Family Healthcare (FAMIS)

0910.050.05 LOSS OF TMA ELIGIBILITY AFTER SIX MONTHS

An ex parte review should be completed to evaluate possible eligibility under other program.  The system will make the following changes to TMA cases losing eligibility for TMA for failure to complete the first quarterly report.

If the TMA case has children active on the case, the system will transfer the children (including parents under 19) currently active on a TMA case to MC+ when the adults lose eligibility for TMA.  The parent’s eligibility will change to “Z” (included) and the children will be shown as a “Q” level of care.  The system will change the case from a TMA case to a MC+ for Children case at payroll closing effective with the first of the following month.  Evaluate the children’s continued eligibility under the MC+ program.

If the TMA case reflects only adults on the case, the case will close.