TMA Premium Example 3

Example 3: Single parent mother, age 28 with one child, age 9. Household has been on TMA for six months as Mom is employed full-time. The QRF shows that Mom earns $1,400 per month and pays no child care. Mom does not have health insurance coverage on herself or her child.

Factors to consider:

• This is a single-parent household, so ADC/MN eligibility exists without applying the 100 Hour Rule.
• Mom's countable income falls between 100% and 185% FPL, so she would appear to be subject to a TMA premium.
• Mom's income clearly exceeds both the MNIL and 100% FPL for two, so the result would be a large Share of Cost.
• There is no health insurance coverage and the income is below 185% FPL, so Kids Connection on the child is an option.
• The initial period of Medicaid eligibility was more than six months ago.

Result: In this situation, if the countable income is below 185% FPL when following "normal" Medicaid budgeting procedures, the child may remain eligible for Kids Connection. At the same time, if the TMA budget shows that the TMA income (gross earned income minus cost of child care) is less than 185% FPL, Mom may be eligible for TMA with a premium. The worker would close Mom until she pays the premium while at the same time keeping the child open with K.C.

Depending on the types of income this family may have, it is possible that the result would be that Mom is eligible for TMA while the child is over income for K.C. For example, if the child has SSA or a significant amount of child support, we would count that income on the K.C. budget but not on the TMA budget. If this is the case, the child would be included in the TMA unit and would also be subject to the premium.

Note: If the child had been in their initial six months of continued eligibility, we cannot impose the premium on the child.

(Rev. 7/1/03)