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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 Assistance – Examples

TMA Example 1 Parent/caretaker relative (P/CR) Medicaid case becomes ineligible for Medicaid effective April due to increased earnings of the parent/caretaker relative. The unit has been eligible for Medicaid in 3 of the last 6 months preceding the month of ineligibility. The unit is eligible for the first 6 months of the 12 months of TMA.

TMA Example 2 P/CR Medicaid case becomes ineligible for Medicaid effective April due to increased earnings of the parent/caretaker relative. The unit has NOT been eligible to receive Medicaid in 3 of the last 6 months preceding the month of ineligibility. The unit is NOT eligible for TMA. A Medicaid budget would need to be computed to determine if medical eligibility exists for the unit. Review for continuous eligibility.

TMA Example 3 P/CR Medicaid case with no earned income becomes ineligible for Medicaid effective April due to increased collection of spousal support. Assuming the unit had received Medicaid in 3 of the last 6 months preceding the month of ineligibility. The unit is not eligible for TMA since the loss of Medicaid was not due to increased earnings. 477 NAC 27-006.01

TMA Example 4 In May, the Medicaid case is in its 2nd month of the 12 months of TMA. The unit consists of Dad, Mom and a child. The child turns 19 in May and graduates from high school. The unit no longer contains a dependent child. Ten day notice is given and the TMA case is closed effective 6/1. 477 NAC 27-006.04C

TMA Example 5 The unit consists of Mom and 2 children. They are in their 3rd month of the 12 months of TMA. Mom either marries or the father of the children moves back home. Dad is added to the TMA unit. Mom, Dad and the 2 children would remain eligible for at least the first 6 months of the 12 months of TMA. Dad is added to the unit and his income would have to be counted beginning with month 7 of TMA to determine if the unit is under 185% FPL. 477 NAC 27-006.04 through 27-006.04C

TMA Example 6 Same situation as Example 5, however, the unit is in the 8th month of the 12 months of TMA when Dad returns to the household. Again, Dad is added to the TMA unit and his income is considered when the three month average income is computed in month 10 to determine if the unit is over 185% FPL for months 11 and 12. Dad is also added to the FPL level. If the unit's income remains under 185% FPL, the family remains eligible for TMA. If the unit's income is over the 185% FPL, the case is closed the end of month 10 and the children's eligibility for Medicaid is determined. Review for continuous eligibility.

Note: You would already have received Mom's report of her 3 months earnings in month 10. You would look prospectively at Dad's income for months 11 and 12.