Rule 67:46:13 TRANSITIONAL MEDICAL BENEFITS

CHAPTER 67:46:13

TRANSITIONAL MEDICAL BENEFITS

Section

67:46:13:01 Definitions.

67:46:13:02 Initial eligibility for transitional medical benefits.

67:46:13:03 TMB limited to 12 consecutive months.

67:46:13:04 Continuing eligibility for TMB.

67:46:13:05 to 67:46:13:10 Repealed.

67:46:13:11 Ineligibility for fraud.

67:46:13:01. Definitions. Terms used in this chapter mean:

(1) "Parent/caretaker relative," a Medicaid coverage group consisting of low income families eligible for Medicaid under the provisions of chapter 67:46:12; and

(2) "TMB" or "transitional medical benefits," continued medical coverage immediately following ineligibility for parent/caretaker relative Medicaid.

Source: 24 SDR 24, effective August 31, 1997; 36 SDR 215, effective July 1, 2010; 41 SDR 7, effective July 29, 2014.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

Cross-Reference: Medicaid eligibility -- Parent/caretaker relative, § 67:46:12:02.

67:46:13:02. Initial eligibility for transitional medical benefits. An individual that becomes ineligible for parent/caretaker relative Medicaid and any dependent child in the parent/caretaker relative's household is eligible for TMB if the following conditions exist:

(1) The individual was receiving Medicaid under the provisions of chapter 67:46:12 in the immediately preceding month but became prospectively ineligible because the parent/caretaker relative had increased income from employment; and

(2) The individual received Medicaid under the provisions of chapter 67:46:12 in any 3 or more months during the 6-month period immediately before the month in which the parent/caretaker relative became ineligible.

Source: 24 SDR 24, effective August 31, 1997; 36 SDR 215, effective July 1, 2010; 41 SDR 7, effective July 29, 2014.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

67:46:13:03. TMB limited to 12 consecutive months. Transitional medical benefits may begin the first month the parent/caretaker relative is ineligible for Medicaid under the provisions of chapter 67:46:12 and is limited to the 12 consecutive months immediately following ineligibility for Medicaid.

Source: 24 SDR 24, effective August 31, 1997; 36 SDR 215, effective July 1, 2010; 41 SDR 7, effective July 29, 2014.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

67:46:13:04. Continuing eligibility for TMB. Eligibility for TMB continues for 12 consecutive months if the family continues to reside in the state and a dependent child who was a member of the family at the time the family was determined first eligible for TMB continues to live with the family.

Source: 24 SDR 24, effective August 31, 1997; 36 SDR 215, effective July 1, 2010; 41 SDR 7, effective July 29, 2014.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.

Cross-Reference: Definitions, § 67:46:12:01.

67:46:13:05. TMB eligibility during second six months. Repealed.

Source: 24 SDR 24, effective August 31, 1997; repealed, 36 SDR 215, effective July 1, 2010.

67:46:13:06. Report forms required -- Ineligibility for delayed or incomplete reports. Repealed.

Source: 24 SDR 24, effective August 31, 1997; repealed, 36 SDR 215, effective July 1, 2010.

67:46:13:07. Good cause for filing late or incomplete report form. Repealed.

Source: 24 SDR 24, effective August 31, 1997; repealed, 36 SDR 215, effective July 1, 2010.

67:46:13:08. Determination of family's average monthly gross-earnings. -- TMB. Repealed.

Source: 24 SDR 24, effective August 31, 1997; repealed, 36 SDR 215, effective July 1, 2010.

67:46:13:09. Determining family's child care costs for TMB. Repealed.

Source: 24 SDR 24, effective August 31, 1997; repealed, 36 SDR 215, effective July 1, 2010.

67:46:13:10. Determining family size -- TMB. Repealed.

Source: 24 SDR 24, effective August 31, 1997; repealed, 36 SDR 215, effective July 1, 2010.

67:46:13:11. Ineligibility for fraud. If a court of law finds that a member of a Medicaid household committed fraud resulting in mistaken eligibility for Medicaid for one of the six months preceding the current period of Medicaid ineligibility, all members of the Medicaid household in which the fraud was committed are ineligible for continued medical coverage under this chapter.

Source: 24 SDR 24, effective August 31, 1997; 41 SDR 7, effective July 29, 2014.

General Authority: SDCL 28-6-1.

Law Implemented: SDCL 28-6-1.