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TITLE 16 HEALTH AND SAFETY DELAWARE ADMINISTRATIVE CODE 2 • in error; • pending a hearing if the agency’s action is upheld and the Medicaid provided is recoverable as an overpayment; or • for a month of ineligibility because of administrative notice requirements. Medicaid must have been received in Delaware for three out of the six months. 15110.3 Increase in Earned Income or Hours of Employment The family must become ineligible for Medicaid because of an increase in earned income or hours of employment of the parent or caretaker relative. This happens when: • an increase in earned income makes the family ineligible; or • an increase in other income when combined with an increase in earned income causes ineligibility. The parent or caretaker relative whose earnings cause ineligibility must meet the three out of six months requirement in Section 15110.2. The increase in earned income or hours of employment must have a causative effect on the loss of eligibility. The following steps are used to determine if an increase in earned income (or other factor) had a causative effect. 1. Determine if the increase in earned income or hours of employment would have resulted in the loss of eligibility if all other factors in the case remained the same (there was no other change in income, no change in family composition, etc.). If yes, the family is eligible for the Transitional Group. If no, go to step 2. 2. Determine if events other than the increase in earned income or hours of employment would have resulted in the loss of eligibility if the earned income or hours of employment had stayed the same. If yes, the family is not eligible for the Transitional Group. If no, go to step 3. 3. Determine if the family is ineligible when all changes are considered. If yes, the family is eligible for the Transitional Group. The increase in earned income or hours of employment was essential to the loss of eligibility. Without that increase, the family would not have lost eligibility. If no, eligibility continues under the Parent/Caretaker Relative Group. 15110.4 Child Living in the Home The parent or caretaker relative must continue to have a dependent child, as defined in Section 15100.1 living in the home. When the only child no longer meets the age requirement, the parent or caretaker relative is no longer eligible for the Transitional Group. When one child turns age 18 or 19, but there is another child in the family, the child who turns age 18 or 19 is no longer considered a member of the Transitional Group family unit. The rest of the family remains eligible for the Transitional Group. 15110.5 Composition of a Transitional Group Family Unit Transitional Group coverage is provided to all individuals who were included in the family at the time the family became ineligible. This includes a dependent child under the Children Group described in Section 15300. A recipient of SSI is not included in the family unit. Family members who enter the household or family members who were absent but return may be found eligible. An individual who enters the family unit (including a child born to the family during the transitional period) may be eligible for Transitional Group coverage if that individual would have been included in the parent or caretaker relative’s family unit if the household were applying in the current month. The earned income of an individual who has entered or returned to the family unit is included in the gross earnings test and that individual is counted when determining the family size. The earned income of a dependent child, regardless of student status, is not counted. 15110.6 First Month of Transitional Group Eligibility Transitional Group eligibility begins with the month of ineligibility under the Parent/Caretaker Relative Group due to an increase in earned income or hours of employment. A family who is not timely in reporting the start of employment or an increase in earned income or hours of employment could have the extension period reduced. The family must be notified they are eligible for the Transitional Group and the reasons why coverage under the Transitional Group could be terminated. 15110.7 Transitional Group Eligibility during First Six-Month Period