TMA Premium Payments --- Process and Examples

468-000-329

If a family qualifies for TMA (Transitional Medical Assistance), they are entitled to the first six months of eligibility without regard to income. However, beginning with Month 7 the family is subject to an income test. The family loses TMA eligibility if the countable earned income is greater than 185% FPL for the appropriate household size. The countable income is determined by taking the gross earned income and subtracting the cost of child care (including that amount paid by Child Care Assistance).

Note: Unearned income is not considered in TMA budgeting. As indicated above, countable TMA income is determined by taking the gross earned income and subtracting the cost of child care. The $100 Earned Income Disregard is NOT allowed in TMA budgeting.

In order to determine the household's income, earnings and child care costs from the first three months of TMA are reported via a QRF (Quarterly Report Form). Income from the first QRF (for Months 1, 2 and 3) is used to determine whether the family is eligible for TMA beyond Month 6. Assuming that the QRF and income verification are provided, there are three possible outcomes:

1. The countable income from Months 1 through 3 is greater than 185% FPL and is reflective of the current employment situation, TMA eligibility does not exist beyond Month 6 and the TMA case should be closed allowing for timely and adequate notice. Eligibility for Medicaid under other categories (ADC/MN, Poverty Level Childrens Medical, Kids Connection, etc.) should be explored.
2. The countable income is less than 100% FPL and all TMA unit members remain eligible for TMA without any premium.
3. The countable income falls between 100% and 185% FPL. The case manager should then determine whether the premium applies to all TMA unit members or only to the adult(s). TMA premium amounts are found at 468-000-215. The household should be notified of their premium via Form EA-78.

WHO PAYS THE PREMIUM? The TMA premium may be required only for the adult(s) in the family; it may also be required for the child(ren), or it may not apply to the family at all. This will depend on the income, family size, composition of the family, and ages of the children. Other factors which must be considered include when the last full eligibility review was conducted and whether the child(ren) are covered by creditable health insurance.

Reminder: For Kids Connection or CMAP, the $100 Earned Income Disregard is subtracted from earned income. The result may be that the children qualify for Medicaid without a premium. However, in KC and CMAP, unearned income must be counted.

TMA Premium Example 1

TMA Premium Example 2

TMA Premium Example 3

Premium Payment Procedures

Returned Check

(Rev. 7/19/04)