M E M O R A N D U M

IM-173  12/04/00  TRANS. MED. ASSIST. QTRLY REPORTS F.M.R. #40


SUBJECT:
TRANSITIONAL MEDICAL ASSISTANCE QUARTERLY REPORTS AND INFORMATION SHEET 

FORMS MANUAL REVISION #40:IM-55A, B, C, AND IM-4TM
 
DISCUSSION:
The Transitional Medical Assistance (TMA) quarterly reports (IM-55A, IM-55B and IM-55C) and the TMA Information Sheet (IM-4TM) have been revised.  The forms have been simplified and shortened.  Information about Transitional Childcare has been removed from the IM-4TM (formerly the IM-4TM/TC).

Transitional Medical Assistance Quarterly Reports

The Quarterly Report forms no longer ask the recipient to list all income by pay period for the quarter.  The revised report asks only that they report the total earnings for each of the three months.  The instruction to supply earned income verification has been removed, as verification is not required for TMA.  The question about unearned income has been removed from the forms.  Questions about pregnancy, disability and blindness have been added to aid the worker in determining eligibility for other programs when TMA ends.

Transitional Medical Assistance Information Sheet

The Transitional Medical Assistance information sheet (IM-4TM) has been revised to explain to the recipient of MAF that they are eligible for TMA when the closing was due to employment, increased earned income and or loss of an earned income disregard.  The form must be included with the IM-33MAF when approving for TMA.  An initial supply of the revised IM-4TM form has been sent to the local offices.
 
NECESSARY ACTION:
  • Review this memorandum with appropriate staff.
  • File copy of the revised IM-55A, B, and C, with instructions in the Forms manual.
  • Copy the IM-55A, B, and C from the forms manual when the county office is initiating the form.
  • Begin using the new IM-4TM upon receipt.  Order additional supplies of IM-4TM from the warehouse.
  • Destroy all old versions of the IM-4TM/TC.
  • File the revised IM-4TM form in the Forms manual.
MJS
Distribution #2
Forms not available on-line, hard copy only
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