*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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. ***
Effective: June 1, 2014 |
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03.25.35 - Transitional MA / Transition Year MA (TMA/TYMA) |
Archived: June 1, 2016 (Previous Versions) |
Some members of families with children who become ineligible for Medical Assistance (MA) under Method A may extend their MA coverage under Transitional MA (TMA) or Transition Year MA (TYMA).
l TMA may provide four months of additional coverage to people who become ineligible for MA due to increased child support or spousal maintenance.
l TYMA may provide up to 12 months of additional coverage to people who become ineligible for MA due to increased earned income. The 12 months is divided into two periods of six months each. There are more eligibility and reporting requirements during the second six-month period than during the first six months.
Eligibility Requirements
To be eligible for either TMA or TYMA, 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 increased earnings (TYMA).
Increased Earnings - TYMA
To qualify for TYMA, the increase in earned income may be due to any of the following:
l Increased earned income of a parent or relative caretaker.
l Loss of the parent, relative caretaker, or child's earned income disregard.
Note: Increased income includes the employment of a biological or adoptive parent who returns to the home. It does not include marriage of the parent to a stepparent.
Enrollees who become ineligible for MA under another basis because they did not verify earned income are not eligible for TYMA.
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 all household members. He is employed and his earnings cause 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.
Multiple Reasons for MA Ineligibility
If a person becomes ineligible for MA for more than one reason, determine if the increased child support, spousal maintenance, or increased earnings (including hours of employment or loss of the disregards) would have caused ineligibility without regard to the other change. Review the deductions/disregards section below if the person has both increased child support or spousal maintenance and increased earnings, hours of employment or loss of the disregards.
Follow these steps to determine if an increase in child support, spousal maintenance, or earnings (including hours of employment or loss of the disregards) caused the loss of MA.
1. Determine if the increase in child support, spousal maintenance or earnings (including hours of employment or loss of the disregards) would have resulted in loss of MA eligibility if all other factors in the case remained the same (that is, there was no other change in income, family composition, MA standards, etc.).
n If yes, the person is eligible to receive TMA or TYMA.
n If no, go to step 2.
2. Determine if events other than the increase in child support, spousal maintenance or earnings (including hours of employment or loss of the disregards) would have resulted in loss of MA eligibility if the child support or earnings (including hours or disregards) had stayed the same.
n If yes, the person is not eligible to receive TMA or TYMA.
n If no, go to step 3.
3. Determine if the person is ineligible for MA when all changes are considered.
n If yes, the person is eligible for TMA or TYMA. The increase in child support, spousal maintenance or earnings (including hours of employment or loss of the disregards) was essential to the loss of MA eligibility. Without that increase, the person would not have lost MA eligibility.
n If no, the person is not eligible for TMA or 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 that results in her 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 even without the change in household composition.
MA Ineligibility Due to a Combination of Increased Child Support and Earnings
If a person becomes ineligible for MA due to a combination of increased child support or spousal maintenance AND earnings (including hours of employment or loss of the disregards), follow these steps to determine if the person should get TMA or TYMA.
1. Determine if the increased earnings alone would have resulted in the loss of MA.
n If yes, the person is eligible for up to 12 months of TYMA.
n If no, go to step 2.
2. Determine if the increased child support alone would have resulted in the loss of MA.
n If yes, the person is eligible for 4 months of TMA.
n If no, go to step 3.
3. Determine if the person is ineligible for MA when both the increase in child support and earnings are considered.
n If yes, the person is eligible for up to 12 months of TYMA because the increase in earnings is essential to the loss of MA.
n If no, the person is not eligible for TMA or TYMA.
Example:
Tamia and her daughter Tia were flagged as potentially eligible for TMA/TYMA in three of the past six months. At renewal, Tamia reports that Tia’s father began to pay all of his child support. She also reports her job has changed from part-time to full-time. Because of these changes, Tamia’s income now exceeds her income limit of 100% FPG. Tia’s income now exceeds her income limit of 150% FPG.
Action:
Determine if Tamia and Tia are eligible for TMA or TYMA. Because MA does not count the child support in Tamia’s income, her increased earnings were the sole reason for losing MA. Therefore, Tamia is eligible for TYMA. Because MA counts both the child support and Tamia’s earnings in Tia’s income, determine which caused her to lose MA.
n If the increased income from Tamia’s earnings alone resulted in Tia’s loss of MA, she is eligible for TYMA.
n If the increased income from earnings did not cause Tia’s income to exceed 150% FPG, determine if the increased child support alone resulted in Tia’s income exceeding 150% FPG. If it did, she is eligible for TMA.
n If neither one of these income increases on its own caused Tia’s income to exceed 150%, then she is eligible for TYMA.
Second Six Months of TYMA
To continue to receive TYMA beyond the first six months, the household must meet several additional requirements:
l Receive TYMA for the entire first six-month period.
