*** The Health Care Programs Manual (HCPM) has been replaced by the Minnesota Health Care Programs Eligibility Policy Manual (EPM) as of June 1, 2016.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: December 1, 2006 |
|
03.25.35.20 - New Household Members for TMA and TYMA |
Archived: June 1, 2016 |
When a new member enters a household in which at least one member of the existing household is receiving TMA or TYMA, first determine if the new member is eligible for MA under another basis. If the new member is not eligible for MA without a spenddown, but does have an MA basis of eligibility, consider the new member's relationship to other household members who are receiving TMA or TYMA.
Note: If an auto newborn is part of the TMA/TYMA household when the auto newborn period ends, treat the auto newborn as a new household member.
Relationship to Other Household Members.
Process for Adding New Household Members.
Relationship to Other Household Members
Is the new household member the spouse of a TMA or TYMA enrollee?
l If yes, give the new member the same eligibility as the spouse.
l If no, does the new household member have a child who receives TMA or TYMA?
n If yes, give the new member the same eligibility as the child.
n If no, is the new member a child whose parent receives TMA or TYMA?
m If yes, give the child the same eligibility as the parent.
m If no, there is no TMA or TYMA eligibility.
If the new member is a stepparent or stepchild of a person who receives TMA or TYMA, the new member is not eligible for TMA or TYMA.
Process for Adding New Household Members
Add new members who are eligible to be added to TMA or TYMA effective on the first day of the first full month they are in the household.
l Their TMA/TYMA will continue for the same time period as the spouse or child to whose TMA/TYMA they are added.
l For TYMA, the new member will be subject to the same quarterly reporting schedule.
l For new members added during the second six months of TYMA, gather income information to determine continued eligibility before adding the person. See reporting requirements for further information.
Example:
Kelli’s daughter Isabelle has received TYMA since August 1. Kelli's boyfriend Michael, who is Isabelle’s father, returns to the home on November 3. He is not eligible for MA without a spenddown.
Action:
Since Michael is Isabelle's father, add him to the TYMA household effective December 1. TYMA will continue for Michael and Isabelle through the end of the following July if they meet all other TYMA eligibility requirements.
For further information on how to determine TMA/TYMA eligibility, see:
Transitional MA/Transition Year MA (TMA/TYMA).
Potential Eligibility for TMA/TYMA.
Concurrent Eligibility for TMA/TYMA.