400.15.02A EXTENDED MEDICAID FOR 12-MONTHS FOR INCREASED WAGES

If increased wages cause ineligibility for the parent(s) or caretaker relative(s) covered in COE-075, and the parent(s) or caretaker relative(s) correctly received Medicaid in at least 3 of the last 6 months prior to the month ineligibility began, the parent(s) or caretaker relative(s) are entitled to extended Medicaid for 12 consecutive months beginning with the month of ineligibility. NOTE: The month of ineligibility is the month in which the parent/caretaker would have coverage end due to increased wages or hours of employment or new wages if not for Extended Medicaid. Transitioning to Extended Medicaid is an adverse action. If action is taken by the 15th of the month, the month of ineligibility and the first Extended Medicaid month are the next month. If action is taken after the 15th, the month of ineligibility and start of Extended Medicaid are the month after next. Example 1: New employment for a parent eligible in COE-075 begins September 1st, which causes the parent to exceed the income limit in September. The employment is reported on September 20th. The first month of ineligibility is November, which is entered in MEDS as the first extended medicaid eligible month. November is the first month of the 12-consecutive months of Extended Medicaid. Example 2: An increase in wages and hours of employment for the spouse of a caretaker relative begins September 1st but is not reported until December 15th. The Specialist must verify wages using electronic wage verification if available or paper verification if unavailable, per ongoing policy. In this example: • Wages verified by MDES confirm the month of ineligibility is September. • The Specialist processes the decision on December 16th. • February is the month of ineligiblity and the first month of Extended Medicaid because Extended Medicaid is an adverse action. • Both caretakers are allowed Extended Medicaid through the following January. Children and Extended Medicaid Extended Medicaid applies to parent/caretakers and their dependent children under age 18. Children are less frequently transitioned to Extended Medicaid because they usually have eligibility in a child COE. However, if a child becomes ineligible and there are months remaining in the parent/caretaker Extended Medicaid period, the child’s coverage must continue until the Extended Medicaid ends. Children who must be transitioned to Extended Medicaid due to ineligibility in a child COE should have a review set for the end of the Extended Medicaid period. Reported Changes while on Extended Medicaid A child in the home under 18 is a condition of continued eligibility in Extended Medicaid. When the youngest child in the home turns 18, Extended Medicaid will end, even if the 12 months have not expired. If all children under 18 leave the home, the parent/caretaker must be closed.If at any time the parent or caretaker relative reports loss of earnings or decreased earnings such that the family is eligible in COE-075 again, the case must be documented to indicate ongoing eligibility and the end of extended Medicaid. There is no limit to the number of times a parent or caretaker relative can be eligible for extended Medicaid provided they have been eligible three out of six months prior to the month ineligibility would have resulted.