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

09/01/03

I. INTRODUCTION

A. Overview

Twelve Months Transitional Medicaid (TMA) can be given to a Work First, including Benefit Diversion, Job Bonus, or MAF-C assistance unit when the earned income of a parent/specified relative in the assistance unit causes ineligibility. The assistance unit must have been eligible for and received Work First Family Assistance (including Benefit Diversion), or MAF-C in North Carolina in at least three of the six months immediately preceding the first month of ineligibility. There must be an eligible child receiving Medicaid or North Carolina Health Choice in order for the parent/specified relative to receive Transitional Medicaid. The transitional period can last up to 12 consecutive months.

When a family loses eligibility for Work First Family Assistance, Job Bonus or MAF-C evaluate for Transitional Medicaid following policy in this section. If eligible for Transitional Medicaid the twelve-month period begins with the first month the assistance unit was ineligible for Work First Family Assistance (including Benefit Diversion), Job Bonus or MAF-C. The parent or specified relative must report earnings quarterly. The aid program/category is A-AF. The payment type is 5.

At any time during the Transitional Medicaid period that the assistance unit is no longer eligible for Twelve Months Transitional Medicaid, conduct an ex parte review to determine ongoing eligibility in other aid program/ categories. A full re-determination must begin the 11^th month or prior to the end of the 12 months of Transitional Medicaid.

B. Definitions

1. “Received Work First or MAF-C” includes:

a. Benefit Diversion - Only transfer to Twelve Months Transitional Medicaid when the Benefit Diversion certification period ends, or

b. Job Bonus, or

c. Cases authorized as open/shut, or

(I.B.1.)

d. Reopened Work First or MAF-C cases.

When a case is terminated but the recipient returns requested information within 10 days following the month of termination, certain cases can be reopened. If the reopened case is ineligible due to earned income of the parent/specified relative, authorize the case for Twelve Months Transitional Medicaid.

2. “Received Work First or MAF-C” does NOT include months the case:

a. Received assistance which must be recouped, or

b. Received assistance as the result of a request for an appeal, or

c. Received assistance fraudulently as determined by a court.

3. “Increased earned income” is defined as new or additional employment, increase in the required hours worked, or increase in rate of pay. Refer to MA-3300, Income, for a definition of new employment.

4. “Financially ineligible” means the parent/specified relative’s earnings cause the assistance unit’s net income (after allowable deductions) to exceed the Work First Need Standard.

5. “Financially ineligible” for MAF-C means the parent/specified relative’s earnings cause the assistance unit’s net income (after allowable deductions) to exceed the categorically needy income limit.

6. The parent/specified relative can be the only individual in the assistance unit when he has children receiving Medicaid or NCHC under another aid program/category such as MIC or SSI Medicaid.

7. A parent/specified relative is not an independently living child.