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Effective: December 1, 2006 |
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03.25.35.10ar1 - Concurrent Eligibility for TMA and TYMA (Archive) |
Archived: July 1, 2008 |
Some people may meet the eligibility criteria for both TMA/TYMA and another Medical Assistance (MA) basis of eligibility at the same time. This is referred to as "concurrent eligibility."
People with concurrent eligibility remain eligible for MA under the non-TMA/TYMA basis. However, the months of the concurrent TMA/TYMA period are tracked. If their income exceeds the standard for their original MA basis (which would result in a spenddown ), any remaining months of the TMA/TYMA eligibility period are available to them.
Concurrently Eligible Under Method A.
Concurrently Eligible Under Method B.
Concurrently Eligible Under Method A
Children under age 19 and pregnant women who are eligible under Method A have a higher MA income standard than the 100% FPG standard for TMA/TYMA. Therefore, if they become eligible for TMA/TYMA, they may be concurrently eligible as children under 21 or pregnant women.
Example:
Nancy and her son Ray, age three, have been MA-eligible for six months and have been flagged as potentially eligible for TMA/TYMA for all six months. Nancy begins receiving child support for Ray that causes his income to exceed 100% FPG. His income remains below his standard of 150% FPG. Since the child support is not counted for Nancy, her income remains below 100% FPG.
Action:
Because Ray’s income now exceeds 100% FPG, his four-month period of TMA eligibility begins even though he also remains eligible under the Children Under 21 basis. If his income increases beyond 150% FPG during the four-month TMA period, he is eligible for TMA for any remaining months.
In the third month of Ray’s TMA eligibility, Nancy reports increased earnings. Her income now exceeds 100% FPG. Ray’s total income, including child support and Nancy’s deemed earnings, exceeds 150% FPG.
Action:
Nancy and Ray are now eligible for up to 12 months of TYMA. Close Ray's TMA and begin the 12-month period of TYMA.
Concurrently Eligible Under Method B
People who are flagged as potentially eligible for TMA/TYMA but use Method B for their current MA eligibility may be concurrently eligible for TMA/TYMA.
Example:
Myra and George apply for MA for themselves and their son Joshua. Myra works part-time and earns less than 100% of FPG. George recently became disabled and has applied for RSDI . He is certified disabled by the State Medical Review Team (SMRT) and found eligible for the CADI waiver.
Action:
Flag all three household members for potential TMA/TYMA. However, because of CADI waiver policy, George must use a Method B basis of eligibility, and Myra’s income is not deemed to him.
Myra’s income increases above 100% FPG when her earned income disregard cycle ends. She and Joshua become eligible for TYMA.
Action:
George remains on MA Method B/CADI. TYMA runs concurrently for George.
Four months later, George is approved for RSDI and will now have a spenddown.
Action:
If he continues to receive CADI services, he must remain on MA Method B with the spenddown. If George discontinues CADI, he can receive TYMA for the remaining months of the family’s TYMA eligibility period.
People with fluctuating income may move between another MA Method A basis of eligibility and TMA/TYMA. If TMA/TYMA enrollees have an income reduction resulting in income at or under 100% FPG, they become eligible again under their previous MA basis. When this happens:
l Stop counting the TMA/TYMA months.
l Determine how many remaining TMA/TYMA months are available if income again increases beyond 100% FPG.
l Also determine if the person meets the criteria for a new TMA/TYMA period.
Example:
Carlos, Michelle and their son Lorenzo, age three, have been enrolled in MA since August. They all have net income below 100% FPG and have been flagged for potential TMA/TYMA since August. On November 15, Michelle reports that Carlos got a raise from his employer. Their income is now above 100% FPG, but below 150% FPG.
Action:
Since all three have been flagged in three of the last six months and there was an increase in earned income, TYMA eligibility begins December 1. However, Lorenzo remains eligible with a Child under 21 basis, with TYMA eligibility running concurrently.
On January 9, Michelle calls to report that Carlos has been laid off. Their income is now below 100% FPG.
Action:
Approve Michelle and Carlos as parents/caretakers as of February 1. Do not count any months they are eligible as Parents/Caretakers toward the TYMA eligibility period.
On February 13, Michelle calls to report that Carlos has found another job. Their income is once again over 100% FPG but below 150% FPG.
Action:
The TYMA period that ran during December and January resumes on March 1 with ten remaining months available. The TYMA and Children Under 21 bases run concurrently for Lorenzo.
Note: If their MA eligibility as parents/caretakers had continued for three months with countable income equal to or less than 100% FPG (enabling them to meet the potential eligibility criteria), the household would again be eligible for a full 12 months of TYMA when MA ends under their other bases of eligibility.
For further information on how to determine TMA/TYMA eligibility, see:
Transitional MA /Transition Year MA (TMA/TYMA).
Potential Eligibility for TMA/TYMA.
Reporting Requirements for TYMA.