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

Transitional Medical Timeline

The Medicaid client calls to report that she has found a job. The budget is updated and the client fails Parent/Caretaker Relative group. The client has received Medicaid (without a Share of Cost) in three of the previous six months.

The client is determined ineligible due to earnings. Staff sends notice advising the client that Transitional Medical begins effective 9/2013. N-FOCUS sets the TMA Begin Date as 09/2013.

Note: While earnings (and cost of child care as appropriate) must be reported on a quarterly basis completion and/or return of the Quarterly Report Form (QRF) is NOT an eligibility requirement. The client may only provide the requested information required on the form or unless there is a change indicated, current income known to the agency can be used as the attested amount and compared with electronic data sources to budget for the corresponding QRF period.

The following is a “timeline” example illustrating TMA notice and reporting requirements: ______________________________________________________________________ MONTH 1 - September; 1st month of TMA. No action necessary. ______________________________________________________________________ MONTH 2 - October; 2nd month of TMA. No action necessary. ______________________________________________________________________ MONTH 3 - November; 3rd month of TMA; the first QRF is mailed to the client at the end of this month. The first Quarterly Report Form is due by the 10th day of month 4 (December). ______________________________________________________________________ MONTH 4 - December; 4th month of TMA; the first QRF is due by the 10th. No action is REQUIRED at this point if the QRF is not received timely. ______________________________________________________________________ MONTH 5 - January; 5th month of TMA. No action necessary. ______________________________________________________________________ MONTH 6 - February; 6th month of TMA; the 2nd QRF is mailed to the client at the end of this month. Use income from months 1, 2, & 3 to calculate the budget for month 7.

1st quarter's report of earnings received 1st quarter's report NOT received Compute budget (income/child care costs) CLOSE CASE FOR MONTH 7 Compare result to 185% FPL Case manager must send timely notice Income < 185% FPL Income > 185% FPL

TMA continues. Subject to premium if income exceeds 100% FPL. Determine eligibility for MED (must send timely notice).

Note: If the first quarter's earnings are received within 90 days of the closure date, the closure is lifted and TMA continues. ______________________________________________________________________