Medical Assistance for Families with Children and Adults

2.2.4.3 Transitional Medical Assistance and Transition Year Medical Assistance (Archive)

Some Medical Assistance for Families with Children and Adults (MA-FCA) enrollees may extend their MA coverage under Transitional MA (TMA) or Transition Year MA (TYMA) after they are no longer considered MA eligible.

TMA may provide up to four months of additional coverage to people who become ineligible for MA-FCA due to increased spousal support (alimony).

TYMA may provide up to 12 months of additional coverage to people who become ineligible for MA-FCA due to increased earned income including income from a parent or relative caretaker who returns to the household. The 12 months consists of two periods of six months each, which have different eligibility and reporting requirements. There are more eligibility and reporting requirements during the second six-month period than during the first six-month period.

No application is required for TMA/TYMA. People who lose MA due to increased income or spousal support automatically qualify for TMA/TYMA if they meet other requirements.

Eligibility Requirements

To be eligible for either TMA or TYMA, the person must:

• Be a birth, natural, step or adoptive parent or relative caretaker, a child under age 19, or a pregnant woman.

• Have had MA-FCA coverage in at least three of the six months before the income increase. Re-evaluation of eligibility and reverification for any of the three of the six months before the income increase are not required.

• Live in a household that includes a child age 18 or younger.

• Lose eligibility for MA-FCA because of increased spousal support (TMA) or increased earnings (TYMA).

Children under age 19 and pregnant women are eligible for TMA or TYMA if they were at or below 133% FPG when they were first determined MA eligible. TMA or TYMA eligibility begins after their income increases above 133% FPG and runs concurrently while they remain eligible under the child or pregnant women MA basis. TMA or TYMA coverage is available for children under age 19 and pregnant women for any remaining TMA or TYMA months after their income increases above the child or pregnant women income standards.

TMA and TYMA are not available for:

• Enrollees whose MA coverage ends because they did not verify earned income are not eligible for TYMA.

• Parents or relative caretakers who are convicted of MA fraud for any of the six months before the start of the TMA/TYMA period or for any month of TMA/TYMA.

Enrollees who are determined eligible for TMA/TYMA are exempt from annual renewals for the duration of the TMA/TYMA eligibility.

Second Six-Month Extension of TYMA

To continue to receive TYMA beyond the first six months, the household must meet several additional requirements:

• Receive TYMA for the entire first six-month period.

• Complete quarterly reports in third, sixth, and ninth month of TYMA eligibility. Enrollees can provide income and childcare information in writing or by phone.

• Have gross earned income at or below 185% FPG calculated by averaging the family’s gross monthly earnings minus costs for childcare necessary for the employment of the caretaker relative for the immediately preceding 3-month period. Sponsor deeming does not apply to TYMA. See the MA-FCA Sponsor Deeming policy for more information.

• Have a parent or relative caretaker in the household with earned income unless there is good cause for the lack of earnings. Good cause for a lack of earnings during the second six-month extension of TYMA includes, but is not limited to, involuntary loss of employment and illness.

First Quarterly Report

A TYMA enrollee must receive a Transition Year Medical Assistance First Quarterly Report (DHS-2975A) at the end of the third month of TYMA eligibility. The family must report to the agency the family’s gross monthly earnings and the family’s costs for childcare, which is the cost necessary for the employment of the parent or caretaker relative, in each of the first three months. The report is due on the 21^st day of the fourth month of the initial six-month period. Paper proof of childcare costs is not required.

If the TYMA enrollee returns the form or responds by phone indicating there is no longer a dependent child in the home, the enrollee is no longer eligible for TYMA and is closed with advanced 10-day notice.

Second and Third Quarterly Reports

TYMA enrollees must also report earnings and childcare costs for each of the previous three months by the 21st day of the seventh and 10^th month of the TYMA period. Paper proof of childcare costs is not required.

Failure to Comply with Reporting Requirements

Failure to report by the 21^st day of the reporting month will end the family’s TYMA benefits, unless the person has established good cause for the failure to report on a timely basis. Once the person completes the reporting requirement, TYMA coverage is restored the next month and continues for the remainder of the original 12-month period, if the person’s TYMA eligibility has not otherwise ended.

If the family does not comply with the reporting requirements, coverage is suspended but eligibility is not closed until the end of the 12-month period.

Fluctuating Income and Remaining TMA/TYMA Months

Enrollees with fluctuating income may move between another MA-FCA basis of eligibility and TMA or TYMA. If TMA or TYMA enrollees have an income reduction resulting in income at or under the MA-FCA income limit, they become eligible again under their previous MA-FCA basis. When this happens, TMA or TYMA ends, and any remaining TMA or TYMA months are available if income again increases beyond 133% FPG within the original 12-month period.

If people enrolled in TMA or TYMA are closed and later reapply for health care, they may be eligible of any remaining months within the original 12-month period.

If the person has had MA-FCA eligibility for three or more of the past six months, the person again may meet the eligibility criteria for a new period of TMA or TYMA eligibility.

New Household Members for TMA and TYMA

When a new member enters a household in which at least one member of the existing household is receiving TMA or TYMA, and the new member is not eligible for MA under another basis, the new member may be eligible for TMA or TYMA depending on his or her relationship to other household members who are receiving TMA or TYMA.

If an auto newborn is part of the TMA/TYMA household when the auto newborn period ends, the auto newborn is considered a new household member.

Relationship to Other Household Members

If the new household member is the birth, natural, step or adoptive parent, relative caretaker, spouse, child or stepchild of another member of the household who receives TMA or TYMA, then the new member has the same eligibility as the household members receiving TMA or TYMA.

New members who are added are eligible for TMA or TYMA effective on the first day of the first full month they are in the household. Their TMA/TYMA will continue for the same time period as the spouse or child to whose TMA/TYMA they are added. For TYMA, the new member will be subject to the same quarterly reporting schedule. For new members added during the second six months of TYMA, updated information to determine continued eligibility is required before the person is added.

Legal Citations

Minnesota Statutes, section 256B.0635, subdivision 1(b)

Minnesota Statutes, section 256B.0635, subdivision 2

Social Security Act, section 1925

Social Security Act, section 1931

Published:  June 1, 2016

Archived:  September 1, 2016