Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 477 - MEDICAID ELIGIBILITY
Chapter 27 - ELIGIBILITY FOR THE AGED, BLIND, AND DISABLED; MEDICALLY NEEDY; QUALIFIED DISABLED WORKING INDIVIDUALS; MEDICAID INSURANCE FOR THE WORKERS WITH DISABILITIES; BREAST AND CERVICAL CANCER; EMERGENCY MEDICAL SERVICES ASSISTANCE; AND KATIE BECKETT
Section 477-27-008 - TRANSITIONAL MEDICAL ASSISTANCE (TMA)

Universal Citation: 477 NE Admin Rules and Regs ch 27 § 008

Current through September 17, 2024

008.01 TRANSITIONAL MEDICAL ASSISTANCE (TMA) ELIGIBILITY. A household may receive up to 12 months of Transitional Medical Assistance (TMA) if the parent or caretaker relative:

(1) Is in the household;

(2) Has earned income that results in ineligibility for Medicaid as a parent or caretaker relative using modified adjusted gross income (MAGI) methodology; and

(3) Is employed.

008.01(A) PRIOR ELIGIBILITY REQUIREMENT. The parent or caretaker relative must have received, or met income and resource eligibility to receive, a grant or Medicaid for which the individual was eligible in three of the last six months preceding ineligibility.

008.01(B) FRAUD EXCLUSION. The household is ineligible for Transitional Medical Assistance (TMA) if it received Medicaid as a parent or caretaker relative using modified adjusted gross income (MAGI) methodology in one or more of the three qualifying months as a result of convicted fraud during the last six months before the beginning of the transitional period.

008.01(C) EFFECTIVE DATE. Transitional medical assistance (TMA) begins with the month of ineligibility for Medicaid as a parent or caretaker relative.

008.02 RESOURCES. There is no resource test while the household is receiving Transitional Medical Assistance (TMA).

008.03 SANCTIONS. A parent who has been sanctioned for noncooperation with child support or third-party liability (TPL) provisions is not eligible for Transitional Medical Assistance (TMA) until cooperation is resolved.

008.04 CHANGES IN HOUSEHOLD COMPOSITION. When an individual is added, returns, or leaves a household, eligibility is impacted according to the provisions below.

008.04(A) INDIVIDUAL RETURNS OR IS ADDED TO THE HOUSEHOLD. When an individual returns or is added to the household, eligibility must be reassessed for the entire household.

(i) If the individual is a responsible relative, their income must be used when reassessing eligibility, regardless of whether this individual requests Medicaid coverage;

(ii) If the individual is a parent included in the tax household of the parent eligible for Transitional Medical Assistance (TMA), and the household remains ineligible for Medicaid as a parent or caretaker relative based on modified adjusted gross income (MAGI) methodology, this individual is added to the Transitional Medical Assistance (TMA) household; or

(iii) If the individual is a child included in the tax household of the parent eligible for Transitional Medical Assistance (TMA), the child is added to the Transitional Medical Assistance (TMA) cycle of that parent.

008.04(A)(1) APPLICATION REQUIREMENT. An individual who returns or is added to the household must submit an application for Medicaid if the individual has been ineligible for more than 90 days and requests Medicaid coverage.

008.04(B) FAMILY MEMBER LEAVES THE HOUSEHOLD. If a family member leaves the home, Medicaid eligibility for the remaining household members must be reassessed.

(i) If a parent or caretaker relative leaves the household, and the remaining parent or caretaker relative continues to be ineligible as a parent or caretaker relative using modified adjusted gross income (MAGI) methodology, the Transitional Medical Assistance cycle continues;

(ii) If the only dependent child leaves the household, the entire household loses eligibility for Transitional Medical Assistance (TMA); or

(iii) If the only dependent child no longer meets the age qualification, the entire household loses eligibility for Transitional Medical Assistance (TMA).

008.05 BREAKS IN THE TRANSITIONAL MEDICAL ASSISTANCE (TMA) CYCLE. A change in circumstances may or may not restart the Transitional Medical Assistance (TMA) eligibility cycle.

