All Medicaid Programs |
Obsolete Policy |
Policy Effective Jan. 1, 2014 - August 31, 2014
Contact DWS Program Specialist for previous policy
Eligibility for 4 Month Extended Coverage
Four months of extended Medicaid is available to the following individuals who would otherwise lose eligibility due to a change in spousal support income, earned income or increased work hours.
A parent/caretaker relative who has received PCR coverage in 3 of the last 6 months;
A pregnant woman whose income does not exceed the PCR income limit in 3 of the last 6 months; however, if there are no other children besides the unborn, the 3 months must occur during the 3rd trimester and post-partum period; and
Any dependent child in the household who would lose eligibility under the MAGI-based Child Medicaid program due to the increase in income.
Increased Spousal Support Income
Provide extended Medicaid for 4 months when a parent or caretaker relative, or eligible pregnant woman, has an increase in spousal support income. An increase in child support will not cause Medicaid to close because child support is not counted as income under the MAGI-based income rules.
Earned Income
If the 12 month Transitional Medicaid program is not continued beyond 2013, provide extended Medicaid for 4 months when:
A parent or caretaker relative, or eligible pregnant woman, has an increase in earned income that causes the parent or caretaker relative, or pregnant woman, to exceed the PCR income limit, or
A 2-parent household has an increase in earned income that causes them to lose PCR eligibility, or an increase in hours of employment resulting in a loss of deprivation.
If Congress approves a continuation of 12-Month Transitional Medicaid beyond 2013, the 12 month Transitional Medicaid takes precedence over the 4-month Medicaid when earned income or work hours increase.
Multiple changes
When other changes occur during the same month as the increase in the spousal support or earned income or work hours increase, the household may qualify for 4 Month Extended Medicaid if the increase in the income or work hours played a role in the household losing eligibility for PCR Medicaid.
Other Requirements
The household must continue to meet Utah residency requirements and there must be at least one dependent child in the home.
Any other changes in household circumstances do not affect eligibility during the 4 months of extended coverage.
Include the following individuals in the 4-Month Program.
The parent or caretaker relative in the coverage
The spouse of the parent or caretaker relative
The dependent children of the parent or parents, who live with the parent or are temporarily absent
The dependent children who qualified the non-parent caretaker relative for PCR Medicaid, and who live with the caretaker relative or are temporarily absent
Any child born into the household during the 4-month Medicaid, unless the infant qualifies for the deemed newborn coverage group
There is no deprivation requirement during the 4-month extended Medicaid. If an absent parent returns to the home, add the absent parent to the coverage.
There is no asset test.
When to Begin 4 Month Extended Medicaid
4 Month Extended Medicaid begins with the month following the month of the PCR Medicaid closure. If the household receives an extra month of PCR Medicaid because of the 10 day notice requirement, count that month as the first month of 4 Month Extended Medicaid.
Changes
Close the case if the household moves out of state. The household may receive Medicaid for any of months left in the initial 4 month period if the household returns to the state of Utah before the end of the four months.
Close the case if there is no longer a dependent child residing in the household.
A new household member moves in or a new baby is born:
Add the new household member to the 4 Month Extended Medicaid if that person is a spouse of the parent or caretaker relative, or a dependent child who fails the income test for the MAGI-based Child Medicaid program.
If a household member moves out, remove the household member from 4 Month Extended Medicaid unless the absence is only temporary.
If a child who is eligible for the MAGI-based Child Medicaid program will lose such eligibility due to a subsequent change in household income, move the child to the extended Medicaid for any remaining months of the extended coverage.