Medicaid Policy                                                                 

343 4 Month Extended and 12 Month Transitional Medicaid

Effective Date: January 1, 2025

 

Previous Policy

Resource - Household Summary for Family Related Medicaid Programs

 

A. Extended Coverage 

Medicaid provides extended Medicaid coverage for families who:

o   Have been determined eligible for and received Medicaid,

o   Met the PCR income criteria, and

o   Then lose that coverage due to certain changes.

A pregnant member who meets the criteria for PCR coverage can also receive extended Medicaid.

Children should  be moved to the 4 Month Extended or 12 Month Transitional Medicaid only if:

• It Is the end of their certification period, and
• The child(ren) are no longer eligible for Child Medicaid, and
• The parent(s) remain eligible for transitional coverage.  

If the children are on the CHIP program, the parent will have to request that the children move to the 4 Month Extended or the 12 Month Transitional program with the parents. If the parents do not request the Medicaid program for the children at that time, they can move with the parents at the end of the CHIP certification period.

 

B. 4-Month Extended Medicaid

A parent, caretaker relative or eligible pregnant woman, and the dependent children living with the parent can receive 4 months of extended Medicaid when the parent or caretaker relative becomes ineligible for MAGI-based Parent/Caretaker Relative coverage as a result of spousal support payments.  (See 343-1.)

 

C. 12-Month Transitional Medicaid

12 Month Transitional is a program that allows eligible households to receive up to 12 months of Medicaid after the parent or caretaker relative loses eligibility for MAGI-based Parent/Caretaker Relative coverage because of the parent's or caretaker relative's earnings or employment hours.  (See 343-2.)

 

D. When Multiple Changes Cause PCR to Close

When a household has multiple changes during the same month, such as an increase in earnings and spousal support or a household change, determine which change is the causal factor that makes the family ineligible for the PCR program.

Use the following process to determine eligibility for extended benefits, if any.

1. If a person leaves or enters the household in the same month that income increases, make the change to the household size without making the income change. If the household is still PCR eligible with the new household size, take action on the increase in income as follows:
   1. If the increase was in spousal support and the parent had no earned income, the household is eligible for the 4 Month Extended program.
   2. If the increase was in spousal support, and the parent had existing earned income,
      1. Disregard all the earned income while comparing the increased spousal support to the income limit for the household size. If the household fails PCR with the spousal support alone, the household is eligible for the 4 Month Extended program. Add the earned income back to the case.
      2. If the increased spousal support alone does not fail PCR, add in the earned income. If the household now fails, the household is eligible for the 12 Month Transitional program.
   3. If the parent's earned income increased and the parent had no spousal support, the household is eligible for the 12 Month Transitional program.
   4. If the parent had an increase of both the spousal support and earned income, the household will be eligible for the 12 Month Transitional program.
   5. If the change to the income does not cause the PCR to fail, make the changes and continue with PCR coverage.
2. A change in the income without a change in the household size will follow the same steps as outlined above.
3. A change in household size will follow the policy outlined in 815-4.

 

Example 1:

Mrs. Smith was approved for and received PCR for the past three months. Her household consists of herself and her two children. She had an increase in earned income and spousal support in the same month.  

 

Mrs. Smith would qualify for 12 Month Transitional.

 

Example 2:

Carrie is receiving PCR for herself. She has three children. Carrie reported that her oldest child left home to live with his father. In the same month, she reported that her spousal support payments from her ex-husband increased from $650 to $850 per month. Before counting the increased support, we remove the child from the household and determine that with $650 in spousal support, Carrie is still eligible for PCR. When comparing $850 in spousal support to the PCR income limit of 3, Carrie is now ineligible; she will qualify for the 4 Month Extended program.

 

Example 3:

Bonnie has received PCR for the last six months. She has two dependent children.  Her part-time job pays her $500 per month. The absent parent pays $100 per month in spousal support.  In December, Bonnie reports that the spousal support will increase to $400. The spousal support alone does not make Bonnie ineligible for PCR.  When the earned income is included, she fails PCR. She will be eligible for the 12 Month Transitional program.