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Effective: December 1, 2006 |
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03.25.35ar1 - Transitional MA / Transition Year MA (TMA/TYMA) (Archive) |
Archived: July 1, 2008 |
Some members of families with children who become ineligible for Medical Assistance (MA) under a Method A basis of eligibility may be eligible for additional coverage under Transitional MA (TMA) or Transition Year MA (TYMA).
l TMA may provide four months of additional coverage to people who become ineligible due to increased child support or spousal maintenance.
l TYMA may provide up to 12 months of additional coverage to people who become ineligible due to increased earned income. The increase in earned income may be due to any of the following:
n The increased earnings of a parent or caretaker's increased earned income.
n The loss of an earned income disregard (either a parent/caretaker or a child).
The person must meet all of the following:
l Have received MA and been flagged as potentially eligible for TMA/TYMA in at least three of the six months preceding the income increase.
l Remain in a household that includes a dependent child.
l Lose eligibility for MA Method A under the 100% FPG standard because of increased child support or spousal maintenance (TMA), or a parent/caretaker's increased earned income or loss of an earned income disregard (TYMA).
Note: Increased income includes the employment of a biological or adoptive parent who returns to the home. It does not include marriage of the caretaker to a stepparent.
Example:
Mary and her two children have been MA-eligible since January. In June, her husband Perry returns to the home. He is the children’s father and his income is deemed to the rest of the household. He is employed and his earnings cause the rest of the family’s income to exceed 100% FPG.
Action:
Approve Mary, Perry and the children for up to 12 months of TYMA if Mary and the children were flagged as potentially eligible in at least three of the last six months.
Eligibility factors are listed below with any information that is unique for this group. Links to standard program guidelines are included as well.
Citizenship/Immigration Status.
Insurance and Benefit Recovery.
Relationship to Other Groups/Bases.
Other Groups/Bases to Consider.
Application Process (standard guidelines)
No application is required for TMA/TYMA. People who become eligible under a TMA/TYMA basis of eligibility were already MA-eligible, and are just changing from one MA basis to another.
If people reapply for MA after having been eligible for TMA or TYMA, any remaining months of the TMA or TYMA period are available to them if they meet all other requirements.
Example:
Margaret and her son Morgan are approved for TYMA for March through the following February. Morgan leaves the household in early May to live with his father. Margaret is not eligible for MA under another basis, or for GAMC, and does not want to be referred to MinnesotaCare.
Action:
Remove Morgan from the household and close Margaret's MA effective June 1.
In mid-September, Morgan moves back in with Margaret. They reapply for MA.
Action:
Reopen TYMA for October through February (the remainder of their TYMA period that began in March).
Eligibility Begin Date (standard guidelines)
Determine actual TMA or TYMA eligibility at the time each MA-eligible household member's countable income for Method A increases beyond 100% FPG.
l Open TMA or TYMA for the first month for which you can give ten-day notice. There is no retroactive coverage for TMA/TYMA.
l Different household members may begin TMA/TYMA eligibility at different times. See concurrent eligibility for further information.
Do not require a 12-month renewal form from people receiving TMA/TYMA unless a regular 12-month renewal is due when the TMA or TYMA period ends. However, quarterly reports are required for TYMA eligibility.
When determining net income during the second six months of TYMA eligibility, do not require verification of earnings or child care costs.
Enrollees whose MA eligibility under another basis is closed due to failure to provide verification of earned income are not eligible for TYMA.
Social Security Number (standard guidelines)
Follow standard MA guidelines.
If a TYMA enrollee is a sponsored noncitizen, do not deem income from the sponsor during the period of TYMA eligibility.
People must remain Minnesota residents throughout the TMA/TYMA period.
Note: People who lose state residency but return to Minnesota within 12 months of beginning TYMA eligibility (four months for TMA) may qualify for any remaining months in the original period if they meet all other TMA/TYMA requirements.
Example:
Gene and Barbara and their children are found eligible for TYMA beginning February 1. In May they move to North Dakota to accept a new job. They move back to Minnesota in October.
Action:
Reopen TYMA from the date they regain Minnesota residency through January 31 for all family members who meet all other TYMA requirements.
Insurance and Benefit Recovery (standard guidelines)
The caretaker must enroll in the employer's cost-effective health care plan if available. Close TMA/TYMA for caretakers who refuse to enroll. The children remain eligible.
