All Medicaid Programs |
Obsolete Policy |
Policy Effective March 1, 2015 - April 30, 2016
General Requirements
To be eligible for 12 Month Transitional the Parent/Caretaker Relative or eligible pregnant woman must have:
Been eligible for and received PCR Medicaid in 3 of the 6 months prior to the month in which they are no longer eligible for PCR Medicaid. The 3 months do not have to be consecutive. A pregnant woman must have met the criteria for PCR even though she is open on Pregnant Woman Medicaid.
AND
Lost eligibility for PCR Medicaid for one of the following reasons.
The earnings of a parent, caretaker relative or pregnant woman causes the countable income to exceed the limit for the PCR Medicaid.
The household loses deprivation because neither parent in a two-parent household is working less than 100 hours per month.
Once the household has been determined to be eligible for 12 Month Transitional, the household is eligible for 6 months of coverage.
The household must meet ALL of the following requirements to remain eligible for the full twelve months.
o The household must continue to include an age-eligible child.
The household must continue to meet Utah residency requirements.
The household must comply with the income reporting requirements. (See below)
A parent must have earnings in each of the three months in the 3 report periods or have good cause for no earnings. (343-3.)
The parent’s average gross earnings minus the average child care expenses for the second and third report periods must not exceed 185% FPL for the household size. (The child care expenses must be needed so that the parent can go to work.)
There is no asset limit for 12 Month Transitional.
Do not require medical support enforcement or TPL.
When to Start 12-Month Transitional Medicaid
Begin the 12 Month Transitional on the first day of the month for which the parent or caretaker relative is no longer eligible for the MAGI-based PCR Medicaid.
If the household does not report timely and the 10 day notice requirement causes a household to receive PCR Medicaid for a month or months when it is ineligible, that first ineligible month is the first month of 12 Month Transitional Medicaid. Determine if the household would have met the 3 out of the last 6 month requirement for 12 Month Transitional in the first month it would have been ineligible for PCR Medicaid.
Income Reporting Requirement
Households receiving 12 Month Transitional must report income and child care expenses at the end of the first, second and third quarters of the 12 month period.
First Report
A notice is sent to the household in the third month. The notice explains:
A parent must have earnings or good cause for no earnings in the first 3 months.
The household does not have to report if a parent had earnings in all 3 months.
The household must contact you by the 17th of the fourth month if a parent didn’t have earnings in one or more of the first 3 months.
The case remains open if:
The parent does not contact you,
OR
The parent contacts you and has good cause for no earnings. Document the good cause reason on the case. (343-3)
Close the case at the end of 6 months if:
The client reported that a parent didn’t have earnings in one or more of the first 3 months,
AND
There wasn’t good cause for no earnings (343-3).
Second Report
An income report is sent in the 6th month. The earnings are required to complete the report. The form itself is not required.
The household must verify all earnings and provide child care expenses for the 4th, 5th and 6th month by the 17th of the 7th month. If the client returns the report after the 17th of the month and before the last day of the report month, see 343-6.) The child care expenses are not required to complete the report (but the lack of these expenses may cause the case to close).
The case remains open if the information is complete and the household meets all of the eligibility requirements for the program. The case closes at the end of the report month if:
The household did not provide the information needed and the information was not otherwise available; OR
The parent did not have earnings and did not have good cause* in one or more of the 3 report months; OR
The household’s average gross earnings minus the average child care expenses for the 3 months exceeds 185% FPL for the household size.
Third Report
An income report is sent in the 9th month. The earnings are required to complete the report. The form itself is not required.
The household must verify all earnings and provide child care expenses for the 7th, 8th and 9th month by the 17th of the 10th month. If the client returns the report after the 17th of the month and before the last day of the report month, see 343-6. The child care expenses are not required to complete the report (but the lack of these expenses may cause the case to close).
The case remains open if the information is complete and the household meets all of the eligibility requirements for the program.
The case closes at the end of the report month if:
The household did not provide the information needed and the information was not otherwise available. OR
The parent did not have earnings and did not have good cause in one or more of the 3 report months. OR
The household’s average gross earnings minus the average child care expenses for the 3 months exceeds 185% FPL for the household size.
* 343-3 Good Cause For No Earnings
343-4 Good Cause For Late Report
343-6 Reopening a 12 Month Transitional Case