0910.045.00  UNTIMELY REPORT OF OR ACTION ON CHANGE (TMA)

Transitional Medical Assistance instructions assume the change causing MAF ineligibility is reported or discovered and action taken on a timely basis. The following instructions address the effect on an otherwise eligible Transitional Medical Assistance case when the change causing MAF ineligibility is not reported or correct action is not taken on a timely basis. The procedures differ because in the latter situation, the caretaker is not at fault for not completing the quarterly report(s).

0910.045.05  Change Not Reported Timely (TMA)

  1. When the change causing MAF ineligibility is reported or discovered prior to payroll closing in what would be the third month of Transitional Medical Assistance eligibility, use the same procedures outlined previously.
  2. When the change is reported/discovered after payroll closing of the third month but before the 21st day of the fourth month of Transitional Medical Assistance eligibility, use MAF closing procedures to transfer the case to Transitional Medical Assistance. Additionally, give or send the caretaker the quarterly report form.
  3. When the change is reported/discovered after the 21st day of the fourth month but before the end of the sixth month of Transitional Medical Assistance eligibility, complete a closing transaction providing Transitional Medical Assistance for the first six months only. DO NOT give or send the caretaker a quarterly report form. The due date passed and the caretaker cannot be eligible for the second six months. Explore eligibility for other MC+ healthcare programs.
  4. When the change is reported/discovered after the end of the sixth month of Transitional Medical Assistance eligibility, close the MAF case and do not transfer to Transitional Medical Assistance. Explore eligibility for other MC+ healthcare programs prior to closing the MAF case. Complete a claim for MC+ healthcare benefits received for any month after the sixth month unless other eligibility exists.

0910.045.10  Change Not Acted Upon Timely (TMA)

  1. When the error is discovered before payroll closing of the third month of Transitional Medical Assistance eligibility, follow instructions in 1 above.
  2. When the error is discovered after payroll closing of the third month but before the 21st of the fourth month of Transitional Medical Assistance eligibility, follow instructions in 2 above. Allow a reasonable amount of additional time for the caretaker to complete the form, if necessary.
  3. When the error is discovered after the 21st day of the fourth month but before the end of the sixth month of Transitional Medical Assistance eligibility, follow instructions in 3 above, except give or send the caretaker a quarterly report form to complete for the first three months. Allow at least ten days for the caretaker to complete the form, and cancel close the case if necessary.
  4. When the error is discovered after the end of the sixth month of Transitional Medical Assistance eligibility, close the MAF case and transfer to Transitional Medical Assistance. Give or send the caretaker the necessary report forms and allow at least ten days for the caretaker to complete the forms.