What is Transitional Medicaid?
If you received Medicaid under the "Low Income Family Households" Medicaid program (LIF) and your LIF Medicaid case closes, you may be eligible to continue to receive Medicaid in the form of transitional Medicaid (TMA). Most, but not all, households receive LIF Medicaid because they have very low income or are in receipt of cash public assistance benefits and have minor dependent children in their household.
Who is eligible for TMA?
To be eligible for TMA, the family must:
•include a dependent child (less than 21 years of age) or a pregnant woman;
•have received LIF Medicaid for at least three out of the last six months before losing Medicaid eligibility; and
•have become ineligible for LIF Medicaid as a result of earnings from employment, including self-employment, or increased child support.
If your increased income was from child support, you are eligible for TMA for four months. If your increased income was from employment income, you are eligible for TMA for six months and, depending on your income, you may be eligible for another six-month extension of TMA.
If your Medicaid case was closed for any reason other than increased child support or increased employment income, you are not eligible for TMA. You and/or you and your children may be eligible for Medicaid for other reasons.
What do I have to do to get TMA?
Nothing. You should receive a notice from the local Department of Social Services (DSS) saying that your Medicaid is being continued, and how long it will last. If the notice says your Medicaid is being discontinued, but, you do not think that is correct, you should request a fair hearing.
What happens after my TMA runs out?
Before the end of your certification period for TMA, DSS should send you a form to report your wages. If you return the form, DSS will see if you are eligible for another six months of TMA. If you are no longer eligible for TMA, you and your children may still be eligible for Medicaid. You will need to apply for Medicaid through DSS.
Can I request a fair hearing if DSS does not provide me TMA benefits?
Yes. DSS should not reduce or discontinue your Medicaid, including your TMA Medicaid, without first sending you a ten-day notice. You have 60 days from the date of the notice to request a fair hearing. If you request the hearing before the effective date of the notice, your benefits should continue unchanged until a hearing is held and a decision issued.
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Legal Assistance of Western New York, Inc.
This article provides general information about this subject. Laws affecting this subject may have changed since this article was written. For specific legal advice about a problem you are having, get the advice of a lawyer. Receiving this information does not make you a client of our office.
This information is correct as of March, 2001.