT RESPONSE is the only field you can update on the tracking screen. Only entry for Transitional month 3 is allowed. EIS automatically fills in the response for the other two months in the quarter based on your entry for month 3. Allowable entries are:

(VII.E.2)

a. C - Enter this indicator when a completed TBR is received.

b. G - Enter this indicator when the recipient has good cause for not submitting the TBR on a timely basis.

c. I - Enter this indicator when the TBR is incomplete.

3. To quit processing without updating the tracking record, press PF2.

F. Requirements For the 1st Quarter of Transitional Medicaid

If a quarterly report is not returned by the second deadline in the fourth month, the case will show on the TRANSITIONAL CASES DUE REVIEW report. The report is produced in the 4^th month on the night of Work First Regular Run. Cases listed on this report need an ex parte review.

1. If the quarterly report is not returned by the second deadline in the 4th month, determine if good cause exists for not returning the report. The deadline for determining good cause is Work First Regular Run in the 6th month.

a. By Work First Regular Run in the 6th month you must:

(1) Update the Transitional Benefits Reports Tracking screen to show the TBR was received, or

(2) Update the Transitional Benefits Reports Tracking screen to show good cause exists, or

(3) Terminate or transfer the case.

b. If good cause does not exist, conduct an ex parte review to determine ongoing eligibility under other aid program/categories.

c. If good cause is established by the deadline, update the Work First/Transitional Quarterly Reporting Screen.

2. If the case is not transferred or terminated by Work First Regular Run in the 6th month, EIS transfers the case to MAF-C for two months.

3. Refer to VII.B. for the definition of a complete report.

G. Requirements For The 2nd And 3rd Quarters of Transitional Medicaid

In the 6^th and 9^th months of Transitional Medicaid, EIS generates quarterly reports for the appropriate cases.

(VII.G.)

1. If quarterly report status is not updated by the first deadline on the Work First/Transitional Quarterly Reporting Screen, EIS mails out a 2nd TBR report, DMA-5082, with a DMA-5084 good cause insert.

2. The recipient must return the quarterly report or establish good cause for not returning the report by the 2nd reporting deadline in the 7th or 10th month unless there is good cause for not returning the report.

Do not establish good cause for failure to return the reports if:

a. You know that the caretaker lost earnings without good cause in at least one month, or

b. The family’s average gross monthly earnings after subtracting child care expenses exceeded 185% of the poverty level.

3. If good cause is established by the second deadline, update the Work First/Transitional Quarterly Reporting Screen.

4. If you have determined that the report is complete, you must then evaluate the Parent/Specified Relative’s Earnings.

a. Determine from TBRs if the parent/specified relative had no earnings in one or more months of the 2nd or 3rd reporting quarter.

b. If there were no earnings in one of the months, contact the caretaker to establish the reason for the loss of earnings.

c. If the caretaker had good cause for loss of earnings, continue Transitional Medicaid. Refer to VII.C. for determining good cause.

d. If the loss of earnings was for other reasons and no good cause exists:

(1) Transfer the case to MAF-C for two months. Since the TBR has already been updated as having a complete report, EIS will not transfer the case.

(2) In the two months, conduct an ex parte review to evaluate the assistance unit for Medicaid under another aid/program category. Inform the caretaker that he may reapply for Work First.

(VII.G.)

5. 185% of Poverty Level Income Test

a. If the average gross monthly earnings minus the average child care expenses exceeds 185% of the poverty income level for the needs unit, the assistance unit is ineligible for Transitional Medicaid.

b. To determine the average gross monthly income, add together the gross income of the parent/specified relative for every month. This includes the earned income of any financially responsible relative if he has returned to the home. Do not allow for any deductions. Do not include any unearned income. Add the three months together and divide by three.

c. To determine the average child care expense paid by the parent/specified parent, add together the amounts for the three months. Divide this amount by three.

(1) Child care expenses must be necessary for the parent/specified relative’s employment. Do not include child care expenses paid by a third party or child care expenses paid for a month in which the caretaker had no earnings.

(2) There is no limit to the amount of child care expenses which can be deducted.

d. Subtract the average monthly child care expenses from the average monthly earnings.

e. Compare this amount to 185% of the Poverty Income Level for the number in the Transitional Medicaid Needs Unit in the third month of the quarter. Refer to the attachment in MA-3305 for 185% of Poverty Income Levels.

f. If the net gross income exceeds 185% of the Poverty Income Level at the end of the 7th month:

(1) Transfer the case to MAF-C. Since the TBR has already been updated as having a complete report, EIS will not transfer the case.

(2) Conduct an ex parte review to evaluate the assistance unit for Medicaid under another aid program/category.

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(VII.G.)

6. If the quarterly reports are not returned and/or good cause is not established, by the 2nd deadline in the 7th or 10th month, EIS will transfer the case to MAF-C for two months with adequate notice. Conduct an ex parte review to determine eligibility for other aid/program categories.

If the case will be terminated or transferred and there is adequate time to act on the case prior to MAF-C beginning, terminate/transfer the case with timely notice prior to the case transferring to MAF-C.

7. In the tenth month, if all the quarterly reports have been returned timely, the case will show on the TRANSITIONAL CASES DUE REVIEW report. The report is produced in the 10th month on the night of the Work First Regular Run. Complete a redetermination.

a. If the case is not terminated or transferred to another aid/program category by Work First Regular Run in the 12th month, EIS will transfer the case to MAF-C for two months.

b. The case will now be displayed on the Case Management Report as due for review.

H. In the 11th Month of Transitional Medicaid

1. In the 11th month of Transitional Medicaid, conduct a redetermination to determine if the family is eligible for Medicaid in another aid program/category. Refer to MA-3420, Re-enrollment.

2. Do not terminate Transitional Medicaid until eligibility or ineligibility has been established for all individuals in other aid program/categories.

a. If the case is eligible for Medicaid in another aid program/category, send the recipient an adequate notice.

b. If the recipient is ineligible in another aid program/category, send the recipient a timely notice.

3. If you do not complete the redetermination and enter information in EIS by Work First Regular Run, EIS transfers the case to MAF-C for two months. Continue to authorize the case for an additional month until the redetermination is completed.

4. The Case Management Report displays the MAF-C case as due for review.