*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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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03.25.35.10 - Concurrent Eligibility for TMA and TYMA |
Archived: June 1, 2016 (Previous Versions) |
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."
Concurrent eligibility occurs when:
1. an MA enrollee is flagged as potentially eligible for TMA/TYMA in at least three of the past six months, and
2. the enrollee has a basis of eligibility that has an income standard exceeding 100% FPG (for example, child under 21, pregnant women), and
3. the enrollee’s income increases due to child/spousal support or earnings, and
4. as a result of that income increase, the enrollee’s income now exceeds 100% FPG, but is under the income standard for their basis of eligibility, and
5. the enrollee meets all other TMA/TYMA criteria.
MA remains open because the enrollee’s MA basis of eligibility has an income standard that exceeds 100% FPG. However, the income increase triggers the TMA/TYMA eligibility to begin. Track the TMA/TYMA eligibility. If the MA basis of eligibility later ends, the enrollee is eligible for any remaining months in the TMA/TYMA eligibility period, provided he or she still meets the TMA/TYMA requirements.
Concurrently Eligible Under Method A.
Concurrently Eligible Under Method B.
Concurrently Eligible Under Method A
Families with children 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 a parent or caretaker relative, 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 275% 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 275% FPG during the four-month TMA period making him ineligible for MA under the children under 21 basis, he is eligible for any remaining months of TMA .
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 275% FPG.
Action:
Nancy and Ray are now eligible for up to 12 months of TYMA because both lost eligibility for MA Method A due to Nancy’s increased earnings. Close Ray's MA 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 MA Method B may be concurrently eligible for TMA/TYMA.
Note: Most people who choose a Method B basis over a Method A basis do so for waiver eligibility.
Example:
Myra and George apply for MA for themselves and their son Joshua. Both Myra and George have a parent/caretaker basis of eligibility. 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 is eligible for the CADI waiver.
Action:
MAXIS will automatically flag all three household members for potential TMA/TYMA. Because of CADI waiver policy, Myra’s income is not deemed to George. George uses Method B budgeting and is considered a household size of one.
Myra’s income increases to above 100% FPG.
Action:
George remains eligible for MA Method B with the CADI waiver. Myra’s income is not deemed to George because MA eligibility is determined using a household size of one for all months in which George receives CADI services. George also has concurrent eligibility for TYMA for 12 months because he is dually eligible for MA Method A under the parent/caretaker basis and MA Method B under the disabled basis.
Myra is no longer eligible for MA because her net income is over the limit for MA under the parents/caretakers basis (133% FPG). Close MA and approve TYMA for Myra.
Joshua remains eligible for MA Method A with the children under 21 basis as long as his income remains below 275% FPG. Joshua is also concurrently eligible for MA and TYMA. If his income increases above 275% FPG during his 12 months of TYMA eligibility, he is eligible for any of the remaining months of TYMA.
Four months later, George is approved for RSDI and will now have a spenddown.
Action:
If he chooses to continue to receive CADI services, he must remain on MA Method B with the spenddown. If George chooses to discontinue CADI, he can receive TYMA for any remaining months of the family’s 12-month 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 Determine if the person meets the criteria for a new TMA/TYMA period.
If the person has had MA Method A eligibility for three or more months, and was flagged as potentially eligibility for TMA/TYMA in at least three of the past six months, the person again meets the potential eligibility criteria and is eligible for a new period of TMA/TYMA eligibility.
Example:
Carlos, Michelle and their son Lorenzo, age three, have been enrolled in MA Method A 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 and their income MA income standard of 133% FPG, but below 275% FPG.
Action:
Since all three have been flagged in three of the last six months and there was an increase in earned income, begin TYMA eligibility December 1. However, because the household net income remains below 275% FPG, 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 MA Method A for Michelle and Carlos as parents/caretakers as of February 1. Do not count any months they are eligible for MA Method A 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 and their MA income standard of 133% FPG but below 275% FPG.
Action:
The TYMA period that ran during December and January resumes on March 1 with ten remaining months available. The TYMA and MA Method A for 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.
New Household Members for TMA/TYMA.