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Chapter: 2000 Coverage Groups Program: MSSI, SFP 8 budget change is being acted on at the same time, a test budget(s) will be necessary to determine if the change in earned income is the sole cause of ineligibility.

2. At least one assistance group in the household was eligible for and received Medicaid with income below the parent/other caretaker relative income limit (MA R- previously referred to as 1931 Medicaid) in at least three of the preceding six months. The three months can include a month in which Medicaid was received in another state, or a retroactive month. All assistance groups (except individuals previously requesting not to receive Medicaid and children ages 18 to 21) in which the parent or other caretaker relative with new or increased earned income is a counted or eligible member are eligible for transitional coverage, provided all requirements are met.

Note: It is not necessary to change a child’s coverage group to Transitional Medicaid if they remain eligible for Medicaid as a child. If the initial receipt or increase in earned income does not cause ineligibility for other SFU members, do not change those individuals’ Medicaid coverage.

Example: A parent reports increased income over the Parent and Other Caretaker Relative income limit (19% federal poverty level(FPL)), but the increased earned income does not go over the income limit for Children Under Age 19 (133% FPL). 2030.0204 Verification of Initial Earnings (MFAM) Information regarding the date of initial receipt of earnings or the increased earnings must be obtained in order to establish the 12-month period. The recipient’s statement of earnings and the begin date is acceptable. 2030.0600 PRESUMPTIVE ELIGIBILITY COVERAGE (MFAM) Presumptive eligibility is a determination of eligibility made by a Qualified Hospital (QH) based on the applicant’s verbal statements about the SFU's income. The income must be equal to or below the income limit. Citizenship status is not a factor of eligibility for this coverage group.

The following are presumptive eligibility coverage groups: 1. Parents and other caretaker relatives 2. Pregnant women 3. Infants and children under age 19 4. Former Foster Care Children

This is temporary coverage that begins with the date the presumptive eligibility determination is completed by the Qualified Hospital (QH) and ends on the date of the Medicaid determination if an application for regular Medicaid is filed by the last day of the month after the presumptive eligibility determination. If an application for regular Medicaid is not filed by then, presumptive eligibility ends on the last day of the month after the presumptive eligibility determination. Only one presumptive period per 12 months is allowed. For the individual to receive coverage beyond the presumptive period, a regular Medicaid application is necessary and the QH is expected to assist with this application process. 2030.0700 PREGNANT WOMEN (MFAM) Medical assistance for the pregnant woman will be under one coverage group. The coverage group under which the pregnant woman receives benefits is determined by the household composition and income.

The following are coverage groups for pregnant women who:

1. have household income at or below the applicable income standard (no asset test),