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Example 2: A child is initially approved for MA 10 coverage. In month 4 of the CE period, his mother is due for redetermination. Her Medicaid is closed for failing to provide updated income. Medicaid for the MA 10 child must be left open (even if premium is unpaid).

In month 6 of the child’s CE period, the needed information to rescind the redetermination denial is provided and the income causes the child’s premium to increase. Because he was already receiving MA 10 and this is not a category change, it can be authorized.

In month 8, the child’s mother reports that she is getting fewer hours at work. The newly verified income causes his MA 10 to switch to MA 9. Because this is a beneficial category change, it can be authorized.

It should be noted that children are deemed eligible for coverage in MA X due to their mother’s Medicaid status. Redeterminations are not set for this category; instead, eligibility under a new category of medical assistance must be determined when the child turns 1. Except for citizenship, the usual eligibility factors (including social security number) are to be verified. If found eligible, the child’s first CE period would begin the month the new category is authorized.

Newborns who are hospitalized and/or individuals under 19 who would be eligible for Medicaid if they were in a medical institution qualify for continuous eligibility.8

2238.20.05 CONTINUOUS ELIGIBILITY PERIODS FOR CHILDREN IN MA 4, MA 8 AND MASI

MASI/MA 4/MA 8 children under age 19 are entitled to continuous eligibility, but these categories do not have redetermination dates set. However, IEDSS will establish a CE period for these categories as well.

If eligibility fails in one of these categories, IEDSS will explore the hierarchy and attempt to place the child in a different Medicaid category.

Income will need to be requested for MA 4, MA 8, or MASI if there is no, or no current, income in the case at the time of category transition. When a new category forms and passes, the category that forms can be approved and a new CE period will start, in line with the new redetermination date that is set.

If no new category forms and passes, the individual’s existing CE period will continue in the same category. At the end of the CE period, they will be subject to closure if they are still ineligible for any category of assistance.

Note: If a MASI child is no longer considered disabled by SSA and is approved for an HCBS waiver, an HHW category would be appropriate and will not cause the child to lose their waiver services