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at any time without penalty and should promptly do so if they gain coverage on their own through the FFM, so that they do not have to pay back Advanced Premium Tax Credits (APTCs) due to having duplicate FFM and Medicaid coverage for any months during the calendar year.

Members whose new employment offers health insurance may have both employer-sponsored insurance and HIP if they continue to meet other eligibility criteria and pay their PAC payments. HIP will be the payer of last resort, and will only pay for Medicaid-eligible services, and only up to the Medicaid limit.

3815.05.00 CIRCUMSTANTIAL ELIGIBILITY FACTORS

In this context, circumstantial eligibility factors are TMA-specific requirements which are not technically noncompliance reasons, and do not broadly apply to all Medicaid or HIP. Failure to qualify according to these factors will cause TMA protections to be removed for the entire family, but all adult and child members will be explored for alternative eligibility via the Medicaid hierarchy. • The last minor dependent leaves the household or ages out of TMA (18th birthday) • The last TMA HIP parent or caretaker leaves the household (including incarceration) • After month six (6) the MAGI income, less out-of-pocket child-care expenses, exceeds 185% FPL • The caretaker no longer has earned income and has no good cause for not having earnings • The TMA period expires after the end of twelve (12) months Those who qualify for any other coverage such as Hoosier Healthwise for children or non-TMA HIP for adults (whose income has decreased to back under the HIP limit) will transition to the new categories without being required to file a new application. If there is no passing category, the member’s benefits will be closed. 3815.10.00 CATEGORICAL ELIGIBILITY FACTORS

Categorical eligibility factors are due to normal changes in eligibility between Medicaid categories. Adults will be moved out of TMA HIP if eligible for a non-HIP category, but if a second parent still qualifies for TMA HIP when this occurs, TMA protection will continue for that parent and the dependent child/ren. These changes could occur due to:

• Age (65th birthday) • Receipt of Medicare • Blindness (MA B) • Disability (MASI, MA D/DW/DI) • Pregnancy