Page 100

MRG UPDATED: JANUARY 2012 98 CATEGORICAL FACTORS MEDICAID EXTENSIONS/CONTINUATIONS TRANSITIONAL MEDICAID (TMA) Interpretation: The TMA extension is for twelve (12) full months. If the recipient is entitled to TMA, the twelve months of TMA begins the first of the month immediately following the month in which the recipient lost eligibility under LIF in either a Temporary Assistance or Medicaid case. However, if the recipient becomes ineligible for Medicaid under LIF at the end of the month and, because of the ten-day notice requirement, his/her case is closed during the first ten (10) days of the following month, the twelve (12) month TMA extension begins the first day of the month in which the notice period ends. NOTE: Eligibility is not evaluated under FHPlus, Medically Needy or expanded levels until the twelve month authorization period has ended. Generally, there are only three (3) reasons for terminating the TMA extension prior to the end of the full twelve (12) months: (1) There is no longer a dependent child in the household. For TMA purposes, a dependent child is a person under the age of 21 who is living with his/her parent/caretaker relative. This child may or may not be an active member of the Temporary Assistance or Medicaid case. This also includes children temporarily living outside of their home; or (2) A court of law has found that the person received social services benefits fraudulently; or (3) The family no longer resides in New York State. Disposition: When terminating TMA because there is no longer a dependent child in the household, a timely and adequate notice is sent. (See OTHER ELIGIBILITY REQUIREMENTS DECISION AND NOTIFICATION DISCONTINUANCE OR REDUCTION TIMELY NOTICE) If the end of the notice period occurs during the month in which the local district learned that the dependent child is no longer in the household, TMA is terminated at the end of that month. If the notice period extends into the following month, TMA is discontinued at the end of the notice period. The availability of third party health insurance (TPHI) coverage is pursued. Enrollment in employer group health insurance is not a condition of eligibility for TMA. However, if a TMA recipient is enrolled