TMA Premium Example 1

Example 1: Household consists of Mom (age 23) and one child, age 4. The first QRF indicates that the countable monthly income is $1,300. Mom does carry health insurance on both herself and her child. One hundred percent FPL for a two-person household is $1,261, so this family may be subject to a TMA premium. The last eligibility review was completed five months ago.

Factors to Consider:

• This is a single-parent household, so ADC/MA eligibility exists for Mom and there is no 100-Hour Rule.
• The child is MAC-age so would be budgeted at 133% FPL. Kids Connection is not an option due to the health insurance coverage.
• The last eligibility review was less than six months ago, but because it was not the initial determination, the child is not assured of any period of Continued Eligibility so may be subject to a premium along with Mom.

Result: The Mom in this case must make a decision. The income exceeds the MNIL for two, so she would be subject to a Share of Cost if we were to close the TMA and run her through "regular" Medicaid budgeting. The income is less than 133% FPL for two, so the child would remain eligible without a Share of Cost. Mom would remain on TMA with a premium while the child would be eligible as a MAC child.

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