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

MONTH 7 - March; 7th month of TMA; the 2nd QRF is due by the 10th. Use income from months 4, 5, and 6 to calculate budgets for months 8, 9 & 10.

2nd quarter's report of earnings received

2nd quarter's report NOT received Compute budget (income/child care costs) CLOSE CASE FOR MONTH 8 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 second quarter's earnings are received within 90 days of the closure date, the closure is lifted and TMA continues. ______________________________________________________________________ MONTH 8 - April; 8th month of TMA. No action necessary.

Note: If the second quarter's earnings are received within 90 days of the closure date, the closure is lifted and TMA continues. ______________________________________________________________________ MONTH 9 - May; 9th month of TMA; the 3rd QRF is mailed to the client at the end of this month, and is due by 10th day of month 10. ______________________________________________________________________ MONTH 10 - June; 10th month of TMA; the 3rd QRF is due by the 10th. Use income from months 7, 8, & 9 to calculate budgets for months 11 and 12. If the income verification is not received, benefits should be closed for month 11. ______________________________________________________________________ MONTH 11 - July; 11th month of TMA. No action necessary.

NOTE: If the third quarter's earnings are received within 90 days of the closure date, the closure is lifted and TMA continues. TMA should not continue past month 12.

Good Cause for Failing to Submit Information Required from the QRF: For later QRF reporting due to a client claiming good cause please send the case to Central Office for review. 477 NAC 27-006.07B4a ______________________________________________________________________ MONTH 12 - August; 12th month of TMA. At the end of month 12, the TMA case needs to be closed. Determine if a renewal form was sent to the client and what action is needed. Eligibility for Medicaid (but not TMA) shall be determined for all family members. The family cannot receive TMA again until they can meet the "3 out of 6" test again.

Note: Anytime TMA is terminated due to failure to provide verification of income or if the income is in excess of 185% FPL, the children and any medically needy individual must be reviewed for continuous eligibility and eligibility under other programs if all requirements are met (i.e. a current application/renewal form and income are on file, etc.)