Exception: People who do not receive the entire first six-month period because they lose Minnesota residency may be eligible for the second six-month TYMA period. See Residency below.
l Complete quarterly reports.
n Clients can provide income and child care information in writing or by phone. Follow up with clients if a quarterly report is not returned by mail.
l Have gross earned income at or below 185% FPG, and
l Have a parent/relative caretaker in the household with earned income unless there is good cause for the lack of earnings. See Income Guidelines below for more information.
Eligibility factors and links to standard program guidelines are provided below.
Citizenship/Immigration Status.
Insurance and Benefit Recovery.
Relationship to Other Groups/Bases.
Application Process (standard guidelines)
No application is required for TMA/TYMA. People who lose MA due to increased income or child/spousal support automatically qualify for TMA/TYMA if they meet other requirements.
If people enrolled in TMA/TYMA are closed and later reapply for health care, any remaining months of the TMA or TYMA period are available to them if they meet all other requirements.
Note: The clock on the TMA/TYMA period keeps ticking while they are not enrolled in health care. If they reapply, they are only eligible for the months remaining in their TMA/TYMA period.
Example:
Margaret and her son Morgan are approved for TYMA for March through the following February. Morgan leaves the household in early September to live with his father. Margaret is not eligible for MA under another basis and does not want to be referred to MinnesotaCare.
Action:
Remove Morgan from the household and close Margaret's MA effective October 1.
In mid-November, Morgan moves back in with Margaret. They reapply for MA.
Action:
Review TYMA eligibility under the second six-month criteria for December through February (the remainder of their TYMA period that began in March) if they are not eligible for MA without a spenddown.
Eligibility Begin Date (standard guidelines)
Determine TMA or TYMA eligibility at the time each MA-eligible household member's countable income for Method A increases above 100% FPG.
l Close MA with a ten-day notice and open TMA or TYMA for the following month.
l Different household members may begin TMA/TYMA eligibility at different times. See concurrent eligibility for further information.
There is no retroactive coverage for TMA/TYMA.
Do not require a 12-month renewal 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 to receive the second six months of TYMA eligibility.
Do not require verification of income or child care costs when determining net income during the second six months of TYMA eligibility. See Reporting Requirements for TYMA.
Social Security Number (standard guidelines)
Follow standard MA guidelines.
Follow standard MA guidelines.
Exception: If a TYMA enrollee is a sponsored noncitizen, do not deem income from the sponsor during the period of TYMA eligibility.
People must be Minnesota residents to receive TMA/TYMA.
People who lose state residency during the TYMA period 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.
Note: People who lose state residency during the first six months of TYMA eligibility and later return to Minnesota are treated as if they received TYMA during the months of absence. As a result, they do not need to have received TYMA during the full first six months to receive the second six months of TYMA.
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 parent/relative caretaker must enroll in the employer's cost effective health care plan if available. Close TMA/TYMA for parent/relative 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.
During the second six months of TYMA, gross earned income, less any child care expenses necessary for the employment of the parent or caretaker, must be equal to or less than 185% FPG.
185% FPG Income Standards |
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Household Size |
Monthly Standard |
Six-Month Standard |
Annual Standard |
1 |
$1,800 |
$10,800 |
$21,600 |
2 |
$2,426 |
$14,556 |
$29,112 |
3 |
$3,052 |
$18,312 |
$36,624 |
4 |
$3,678 |
$22,068 |
$44,136 |
5 |
$4,304 |
$25,824 |
$51,648 |
6 |
$4,930 |
$29,580 |
$59,160 |
7 |
$5,556 |
$33,336 |
$66,672 |
8 |
$6,182 |
$37,092 |
$74,184 |
9 |
$6,808 |
$40,848 |
$81,696 |
10 |
$7,434 |
$44,604 |
$89,208 |
Add'l |
$626 |
$3,756 |
$7,512 |
See Deductions/Disregards below for more information.
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.
During the second six months of TYMA, a parent/relative caretaker in the household must have earned income or good cause for unemployment in each month. A parent/relative caretaker has good cause if the lack of earnings:
l Was due to involuntary loss of employment,
l Was due to illness, or
l You establish there was another good cause.
The parent or relative 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 they meet all other requirements because one caretaker is employed.
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.
Note: Do not require verification of child care costs.
l Do not allow any other disregards or deductions.
There are no spenddown provisions for TMA/TYMA.
Covered Services (Prepaid MHCP Manual)
Follow standard MA guidelines.
Follow standard MA guidelines.
The parent or relative caretaker must cooperate with medical support requirements. Close TMA/TYMA for parents or relative caretakers who fail to cooperate without good cause. The children remain eligible.
TMA or TYMA is not available to any parent or relative 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.
l Send the MNsure Application for Health Coverage and Help Paying Costs (DHS-6696).
l Allow ten days for the person to return the application and 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 application 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).
l If the application was received, send the application to MinnesotaCare Operations for entry into the new eligibility system for a MinnesotaCare, Advanced Premium Tax Credit (APTC) or unassisted Qualified Health Plan (QHP) determination.
See concurrent eligibility for TMA and TYMA.