Transitional and Extended Medicaid Benefits 510-05-50

 

Transitional Medicaid Benefits 510-05-50-05

(Revised 01/03 ML #2833)

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(N.D.A.C. Section 75-02-02.1-20)

 

Families who cease to be eligible under the Family Coverage group, and who meet the requirements of this section, may continue to be eligible for Medicaid benefits without making further application for Medicaid.

 

Families who were eligible (at least one individual) under the Family Coverage group in at least three of the six months immediately preceding the month in which the family became ineligible because of the caretaker relative's hours or earnings from employment or because a member of the unit has a reduction in the time-limited earned income disregard, may continue eligible for Medicaid benefits for up to twelve months if:

  1. In the first six-month period:

  1. The family has a child living in the home that meets the Family Coverage group age requirements; and
  2. The caretaker relative remains a resident of the state; or

  1. In the second six-month period:

  1. The family has a child living in the home that meets the Family Coverage group age requirements;
  2. The caretaker relative remains a resident of the state;
  1. The caretaker relative remains employed or shows good cause for not being employed ( in cases where Family Coverage ineligibility resulted from the caretaker relative’s earned income); and
  2. The gross earned income, less child care expenses the caretaker relative is responsible for, which, in either of the three month periods consisting of the fourth, fifth, and sixth months or the seventh, eighth, and ninth months, when totaled and divided by three, does not exceed one hundred and eighty-five percent of the poverty level.
  1. A family becomes ineligible under the Family Coverage group because of the caretaker relative’s earned income when it is determined that the family would continue to be eligible under the Family Coverage group if the caretaker relative’s earned income is not counted, but they fail when the earned income is counted.
  2. A family becomes ineligible under the Family Coverage group because a member of the unit has a reduction in the time-limited earned income disregard when it is determined that the family continues eligible under the Family Coverage group if the reduction is not applied.

  1. A family which seeks to demonstrate eligibility in at least three of the six months immediately preceding the month in which the family became ineligible must have been eligible in this state in the month immediately preceding the month in which the family became ineligible. Eligibility from another state may be substituted for the other two months. Verification of eligibility in another state is required.

  2. Only recipients become eligible for Transitional Medicaid Benefits. Applicants who fail Family Coverage eligibility due to earned income must be eligible under the Family Coverage group for at least one month, including any of the three prior months, before considering whether they received Family Coverage in three of the past six months.

Example 1: A family is eligible under the Family Coverage group in January and February. The case closes at the end of February for failure to provide information. In June, the family reapplies for Medicaid and requests assistance for the three prior months. When the application is processed, the family is NOT eligible for Family Coverage for March, but is in April. They then fail Family Coverage for May due to income. Because this family received three months of Family Coverage in the past six months, because the family became INELIGIBLE for Family Coverage due to earned income in May, and because the family members were recipients, the family is eligible for Transitional Medicaid Benefits effective May 1.

 

Example 2: A family is eligible under the Family Coverage group in January, February, and March. The case closes at the end of March due to failure to provide information. In June, the family reapplied for Medicaid and does NOT request, or is not eligible for, assistance for April and May. When the application is processed, the family is NOT eligible under the Family Coverage group for June due to earned income. Even though this family received three months of Family Coverage in the past six months, they are applicants and not recipients (no approved months based on this application), this family is NOT eligible for Transitional Medicaid Benefits.

  1. If an individual was included as eligible in the Family Coverage case the month the Family Coverage eligibility ended, the individual is included in the Transitional Medicaid Benefits. The following individuals are also eligible for Transitional Medicaid Benefits:

  1. Children (deprived or non-deprived, who meet the age requirements under the Family Coverage group) who are born, adopted, or who enter the home of a caretaker relative during the first or second six month period; and
  2. Parents who were absent from the family when the family became ineligible under the Family Coverage group but who return during either period.

  1. Children who no longer meet the Family Coverage age requirements are not eligible for Transitional Medicaid Benefits.

  2. Budgeting in the second six-month period:

  1. The county agency must send a notice to the recipient in months six and nine, informing the recipient to report earnings and child care expenses. The recipient must report and verify income and child care expenses for the fourth, fifth, and sixth months by the twenty-first day of the seventh month, and for the seventh, eighth, and ninth months by the twenty-first day of the tenth month. Verification of earnings is required.
  2. All earned income of the eligible individuals in the Medicaid unit must be considered in determining eligibility for the second six month period, plus earned income of ineligible natural, adoptive, or stepparents.

In determining the amount of countable earned income, the medically needy income disregards (including the extra check disregard) and the self-employment percentage disregards do not apply.

  1. The gross earned income, less child care expenses, for months four, five, and six are combined then divided by three to arrive at average monthly income. This amount is then applied against 185% of the poverty level to determine if continued eligibility exists. If eligibility continues, the same test is performed for months seven, eight, and nine. If the household remains within the poverty level, and continues to meet the other eligibility criteria, coverage continues through month 12.
  2. Failure to report income in the seventh month and the tenth month, or receipt of income in excess of one hundred and eighty-five percent of the poverty level, causes ineligibility effective on the last day respectively, of the seventh month or the tenth month.

 

Refer to Section 05-85-40 for the Transitional Medicaid Benefits income level.