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REV. MAY 3, 2018 NEBRASKA DEPARTMENT OF MEDICAID ELIGIBILITY MANUAL LETTER #43-2018 HEALTH AND HUMAN SERVICES 477-000-047

477-000-047 – Examples: Transitional Medical Assistance

If a family qualifies for TMA (Transitional Medical Assistance), they are entitled to the first six months of eligibility without regard to income. However, beginning with Month 7 the family is subject to an income test. The family loses TMA eligibility if the countable earned income is greater than 185% FPL for the appropriate household size.

The countable income is determined by averaging the gross monthly earned income and subtracting the cost of child care (including that amount paid by Child Care Assistance). No other disregards are allowed. Unearned income is not considered in TMA budgeting.

In order to determine the household’s income, earnings and child care costs from the QRF report period (each three months) of TMA are reported via a QRF (Quarterly Report Form). Income from the QRFs are used to determine whether the family is eligible for TMA beyond Month 6. Assuming that the QRF and income verification are provided, there are four possible outcomes:

1. The countable income from the QRF is less than 58% FPL and is reflective of the current employment situation. Review all individuals for MAGI eligibility.

2. The countable income from Months 1 through 3 is greater than 185% FPL and is reflective of the current employment situation, TMA eligibility does not exist beyond Month 6 and the TMA case should be closed allowing for timely and adequate notice. Eligibility for Medicaid should be explored.

3. The countable income is less than 100% FPL and all TMA unit members remain eligible for TMA without any premium.

4. The countable income falls between 100% and 185% FPL. The premium, may apply to all TMA unit members or only to the adult(s). Since TMA is considered non-MAGI, we will run the budgets with the children as non-filers to place them in a MAGI child program (if applicable) and the adults would remain in the TMA premium. If the children are not eligible for the MAGI child program then the whole unit would be included in the TMA premium. TMA premium amounts are found in 477-000-012. The household must be notified of their premium.

WHO PAYS THE PREMIUM? The TMA premium may be required only for the adult(s) in the family; it may also be required for the child(ren). This will depend on the income, family size, composition of the family, and ages of the children. Another factor that must be considered is whether the child(ren) are covered by creditable health insurance. If the children pass eligibility for Medicaid or CHIP, they would not have a premium.

If the parent(s) choose to have a share of cost (SOC) in lieu of the TMA premium, all eligibility factors for medically needy must be met. For example, a medical need, resources, a valid application.

Before approving a TMA premium, review each individual for continuous eligibility.

Note: Please do not close the TMA case if the client has not paid their premium. The client will not receive Medicaid services for that month if the premium is not paid.