343-5 Changes During the 12-Month Transitional Period

Effective Date: January 1, 2025

Previous Policy

Change in Household Members

Add a person to the 12-Month Transitional Medicaid when:

That person is the spouse of the parent or caretaker relative, or the dependent child of the parent, AND

The person meets Medicaid eligibility requirements such as citizenship and social security number. Example: You must add to the coverage children who are born or adopted into the household, the new spouse of a parent upon getting married, or family members who were absent from the household when MAGI-based Parent/Caretaker Medicaid (PCR) closed, but returned during the 12 month period.

The household must report the earned income for the new person at the next quarterly income report. (Do not count the new household member’s income until you get that report.)

Deprivation of support is not a factor when adding a new person to the household.

Remove a person from the 12-Month Transitional Medicaid when:

The person leaves the household and the absence is not temporary.

A child no longer meets the age requirement to qualify a parent or caretaker relative for PCR Medicaid.

When to Close 12-Month Transitional

Eligibiltiy for the 12-Month Transitional program ends in the following situations:

The person who leaves is the only age eligible dependent child.

The only child no longer meets the age requirement to qualify a parent or caretaker relative for the PCR Medicaid.

The household permanently moves out of state.

The parent or caretaker relative has received the initial 6 months of the 12-Month Transitional, is completing the second or third quarterly report, and

The person is eligible for PCR Medicaid again due to a decrease in income or an increase in household size, and

reports that the change will be ongoing.

Eligibility for 12-Month Transitional ends if the member fails to complete the quarterly report properly (See 343-2 ).

Complete an eligibility review at the end of the 12-Month Transitional period ( 721 ).

Before terminating coverage for members on 12-Month Transitional, for any reason, re-determine eligibility for other Medicaid programs for each household member ( 827 ).

All recipients who are losing coverage under this program will need to have all factors of eligibility addressed in order to determine ongoing eligibility. If the member is eligible for another program a new 12 month certification period will be given. Exception: Recipients who are pregnant or within their postpartum period cannot lose coverage prior to the end of the postpartum period and will continue their coverage on the Pregnant Woman program unless they are found eligible for a better program. The certification period for this member will end at the end of the postpartum period.

A due process month will need to be issued if ongoing eligibility is not determined with sufficient time to give proper notice. See 811-1