IM-59 04/24/03 CONTINUATION OF CHILDREN'S ELIGIBLITY ON SUSPENDED TMA CASES
|CONTINUATION OF CHILDREN'S ELIGIBLITY ON SUSPENDED TMA CASES|
|Systems work has now been completed to
allow children active on a TMA case to continue eligibility under the TMA
case when caretakers (age 19 and over) are suspended for failure to comply
with quarterly reporting. The individual status of the adult caretaker(s)
will change to suspended, "S" level of care with a "S" (suspended) in field
13g2, effective the first of the following month. The case will remain
active in the system as a TMA case and the children will continue to be
shown as a "T" level of care. As a result of this change, there will
no longer be any suspended TMA cases, only individuals suspended on active
TMA cases. Staff should use their Transitional Medicaid Report Listing
(FIX55303) to monitor those cases where adults will suspend. Continue
to review these cases to evaluate continued eligibility for MC+/Medicaid.
There is no longer an advantage to having the children on a separate MC+ case since programming has been completed to keep the children from closing (IM-170 12/16/02) or suspending when the parents lose eligibility for TMA.
If the recipient contacts DFS claiming "good cause" for not returning a quarterly report on time we should allow whenever possible.
If allowing "good cause" after the adults have been suspended, TMA eligibility should be restored back to the date of suspension. To do this, make the following entries:
Case Action 35
For the suspended individuals, make the following entries:
Enter date back to date of suspension
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 updating
to suspended status and there is another quarter before they exhaust their
eligibility, send the family a quarterly report form.