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PART VII - SPECIAL MA PROCESSING

CHAPTER 1: SPECIAL MA GROUPS AND PROGRAMS

INTRODUCTION 1.1

This chapter presents the policies concerning the following groups or programs and applies to MA only:

 Transitional Medicaid Assistance,  Refugee-Related Assistance,  Pickle Amendment (Section 503 Individuals),  Disabled Widow(er)s,  Early Widow(er)s (Kennelly Widow(er)s),  Adult Disabled Children,  Medicare Buy-In (QMBs, SLIMBs, QI-1, and QDWIs),  Disabled Individuals Returning to Work, and  50-64 Demonstration.

See Exhibit VII-1: Income and Asset Standards below for income and asset standards for these special MA groups.

LEGAL AUTHORITY 1.2

AREA/TOPIC DISTRICT FEDERAL Special MA Groups MA: D.C. Code 4- 110(3) MA: 42 USC 1383c et seq; 42 USC 1396a (a); 42 USC 1396a(a)(10)(E); 42 USC 1396d(p)(1)-(2); 42 USC 1396d(s); 42 USC 1396r-6 et seq.; 42 USC 1396u-3;42 CFR 435.133-.134;42 CFR 435.137-.138 Refugee Medical Assistance MA: 45 CFR 400.93-.107

TRANSITIONAL MEDICAID ASSISTANCE (TMA) 1.3

AR: N/A

AX: TMA is not related to a recipient's losing eligibility for TANF. It is related to a recipient's losing eligibility for regular MA.

TMA is available to groups consisting of parents, caretaker relatives, and/or children under 19 when an increase in earnings or child support causes the group's income to exceed the AX income standard (200 percent of the FPL for parents, 300 percent for children.)

TMA is only available if increased earnings or child support cause the group to exceed the income standard for AX. Also, the group must have received MA for at least three of the six months prior to their income exceeding the income standard for AX.