Page 3

2

However, TMA will be reserved for these families which are in danger of losing coverage altogether due to exceeding the 133% Federal Poverty Level (FPL) MAGI income limit. This will allow these members time to transition to employer or marketplace coverage more appropriate to their employment status.

TMA will not apply to families where the total countable income for the household does not put them in danger of losing their HIP/Medicaid coverage.

TMA households will continue to be built per TANF rules; however, once TMA begins, all income for TMA household members will be counted using MAGI rules.

TMA reports will no longer be sent or required. Reasonable compatibility rules will be used in determining when/whether a family needs to verify income.

3805.00.00 TMA ELIGIBILITY

TMA is not applicable for any non-HIP categories, or for the following individuals in HIP/HIP- related coverage:

• Undocumented immigrants

• Suspended individuals • Pregnant or in a postpartum period

• Native Americans in MANA coverage (opted out of HIP) • HIP State Plan Plus with copays (MAPC)

• Members in conditional status when the income increases • A “caretaker” who is not a specified relative per TANF rules is not eligible to be counted as a Low-Income Parent/Caretaker and is not eligible for TMA.

Other TMA eligibility rules are described in the following sections.

3805.05.00 FORMER LOW-INCOME PARENT/CARETAKER STATUS

Up to 12 months of full medical coverage under the TMA category is available to families when a qualified HIP Low-Income Parent/Caretaker would otherwise fail financial eligibility due to new or increased earned income from a job or from self-employment. TMA does not apply when income increases only from unearned sources such as child support or state/federal benefits.

To initially qualify for TMA, the parent/caretaker with new or increased earnings must have received (and been eligible for) coverage in the Healthy Indiana Plan as a Low-Income Parent/Caretaker in three of the six months immediately preceding the ineligibility.

To be counted towards the three of six requirements, a month must have been: