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

TMA Example 7 The unit consists of Mom and 2 children. They are in their 3rd month of the 12 months of TMA. Mom reports she is pregnant and the father of the unborn has moved in with her. The unborn is added to the unit size as an excluded sibling. Paternity cannot be established for an unborn. The alleged father of the unborn is not added to the unit size and his income would not be counted. Mom and the 2 children would remain in TMA. The alleged father would have no medical coverage unless he is age eligible or disabled and would be a unit size of 1.

TMA Example 8 The unit consists of Mom and 2 children. They are in their 8th month of the 12 months of TMA. One of the children becomes pregnant. Mom and the 2 children remain in TMA and the unborn is added to the unit size as an excluded sibling.

TMA Example 9 The unit consists of Dad, Mom, and 2 children. They are in their 7th month of the 12 months of TMA. Dad is determined disabled by SSA. If Dad would be eligible for ABD Medicaid OR if he is receiving SSI, he must be removed from the TMA unit and budgeted as ABD. If Dad would NOT be eligible for ABD Medicaid or is NOT receiving SSI, he would remain in the TMA unit.

Note: If Dad is eligible for an ABD Medicaid, but removing him from the TMA unit causes the TMA unit to be over the 185% FPL, eligibility for all household members is evaluated. Or, if removing him from the TMA unit to budget in an ABD program case results in a SOC, he can be added back into the TMA unit to eliminate his SOC.

TMA Example 10 The unit is in the 7th month of the 12 months of TMA. Mom reports an increase in her hourly wage that would put the unit over the 185% FPL. The budget would be computed in month 7 based on the new pay schedule to determine eligibility for months 8, 9, and 10.

TMA Example 11 The unit is in their 1st month of the 12 months of TMA. The case is closed at the end of the first month as the family moved to California. The family is only gone for 1 month and then moves back to Nebraska and reapplies for assistance. Mom is still working and the unit is not eligible for Medicaid because of earnings. The unit has been financially eligible to receive Medicaid in 3 of the last 6 months. They would be eligible for TMA, the original TMA cycle resumes.

TMA Example 12 The unit consists of Mom, 2 children ages 6 and 3, and an unborn. The unit is eligible for the first 6 months of TMA. They are not eligible for TMA beyond Month 6 because the earned income minus cost of child care exceeds 185% FPL. The TMA case is closed and a MED budget is run. Mom's eligibility is based on the Pregnant Women income standard for four, 194% FPL. If mom fails PW eligibility, she is continuously eligible through her post-partum eligibility. Eligibility of the three children, if uninsured, is based on the applicable income standard for each child.