2664.7 Extension of Coverage for Temporary Unemployment

Working Healthy recipients who become temporarily unemployed and intend to return to work may remain eligible for a period up to 4 months following the month in which employment ended. Unemployment may be for any reason, but the recipient must provide a clear reason for the unemployment. Continued eligibility during the temporary unemployment period is only provided if the individual is otherwise eligible for Working Healthy. A temporary unemployment period may be granted for an individual who is employed but fails to meet the earned income requirements of 2668.3 (FICA/SECA, minimum wage and earnings tests). This extension is not available to persons whose only employment occurred in a prior medical period per 7330 (2) .

Temporary Unemployment Plan – The individual must have an active Temporary Unemployment Plan (TUP) in place in order to receive continued coverage under this provision. Persons who report becoming unemployed shall be referred to the Benefits Specialist for establishment of the TUP and the individual must cooperate with the Benefits Specialist in this process. The purpose of the TUP is to establish a plan to return to work. The Benefits Specialist has much leeway in the establishment of the plan, as the plan shall consider factors such as disability and job skills. Failure to cooperate with establishment of the plan will result in termination of Working Healthy coverage.

Temporary Unemployment Period – The 4-month period shall begin the month following the month unemployment began. If the individual is cooperating with the Benefits Specialist and all other eligibility factors are met, coverage may be provided through the last day of the 4-month period. Any required review, either an annual review or a six month desk review, must be completed at scheduled intervals during the period. Regular reporting requirements also continue to apply. Persons who have not returned to work at the end of the 4-month period are no longer eligible under Working Healthy, but coverage may be considered under other programs (e.g., LMB, QMB, Medically Needy, etc.)

Impact on Premium Obligation – Any changes to the premium obligation as a result of a change in income are made the month following the month of report. Any new or additional income the individual has begun receiving as a result of unemployment (e.g., disability payments from the employer, Social Security payments, etc.) must be considered in the recalculated premium. However, action to change the premium shall not be delayed in anticipation of a change in income source. The premium will be considered and re-budgeted at the next review, annual or 6-months desk review. The individual must remain current on any premiums during this period.