M E M O R A N D U M

IM-59  04/24/03  CONTINUATION OF CHILDREN'S ELIGIBLITY ON SUSPENDED TMA CASES


SUBJECT:
CONTINUATION OF CHILDREN'S ELIGIBLITY ON SUSPENDED TMA CASES
DISCUSSION:
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.

GOOD CAUSE:

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:

Field 5:                    Case Action 35
Field 32:                  Reenter date the TMA should end
Field 38a:                Enter the appropriate quarterly report code
Field 33, 34, 35:     Enter the appropriate budget

For the suspended individuals, make the following entries:

Field 13e,       Enter date back to date of suspension 
Field 13g,       Enter level of care "T" 
Field 13g2,     Enter "T" for no sanction 

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.
 
NECESSARY ACTION:
  • Review this memorandum with appropriate staff.
CSW
Distribution #6
IM-58
[ 2003 Memorandums ]
IM-60