SUBJECT:
ELIMINATION OF THE EXTENDED TRANSITIONAL MEDICAL ASSISTANCE (ETMA) PROGRAM
FAMILY HEALTHCARE MANUAL REVISION #16: SECTIONS 0910.000.00, 0910.005.00, 0910.055.00 – 0910.055.55
DISCUSSION:
Missouri House Bill 11 (2005) eliminates the Extended Transitional Medical Assistance (ETMA) program effective July 1, 2005.
All active ETMA cases without children on the case will be closed by the system on June 25, 2005. If there are children on the case, it will be converted to a MC+ for Children case. MC+ healthcare coverage ends June 30, 2005 for the parents. Children on the case will become level of care Q effective July 1, 2005.
On June 8, 2005, an Adverse Action Notice (see attached letter) will be mailed to ETMA recipients informing them of their ineligibility for continued coverage. The Adverse Action Notice also informs the recipients that they may remain eligible for MC+ healthcare coverage if they are blind, disabled, pregnant, or if there has been a change in income. Ex-parte and hearing procedures must be followed as addressed later in this memorandum.
County offices will receive a report of all cases notified of the loss of ETMA eligibility and a copy of the actual notice sent to the family.
EX-PARTE REVIEW PROCEDURES:
When the report of cases with individuals losing ETMA eligibility is received, the caseworker must complete an ex-parte review.
If eligibility is not established in the ex-parte review, but the individual(s) responds to the Adverse Action Notice indicating a change in income or indicates potential eligibility for another category of Medicaid, the Medicaid/MC+ coverage for that particular individual must remain open pending a determination of eligibility based on the information. To continue Medicaid/MC+ coverage while eligibility for the other category is being explored, the individual will have to be approved in the category for which potential eligibility exists as all ETMA coverage will end on June 30, 2005. A signed application is not necessary. If two parents are active on the ETMA case and only one claims eligibility for another category of Medicaid, leave the parent without potential eligibility for another category of Medicaid on the ETMA case so his or her Medicaid will end June 30, 2005. Remove the parent who has potential eligibility for another category of Medicaid, close him/her on the ETMA case and approve in the category for which he or she may be eligible. If all parents on the ETMA case claim eligibility for another category, close the ETMA case and approve the individuals on the category of Medicaid for which potential eligibility exists. The individual must be removed from ETMA and approved for the Medicaid/MC+ category for which eligibility is being explored the same day in order to prevent any disruption in healthcare coverage.
If determined ineligible based on reported pregnancy, disability, blindness or change in income, send an Adverse Action Notice (IM-80) specifying the reason eligibility for MC+/Medicaid does not exist. Address the reason for the denial of the new category as well as the reason for loss of eligibility for ETMA. The reason for ETMA ineligibility is, “House Bill 11 (2005) has eliminated the ETMA program effective July 1, 2005.” The IM-80 also serves as the rejection notice for new Medicaid/MC+ category and provides notification of hearing rights for the Medicaid/MC+ case. After the IM-80 expires, and if a hearing is not requested, send an IM-33 stating the reason for the denial of the new category of Medicaid/MC+ and the reason for the loss of ETMA eligibility.
HEARING PROCEDURES:
Families have a right to appeal the individual’(s) loss of ETMA eligibility. The Adverse Action Notice gives them until June 20, 2005 to request a hearing. The notice informs the recipient of the date and time the hearing will be held. The hearings are scheduled for 8:30 a.m. and 1:00 p.m. on June 29, 2005. This allows the Hearing Unit to render a decision prior to July 1, 2005. The Application for State Hearing (IM-87) form must be faxed and mailed to the Hearing Unit on the date the request is made to ensure that hearings on these cases are held as soon as possible.
NOTE: All ETMA hearings will be due to the change in state law. Staff must clearly indicate this on the IM-87 form. If a recipient claims to remain eligible for any other reason, follow the
ex-parte procedures above.
NECESSARY ACTION:
- Review this memorandum with appropriate staff.
LH
ATTACHMENTS:
Advance Adverse Action Notice of ETMA Ineligibility
Closing Notice of ETMA