Transitional Medicaid Benefits 510-03-50-05

Revised 1/12/2023 ML #3696)

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(N.D.A.C. Section 75-02-02.1-20)

A parent or caretaker relative who ceases to be eligible under the Parent/caretaker relative and their spouses category and who meets the requirements of this section may continue to be eligible for Medicaid benefits without making further application for Medicaid.

Note: Children eligible under one of the child categories, will remain eligible under that category when a parent or caretaker relative becomes Transitional Medicaid Eligible.

When at least one parent or caretaker relative, who was eligible under the Parent/caretaker (COE M063) category in at least three of the six months immediately preceding the month in which the individual became ineligible because of the caretaker relative's hours or earnings from employment, may continue eligible for Medicaid benefits for up to twelve months if: The household has a child living in the home that meets the children’s coverage age requirements; and The caretaker relative remains a resident of the state; and The caretaker relative remains employed or shows good cause for not being employed (In families with two caretaker relatives, as long as one of the caretaker relatives remains employed; the provision is met. If both caretaker relatives stop working, the good cause provision applies to the last one that was employed); and

A family becomes ineligible under the Parent/caretaker (COE M063) category because of the caretaker relative’s earned income when it is determined that the household would continue to be eligible under the Parent/caretaker (COE M063) category, if the caretaker relative’s earned income is not counted, but they fail when the earned income is counted.

An individual that seeks to demonstrate eligibility in at least three of the six months immediately preceding the month in which the household became ineligible must have been eligible in this state in the month immediately preceding the month in which the household became ineligible. Eligibility from another state may be substituted for the other two months. Verification of eligibility in another state is required.

Only recipients become eligible for Transitional Medicaid Benefits. Applicants who fail the Parent/caretaker (COE M063) category due to earned income must be eligible under the Parent/caretaker (COE M063) category for at least one month, including any of the three prior months, before considering whether they were eligible under the Parent/caretaker category in three of the past six months.

If a child loses eligibility under one of the child categories during the parent/caretakers 12 month Transitional Medicaid Period, and the reason for the child’s loss of eligibility is due to the parent/caretakers earned income, the child will be added to Transitional Medicaid for the remaining 12 month period of the parent/caretaker. Example 1: Household consists of mom and one child. Mom is eligible under the Parent/caretaker category in January and February. The entire case closes at the end of February per the family's request. In June, the family reapplies for Medicaid and requests assistance for the three prior months. When the application is processed, mom is NOT eligible under the Parent/caretaker category for March, but is in April. Mom fails under the Parent/caretaker category for May due to income.

Because mom received three months,(January, February and April), of coverage under the Parent/caretaker category in the past six months, mom became INELIGIBLE under the Parent/caretaker category due to earned income in May, and the mom was a recipient, Mom is eligible for Transitional Medicaid Benefits effective May 1.

If mom’s child is eligible under one of the child categories, the child remains eligible under that category and ONLY Mom becomes Transitional Medicaid Eligible. If mom’s child is no longer eligible under one of the child categories, the child will also become Transitional Medicaid eligible at the same time as Mom does. If mom’s child loses eligibility under one of the child categories during mom’s 12 month Transitional Medicaid Period, and the reason for the child’s loss of eligibility is due to mom’s earned income, the child will be added to Transitional Medicaid for the remaining 12 month period.

Example 2: Household consists of mom and 2 children. Mom is eligible under the Parent/caretaker category in January, February, and March.

The case closes at the end of March per the family's request. In June, the household reapplies for Medicaid and does NOT request, or is not eligible for, assistance for April and May. When the application is processed, mom is NOT eligible under the Parent/caretaker category for June due to earned income.

Even though mom received three months, (January, February and March) of coverage under the Parent/caretaker category in the past six months, she is an applicant and not a recipient (no approved months based on this application). This household is NOT eligible for Transitional Medicaid Benefits.

If an individual was included as eligible under the Parent/caretaker category the month eligibility ended under the Parent/caretaker category, the individual is included in the Transitional Medicaid Benefits.

The following individuals are also eligible for Transitional Medicaid Benefits:

Children, deprived or non-deprived

Who meet the age requirements under the Children category, and Who are born, adopted, or who enter the home of a caretaker relative during the twelve month period, and Who are not eligible under one of the children categories.

Parents who were absent from the household when the family became ineligible under the Parent/caretaker relative and their spouses category but who return during either period.

Example: Mom and her child are eligible under the Parent/caretaker relative and their spouses category from January through April. Dad moves in during the month of April, and is not eligible under the Parent/caretaker relative and their spouses category. His earnings make mom and Dad ineligible under the Parent/caretaker relative and their spouses category for May, so mom is eligible for Transitional Medicaid Benefits beginning May.

Note: Dad is NOT eligible for Transitional Medicaid Benefits because he was not covered under the Parent Caretaker relative and their spouses category in the month coverage under the Parent Caretaker relative and their spouses category ended.

Children who no longer meet the age requirements are not eligible for Transitional Medicaid Benefits.

If a Transitional Medicaid Benefits case closes for loss of state residency and the household returns to the state and reapplies while still in the twelve-month period, eligibility may be re-established for the remainder of the Transitional period.

Refer to Section 510-03-85-40 for the Transitional Medicaid Benefits income level.