Medicaid Policy                                                                 

721-4 Time and Age Limited Programs 

Effective Date: January 1, 2025

Previous Policy

 

1. Coverage under the following coverage groups ends at a certain age, or after a certain period of time:

1. 1. Time limited:

1. 1. 1. Pregnant Woman (349).

1. 1. 2. 12 Month Transitional Medicaid (343).

• • • • See section (343-5) if coverage on 12 month Transitional Medicaid is ending prior to exhausting the time limit.

1. 1. 3. Family 4 Month Extended Medicaid (343).

• • • • See section (343-1) if coverage on 4 month Transitional Medicaid is ending prior to exhausting the time limit.

1. 1. 4. Refugee Medical Assistance (394).

1. 2. Age limited:

1. 1. 1. Child Under Age 1 (347).

1. 1. 2. Child 0-5 (347).

1. 1. 3. Child 6-18 (347).

1. 1. 4. Adult Expansion Medicaid (348).

1. 1. 5. Targeted Adult Medicaid (346).

1. 1. 6. Foster Care Medicaid (354).

1. 1. 7. Independent Living Foster Care (354-4).

1. 1. 8. Former Foster Care Individuals (354-3).

1. 1. 9. Subsidized Adoption Medicaid (355)

1. 1. 10. Medicaid Cancer Program (390)

1. 1. 11. Medically Complex Children Waiver (382)

1. 1. 12. UPP (1000)

2. When coverage under one of these programs is ending consider eligibility for other programs for those individuals prior to terminating their coverage (827).

3. When coverage is ending due to the time limit, consider eligibility for other programs following these guidelines:

1. 1. Attempt the Ex Parte review process (721-1).

1. 2. If unable to complete the ex parte review, a member participation review is required as outlined in (721-2).

1. 3. If a due process month is needed, follow (811-1).

4. When the member ages off a program during the review month for an age limited program, consider eligibility for other programs following these guidelines:

1. 1. Complete the ex parte review process (721-1).

1. 2. If unable to complete the ex parte review, a member participation review is required as outlined in (721-2). 

1. 3. If a due process month is required, follow 811-1.

1. 4. If the member is turning 19 and now needs to apply on their own behalf per 703-3, follow the steps in 6 listed below.

1. 1. 1. Exception: If the member is a Blind or Disabled recipient follow the steps in 6 listed below when the member is turning 18.

5. When the member ages off a program prior to the review month for an age limited program, consider eligibility for other programs following these guidelines:

1. 1. In order to make an eligibility determination for a new program, factors of eligibility that are required under a new program that were not addressed under their current program will need to be addressed.

1. 2. The agency must limit any requests for additional information from the member to those previously unaddressed factors.

1. 3. A due process month will need to be issued if ongoing eligibility is not determined with sufficient time to give proper notice. See 811-1.

1. 4. If the member is turning 19 and now needs to apply on their own behalf per 703-3, follow the steps in 6 listed below.

1. 1. 1. Exception: If the member is a Blind or Disabled recipient follow the steps in 6 listed below when the member is turning 18

6. When moving members who are described in 4d or 5d above, the agency will need to complete the following:

1. Using the parent or guardian signature, create a new case,

2. Request a new signature page (731), and

3. Address all factors of eligibility for the member,

4. Narrate where the parent or guardian signature can be found.

5. If a due process month is required, follow 811-1.