Basic Considerations

To be eligible for continued Medicaid coverage under TMA, the AU must have correctly received Parent/Caretaker with Child(ren) in three of the six months preceding the first month of Parent/Caretaker with Child(ren) ineligibility. An AU is potentially eligible to receive TMA for 12 months beginning with the first month following the last month of Parent/Caretaker with Child(ren) Medicaid.

To be eligible for continued Medicaid coverage under TMA, Medicaid ineligibility must result exclusively from new or increased Modified Adjusted Gross Income (MAGI) earnings of an adult AU member or child AU Member with earnings above the allowable IRS dependent exemption, referred herein as a "TMA-qualifying event."

TMA-qualifying event includes any of the following:

new employment

increase in earnings as a result of an increase in hours worked

increase in salary or hourly wage

earnings of an eligible member added to the AU

decrease in pre-tax or 1040 deductions

Ineligibility may be caused by new or increased earnings and a concurrent change. If the concurrent change alone caused ineligibility, the AU is ineligible for TMA.

Cooperation with Third Party Liability (TPL) is required at approval for TMA as well as during both 6-month review periods. Refer to Section 2230 - Third Party Liability .

Referral to Child Support Services is not required.

Effective 5/17/2024, the first month of Parent/Caretaker ineligibility and the first month of the TMA period will No Longer Be The Same Month . The first month of Parent/Caretaker ineligibility is based on when the AU’s income actually exceeds Parent/Caretaker FPL. The first month of TMA period is the month after the case worker (CW) takes action based on the change or renewal (including administrative renewals) that an AU member has experienced a TMA-qualifying event and the expiration of timely notice.

The AU still must report a TMA-qualifying event within 10 days of the change. If the AU fails to report the change within 10 days, the CW will no longer be required to look back to determine the effective date of change for TMA. Rather, the effective date now will only be prospective (after expiration of timely notice).

Any individual who moves into the home during the TMA eligibility period is ineligible for TMA, however s/he may qualify for another Medical Assistance COA.

If the individual was previously a member of the TMA AU, the individual may be added.