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ACA/FAMILY MEDICAID 201-13 Family Transitional Medicaid

Supersedes: FMA 201-9, 02/01/2019 Reference: 42 CFR 435.112; ARM 37.82.101, .701; P.L. 100-485; and P.L. 103-194 Overview: ACA Transitional Medicaid (TMA) may be provided to parents, specified caretaker relatives, and children for up to 6 consecutive months following closure of non-medically needy ACA Medicaid (ACA PCR, ACA Adult Medicaid, and ACA Adult), when closure was due to a qualifying event. TMA coverage is available for all family members who are included in the assistance unit. There are no resource or income limits for TMA coverage. NOTE: TMA coverage is not available to any family who fraudulently received Family coverage during the six months prior to the beginning of the TMA period. Fraud must be determined by a court of law. If the household fails to report income timely, it is not fraud. It will be necessary to determine when, if the change had been reported timely, the TMA period would have begun and adjust the 6 months of TMA accordingly. QUALIFYING ADULT: A qualifying adult includes those individuals whose needs and income were included in the assistance unit in the eligibility determination of ACA PCR, ACA Adult Medicaid, and ACA Adult at the time the case closed/became medically needy. QUALIFYING CHILD: A qualifying child is one who: 1. Is under age 19; 2. Meets U.S. citizenship, U.S. National or qualified noncitizen status and: a. Was included in the ACA PCR, ACA Adult Medicaid, and ACA Adult household and related as child/stepchild or other related within 5th degree of kinship (niece/nephew, grandchild) at the time the case became medically need/closed; or b. Is a dependent child receiving Supplemental Security Income (SSI). QUALIFYING EVENT: To be eligible for TMA, the family must have: 1. Received non-medically needy ACA Medicaid in Montana during three of the previous six months prior to the case closing/becoming medically needy and