The household must include a dependent child and a caretaker throughout the period of TMA/TYMA eligibility. For information about adding a new person to the TMA/TYMA household, see new household members.
See income guidelines below.
There is no asset limit for TMA or TYMA.
Income Guidelines (standard guidelines)
There is no income limit for TMA or for the first six months of TYMA.
For the second six months of TYMA, a caretaker in the household must have earned income or good cause for unemployment in each month. The caretaker may be employed at a job other than the job that initially resulted in TYMA eligibility. In a two-parent household, either parent may be employed.
Example:
Stephanie and her children were found eligible for TYMA effective October 1 because Stephanie’s earnings caused each household member’s income to exceed 100% FPG. At the time of the quarterly report due in the 7th month of TYMA eligibility, Stephanie reports that she changed jobs. Her earned income less actual child care costs remains within TYMA limits.
Action:
The family remains eligible for TYMA since she is still employed.
Example:
Jan and Don and their children were found eligible for TYMA effective April 1 because Jan found employment causing income to exceed 100% FPG. At the end of the first six months, Don begins employment and Jan quits her job.
Action:
The family remains eligible for TYMA if all other requirements are met because one caretaker is employed.
During the second six months of TYMA, gross earned income less actual child care costs must be equal to or less than 185% FPG.
l Use income from the previous three months as reported in the 7th and 10th months of TYMA eligibility (see reporting requirements).
l Close people whose net income exceeds 185% FPG at the end of the 7th or 10th month. See end of eligibility below.
l Do not count unearned income.
Example:
Carol and her two children begin receiving TYMA effective August 1. They remain eligible for the second six-month period based on Carol’s quarterly income reports. On the quarterly report for February-April, Carol reports winning $10,000 at a casino.
Action:
Do not consider this money as income or as an asset. The family remains eligible for TYMA if Carol continues to be employed and gross earned income less child care costs is less than 185% FPG.
Deductions/Disregards (standard guidelines)
During the second six months of TYMA, allow only actual child care costs that the household is responsible for.
l Do not deduct costs paid by child care subsidy funds, or other third parties, from gross earnings.
l Do not allow any other disregards or deductions.
There are no spenddown provisions for TMA/TYMA.
l There is no income limit for TMA or for the first six months of TYMA.
l During the second six months of TYMA, people whose net income exceeds the 185% FPG limit are no longer eligible for TYMA.
Covered Services (standard guidelines)
Follow standard MA guidelines.
Follow standard MA guidelines.
If a person becomes ineligible due to a combination of a parent/caretaker's increased earnings and increased child or spousal support, the person is eligible for up to 12 months of TYMA.
Note: If a person becomes ineligible for more than one reason, determine if increased earnings would have caused ineligibility without regard to the other change. If yes, the person is eligible for TYMA.
Example:
Jeanine has received MA for herself and her three children for six months. They have been flagged as potentially eligible for TMA/TYMA. One child leaves the home, resulting in a smaller household size. Jeanine gets a job the same month which would have resulted in income exceeding 100% FPG for each member of the original household size of four, as well as for the current household size of three.
Action:
Approve Jeanine and her two children for up to 12 months of TYMA because the increased earnings would have caused ineligibility for MA under another basis even without the change in household composition.
The caretaker must cooperate with medical support requirements. Close TMA/TYMA for caretakers who fail to cooperate without good cause. The children remain eligible.
A TMA or TYMA basis of eligibility is not available to any caretaker who is 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. The children remain eligible.
At the end of TMA or TYMA eligibility, determine if MA eligibility continues under another basis before terminating the person’s eligibility. Do not require a new application or renewal form unless the person has been active for 12 months or more without a renewal.
l If the person is due for a renewal, send a Minnesota Health Care Programs Renewal Form (DHS-3418). If the person is not due for renewal, determine continued eligibility from information in the case file. If you do not have enough information, request the needed information.
l Allow ten days for the person to return the renewal form or any other required information. Allow a longer period if the person is attempting to obtain the information. Assist the person in obtaining the information as needed.
l If the person submits the completed renewal form (if needed) and/or is cooperating in obtaining needed information, leave MA open until all information is received and you determine whether eligibility continues under another basis.
l Provide ten-day notice of closing for any household member who is not eligible for MA under another basis (including a person who is not cooperating with providing needed information).
Not applicable.