All Medicaid Programs |
Obsolete Policy |
Effective Date: March 1, 2021 - August 31, 2021
TAM uses the MAGI methodology to determine countable income and household size.
Coverage Groups
To be eligible for TAM, individuals must meet a subgroup criteria within one of the following coverage groups. The coverage groups, along with the subgroups are in order of hierarchy.
Chronically Homeless – Is an individual who:
has a diagnosable substance use disorder, serious mental illness, developmental disability, post-traumatic stress disorder, cognitive impairments resulting from a brain injury, or chronic illness or disability and who:
is living or residing in a place not meant for human habitation, in a safe haven, or an emergency shelter for at least 12 months, or on at least 4 separate occasions totaling at least 12 months in the last three years; or
is currently living in supportive housing and has previously met the criteria in section (i) above.
is living or residing in a place not meant for human habitation, a safe haven or in an emergency shelter for 6 months within a 12-month period, and has a diagnosable substance use disorder or serious mental illness; or
is a victim of domestic violence who is residing in a place not meant for human habitation, a safe haven or in an emergency shelter.
Justice Involved – Is an individual who is in need of substance use or mental health treatment and:
is currently involved in a drug or mental health court;
is court ordered to receive substance abuse or mental health treatment through a district or tribal court:
has complied with and substantially completed a substance use disorder treatment program while incarcerated in jail or prison;
was discharged from the State Hospital and was admitted to the civil unit in connection with a criminal charge, or to the forensic unit due to a criminal offense, with which the individual was charged or convicted: or
on probation or parole with a serious mental illness or substance use disorder.
Individuals Needing Treatment – Is an individual who:
was discharged from the State Hospital due to a civil commitment; or
is currently receiving General Assistance (GA) from DWS and has been diagnosed with a substance use or a serious mental health disorder.
The criteria for meeting a coverage group will be determined at application or review.
With the exception of the GA sub-group, all other sub-groups will be verified using a Form 42A, 43A or 44A, which are completed by an approved agency (Table XVII).
Verify the substance use or mental health disorder for the GA sub-group with a Form 1, 20, 20M or 45A. Only request the 45A if the disorder cannot be verified using other means in the case record. Do not request a Form 1, 20 or 20M if it is not already in the case file.
For verifying a substance use or mental health disorder, the Form 1, 20 and 20M are only valid for 12 months from the date completed.
The Form 45A must be completed by a licensed practitioner (Such as a doctor, therapist or nurse practitioner) or an approved agency (Table XVII).
See 731-8 for verification requirements.
To be eligible under the criteria of being released or discharged from prison, jail or the State Hospital, a completed application must be submitted within 60 days from the date the individual was released or discharged.
Non-Financial Requirements
In addition to the non-financial requirements in Section 200, individuals must also meet the following criteria:
An individual must be at least 19 and not yet age 65.
Cannot have a dependent child under the age of 19.
Individuals are not eligible for TAM if they qualify for other programs without a premium or spenddown. Some of the programs are:
Parent and Caretaker Relative,
Pregnant Woman,
Medicaid Cancer Program,
Former Foster Care.
An individual is not eligible for TAM if they are eligible for or receiving Medicare.
If an individual is eligible for TAM, do not put them on:
Adult Expansion program (Individuals may receive Adult Expansion until they become eligible for TAM),
Medically Needy programs; or
Refugee Medical Assistance.
6. An individual may qualify for TAM in the retroactive period, if the individual met the eligibility criteria for one of the TAM coverage groups during the retroactive period.
Financial Requirements
No asset test.
Income must be at or below the income limit for the program.
Open Enrollment Period
The Department of Health may limit the number of individuals covered under the program. Open enrollment may be limited to individuals within a coverage group and/or a subgroup within a coverage group (346 Resource).
The following are exceptions to the open enrollment period:
The review process is completed in the three-month period immediately following the month the review closed for incomplete review (721-1).
The individual was previously on TAM and is moving from another Medicaid program with no breaks in coverage between all the programs.
Certification Period
1. See 715 regarding the length of the certification period.
2. Medicaid coverage will end prior to the 12-month certification period if the individual:
Turns age 65;
Moves out of state;
Fails to apply for other benefits;
Becomes institutionalized (See 604 for suspending coverage); or
Is determined eligible for another Medicaid program, with the exception of Adult Expansion, Refugee or Medically Needy.