IM-170 12/16/02 TRANSITIONAL MEDICAL ASSISTANCE - WHITE VS. MARTIN
|TRANSITIONAL MEDICAL ASSISTANCE - WHITE VS. MARTIN|
|Those TMA cases established as a result
of White Vs Martin will have exhausted their first six (6) months of eligibility
on December 31, 2002. TMA eligibility will be ending December 31,
2002 for a number of these cases as the first completed quarterly report
has not been returned.
Systems work has been completed to transfer children currently active on a TMA case to MC+ if the adults lose eligibility for TMA. This applies to all TMA cases, including TMA cases established as a result of White Vs Martin. 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 the first of the following month. These cases are listed on report FIM31419 TMA Cases to Close issued monthly. Staff should continue to review these cases to evaluate continued eligibility for MC+/Medicaid programs.
A special notice is being sent to all TMA recipients who are losing eligibility for TMA at the end of the first six months (December 31, 2002) for failure to return a completed quarterly report.
If the recipient contacts DFS claiming "good cause" we should allow whenever possible.
If "good cause" is being allowed prior to December 20, 2002, staff would enter the "2" in field 38A. This will allow the case to continue as a TMA case.
If allowing "good cause" after the case has been transferred to MC+ for Children (December 20, 2002), TMA eligibility should be restored. It will be necessary to enter a transaction reinstating the parents and children to MAF (T lOC). The following day, enter the transaction to take back to TMA using the appropriate entries in field 32 and 38a. This should be done as quickly as possible to prevent any disruptions in healthcare coverage or enrollment in managed care whenever possible. If TMA eligibility is restored after December 20, 2002, send the family a quarterly report form for October through December.
If "good cause" is not claimed or not allowed, and the recipient contacts DFS by December 27, 2002 indicating possible eligibility due to disability, pregnancy, blindness or change in circumstances, we should restore the eligibility for TMA using the same procedures above, pending an eligibility determination under the appropriate category of assistance. If determined ineligible for the new category of assistance, take action to stop TMA eligibility for the individual and evaluate children's eligibility under MC+. The closing notice should also address the reason for rejection of the new category.
Note: If one of two parents indicates possible eligibility elsewhere, only reinstate the parent claiming other possible eligibility to the TMA case.