M E M O R A N D U M

IM-99  08/02/02 WHITE VS MARTIN COURT CASE


SUBJECT:
WHITE VS MARTIN COURT CASE
 
DISCUSSION:
A Temporary Restraining Order has been issued in the White Vs Martin court case.  The Division of Family Services has been directed to provide Transitional Medical Assistance (TMA) to those parents with earnings closed effective July 1, 2002 due to income exceeding the new Medical Assistance for Families (MAF) income limit of 77% established by House Bill 1111, if the family had received MAF for at least three of the six months prior to termination.

Information Services and Technology Division (ISTD) used the following criteria to identify cases for reinstatement to TMA:

    • Parents (age 19 and over) who lost eligibility for MAF because of the income limit reduction to 77% FPL,
    • IMU5 is coded as having earned income,
    • Received MAF three of the last six months, and
    • Eligibility has not been established elsewhere.
During the weekend of August 3, 2002 ISTD will change cases that meet the above criteria to TMA and reinstate the parents effective July 1, 2002.   Children on the cases will change from level of care Q to T.  Parents on these cases, residing in a managed care area, will not be enrolled in managed care health plans at this time.  The parents must obtain care through fee-for-service providers until a final Court decision is made.  If the Court determines DFS was required to provide TMA, they will enter the managed care enrollment process at that time.   Children on these cases, who are currently enrolled in managed, will not have a change in enrollment.  A letter is being sent to the parents advising them of the reinstatement of their eligibility to TMA.  (See attached)   Coverage for the parent(s) will continue pending further action by the Court.  If the Court finds that the Division of Family Services was not required to provide TMA, the recipients will be notified of the date coverage will terminate.   Otherwise, if the family meets the requirements of the TMA program, the coverage will continue through June 30, 2003.

ISTD has also identified the parents who lost eligibility for MAF because of HB 1111 who did not have a code for earned income in the IMU5 system or did not meet the three of six month requirements.   These parents will receive a letter advising of their ineligibility for TMA.  This letter will afford them the opportunity to contact DFS if information on file incorrect.  If contacted by the recipient, evaluate eligibility for TMA by determining if they did have earned income and received three of the last six months.  If so, reinstate the parent(s) to MAF and switch to TMA.  Make a copy of the reinstatement notice referenced above to notify the recipient of the TMA approval.  Notify the IM Program and Policy Unit of cases switched manually to TMA as a result of White Vs Martin by emailing WILEDHH.  If they did not qualify for TMA, a notice of denial should be sent.  This allows the individual appeal rights.  Follow normal hearing procedures.

If a MAF case scheduled for closing June 30, 2002  remained active after July 1, 2002 because of the hearing process or a pre-closing review, staff must manually process the switch to TMA if there was earned income and the family received MAF three of the last six months.  To do this, the family must be entered for MAF eligibility.  The following day take action to switch to TMA with TMA eligibility effective July 1, 2002.  Make a copy of the reinstatement letter to notify the recipient of the approval for TMA.  Notify the IM Program and Policy Unit of cases switched manually to TMA as a result of White Vs Martin by emailing WILEDHH. 

REIMBURSEMENT OF MEDICAL EXPENSES:

If the recipient paid for covered medical expenses during July 1, 2002 through August 6, 2002, they may be reimbursed.  Inquiries about reimbursement should be directed to Recipient Services at 1-800-392-2161.
 
NECESSARY ACTION:
  • Review this memorandum with appropriate staff.
CSW
Distribution #6
Attachments
TMA Reinstatement (Letter 1)
TMA Ineligibility (Letter 2)
IM-98
[ 2002 Memorandums ]
IM-100