*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016. Please refer to the EPM for current health care program policy information. ***
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Effective: July 1, 2008 |
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03.25.35.05 - Potential Eligibility for TMA and TYMA |
Archived: June 1, 2016 (Previous Versions) |
One eligibility requirement for a TMA or TYMA basis of eligibility is to have met certain criteria for at least three of the previous six months. This requirement is referred to as "potential eligibility."
Criteria for Potential Eligibility.
When to Act on Potential Eligibility.
Criteria for Potential Eligibility
To have potential eligibility for TMA/TYMA for a given month, the person must meet all of the following conditions:
1. Have a Method A basis of eligibility.
Note: A person with both a Method A and a Method B basis of eligibility can use the Method B basis and meet this first condition for potential eligibility.
2. Be one of the following:
n A parent or relative caretaker with a dependent child in the household.
n A dependent child with a parent or relative caretaker in the household.
n A pregnant woman in her third trimester.
Note: It is not necessary that all household members be on MA, although only those on MA will be potentially eligible for TMA/TYMA.
3. Have net countable income equal to or less than 100% FPG using Method A deeming and income computation rules.
If all three requirements are met in a month, MAXIS will flag ELIG/HC (ABUD panel) for that month for potential eligibility for a future TMA/TYMA basis of eligibility.
When to Act on Potential Eligibility
To be eligible for TMA or TYMA, the individual must have met all three of the potential eligibility criteria and been flagged in at least three of the previous six months. Determine eligibility for TMA or TYMA if a person who meets the potential eligibility criteria in at least three of the previous six months later loses MA Method A eligibility due to one of the following:
l Increased child or spousal support.
l The caretaker's increased earned income or loss of the earned income disregard.
Note: Do not re-evaluate or require verification of income for the months the enrollee was flagged for potential eligibility.
Example:
Anthony and Karen apply for MA with Karen's daughter Melissa, age two. Anthony is Melissa's stepfather, and does not have an MA basis of eligibility. Karen has a Parent/Caretaker basis, and Melissa is a dependent child with a Children Under 21 basis.
Action:
Confirm that MAXIS flagged Karen and Melissa for potential TMA/TYMA eligibility if they have income at or below 100% FPG using Method A deeming, disregards and deductions. Anthony is not potentially eligible for TMA/TYMA.
Example:
Ron and Cathy apply for MA with their daughter, Christina, age five. Ron is disabled. Cathy is working. Ron, Cathy and Christina all have an MA Method A basis: Ron and Cathy both have a parent/caretaker basis, and Christina is a dependent child with a Children Under 21 basis. However, Ron also has a Method B basis as a disabled person, which he has chosen to use for his current MA eligibility.
Action:
Confirm that MAXIS flagged all three household members for potential TMA/TYMA if each person’s countable income using Method A deeming, disregards and deductions is at or below 100% FPG.
Example:
MAXIS flagged Tracy and her son Alex as potentially eligible for TMA/TYMA in three of the past six months. However, at renewal it is determined that Tracy failed to report increased income in one of the flagged months.
Action:
Do not change the flag, even though income in the flagged month may have exceeded 100% FPG.
For further information on how to determine TMA/TYMA eligibility, see:
Transitional MA/Transition Year MA (TMA/TYMA).
Concurrent Eligibility for TMA/TYMA.
Reporting Requirements for TYMA.
New Household Members for TMA/TYMA.