008.05(A) If a temporary reduction or loss of income results in eligibility as a parent or caretaker relative using modified adjusted gross income (MAGI) methodology, but eligibility in that category is lost within one or two months due to income, then the original Transitional Medical Assistance (TMA) cycle continues.

008.05(B) If the Transitional Medical Assistance (TMA) case is closed for any reason, then reopened within 90 days of closure, and eligibility for Transitional Medical Assistance (TMA) continues, the original Transitional Medical Assistance (TMA) cycle resumes.

008.05(C) A new Transitional Medical Assistance (TMA) cycle begins if an individual receives Medicaid as a parent or caretaker relative using modified adjusted gross income (MAGI) methodology for three or more months, then loses eligibility in that category because of income.

008.06 CLOSING TRANSITIONAL MEDICAL ASSISTANCE (TMA). Before closing a Transitional Medical Assistance (TMA) case for any reason, it must first be determined if the individuals in the household are eligible for another Medicaid program.

008.07 TRANSITIONAL MEDICAL ASSISTANCE (TMA) TIMELINE. The transitional medical assistance (TMA) program follows a defined timeline. Eligibility and cost sharing may change throughout the timeline in accordance with the provisions below.

008.07(A) MONTHS ONE THROUGH SIX. Eligibility for months one through six are subject to the following provisions.

008.07(A)(i) INCOME. Individuals in the first six months of Transitional Medical Assistance (TMA) coverage are exempt from income tests.

008.07(A)(ii) REPORT REQUIREMENT. The gross monthly earnings and child care costs for employment, as billed or paid, for each of the first three months of the transitional period must be verified. The first report or verification is due no later than the 21st of the fourth month.

008.07(A)(iii) CAUSES FOR CLOSURE. The household becomes ineligible for Transitional Medical Assistance (TMA) during the first six-month period if any of the following occur:

(1) The household becomes eligible for Medicaid as a parent or caretaker relative using modified adjusted gross income (MAGI) methodology;

(2) The household moves out of the state; or

(3) There is no longer an eligible dependent child in the household.

008.07(B) MONTHS SEVEN THROUGH TWELVE. If the household has earned income and child care deductions for employment that are equal to or less than 185% of the Federal Poverty Level (FPL), it is eligible for transitional medical assistance (TMA).

008.07(B)(i) REPORT REQUIREMENT. The gross monthly earnings and child care costs for employment, as billed or paid, for months seven through 12 must be verified. The second report or verifications of income and child care are due no later than the 21st of the seventh month. The third report or verifications of income or child care are due no later than the 21st of the tenth month.

008.07(B)(ii) INCOME ELIGIBILITY. The household's earned income less any child care costs for employment, as billed or paid, for the three-month report period is averaged to determine income eligibility.

008.07(B)(iii) PREMIUM DUE. Beginning with month seven, the household is subject to payment of a monthly premium if its countable income is between 100% and 185% of the Federal Poverty Level (FPL). Failure to pay the required premium by the 21st of the following month will result in ineligibility for the month for which the premium was owed.

008.07(B)(iv) CAUSES FOR CLOSURE. The household is ineligible for the remaining months of Transitional Medical Assistance (TMA) if it:

(1) Fails, without good cause, to submit required verification of earnings and child care costs for employment;

(2) No longer includes a dependent child;

(3) Has gross monthly earnings and child care deductions for employment in excess of 185% of the Federal Poverty Level (FPL) during the preceding three-month period;

(4) The household moves out of the state; or

(5) An adult in the household regains eligible as a parent or caretaker relative using modified adjusted gross income methodology.

008.07(B)(iv)(a) GOOD CAUSE. Good cause for failing to submit the required program information exists when any of the following occur:

(i) Death of the parent or caretaker relative;

(ii) Verified hospitalization of a household member during the scheduled receipt period for required information; or

(iii) Natural disaster as determined by the Department.

008.07(C) AFTER MONTH 12. Eligibility for another Medicaid program will be determined at the end of the Transitional Medical Assistance (TMA) cycle.

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