IM-59 April 25, 2003

In the third, sixth, and ninth months of Transitional Medical Assistance eligibility, Transitional Medical Assistance quarterly reports are sent to caretakers.  To continue eligibility, a quarterly report form must be completed and returned in the fourth, seventh, and tenth months respectively, by the 21st day of those months.  Failure to return the first quarterly report by the due date results in ineligibility for the second six months, unless good cause exists.  Failure to return the second or third quarterly reports by the due date results in suspension of the caretaker’s TMA eligibility until the completed report is submitted.  The parents are not eligible for TMA during the suspension period unless good cause for failure to report exists.

For the first quarterly report, if the claimant fails to return a completed report by the 12th of the month, a reminder notice is sent to the claimant.  This notice provides no specific information, but instructs the claimant to contact the caseworker if he/she already submitted the report form to ensure the report was received or to investigate why it is incomplete.  For the second or third quarterly report, if the claimant fails to submit the completed report by payroll closing of the seventh or tenth month, caretakers are suspended.  If payroll closing is prior to the 21st of the month, and the claimant submits a completed report after payroll closing but by the 21st of the month, reinstate the caretaker’s eligibility.

When the quarterly report is received, determine if the report is complete, and determine if the family continues to meet Transitional Medical Assistance eligibility requirements.

FIM31412 Parent Losing Eligibility for TMA lists TMA cases where parent lost eligibility by either suspending or converting to MC+ for Children at the end of six or twelve month.

0910.025.05  Quarterly Report Completeness (TMA)

Consider a quarterly report complete when all questions about earnings are answered and the form is signed.  Consider a report complete even if verification of earned income or childcare expense is missing.

0910.025.10  Good Cause For Failure To Return Quarterly Report (TMA)

IM-170  December 16, 2002

Good cause for failure to make a timely report is limited to:

  1. serious illness or death of the recipient or a member of the recipient’s family;
  2. a family emergency or household disaster, such as a fire, flood, or tornado;
  3. other good cause beyond the recipient’s control (discuss such cases with the supervisor to determine if a recipient has good cause and if unable to decide, obtain clearance through normal supervisory channels); OR
  4. the recipient did not receive a quarterly report form for a reason not attributable to the recipient (failure to furnish DFS with a current address is attributable to the recipient).

If the caretaker contacts DFS claiming "good cause", allow whenever possible.  If the caretaker had good cause for failing to return a completed quarterly report, reinstate the caretaker’s TMA eligibility.  Refer to Section 0910.050.05.05 and 0910.050.10.05