This policy was eliminated effective July 1, 2005 by Missouri House Bill 11.
Uninsured adults with net income less than or equal to 100% of the federal poverty level who successfully complete the 12 months of Transitional Medical Assistance (TMA) may receive one year of extended health insurance coverage through the MC+ program. To be eligible for the one-year extension, a caretaker relative must meet the following criteria:
There are no quarterly reports required during the one-year extension. There is no resource limit. Reviews on the cases are to be done annually. Self-declaration of income should be accepted, unless questionable, both during the one year extension and the initial 12 months of TMA. Once an Extended Transitional Medical Assistance case is closed it can not be reopened, unless closed in error.
The Transitional Medical Assistance case must be in active status in the 12th month. If the case is in suspended status it will be closed.
The caretaker relative (whose employment caused ineligibility for Medical Assistance for Families) must remain employed. The reasons loss of employment would not cause ineligibility in the second six months of TMA also apply for the two-year extension.
The caretaker relatives in the family must not currently have insurance that provides coverage for physician's services and hospitalization. The requirement that health insurance not have been dropped in the last six months does not apply to this group. All of the other uninsured requirements for MC+ children in the no-cost and co-pay groups apply. Refer to Section 0920.050.05.
The family's net income must be less than or equal to 100% of the federal poverty level (FPL) during the one-year extension. The assistance group rules are the same as for the initial 12 months of TMA. Determination of income is the same as for MAF. The allowable deductions or disregards from income are the same as for MAF.
There must be an MC+ eligible child in the home for the caretaker relatives to remain eligible. If the last eligible child leaves the home or turns age 19, the caretaker relatives are ineligible.
The caretaker relatives also become ineligible if the children are in the premium group and lose eligibility for one of the following reasons:
In these situations ineligibility is due to there not being an MC+ eligible child in the home, not failure to pay the premium or access to affordable insurance.
Adults who receive Extended Transitional Medical Assistance will receive a more restricted coverage package than that received by MC+ children and other adults eligible for MAF or TMA. The package includes most of the services covered for adult MAF recipients. The major differences between this package and that received by other adult MAF recipients are:
For specific coverage questions, recipients need to contact their health plan, provider, or Recipient Services at 1-800-392-2161.
Cost sharing will be $10 at the time of each provider visit and $5.50 to $7 for each prescription. The co-payment amount is based on the actual cost of the product being dispensed.
Once the initial 12 months of TMA have been successfully completed, the IM system will automatically convert to extended TMA if the caretaker or second parent is uninsured and net income is less than or equal to 100% of the federal poverty level (FPL). In the IMU5 system level of care (LOC) “E” identifies caretaker relatives receiving the extended coverage.
In the twelfth month of TMA the system will determine if the caretaker and/or second parent are uninsured. If there is an “I” (insured) in field 13-03 the case will automatically close. If a caretaker relative is uninsured the system will determine if net income in field 34 is less than or equal to 100% FPL. If net income is above 100% FPL the case will automatically close.
The following changes will occur in the IMU5 system after payroll closing in the 12th month of TMA if an “I” is not present in field 13-03 and net income is less than or equal to 100% FPL:
If eligibility is extended a system-generated letter will be sent explaining the 2-year extension and the changes in health care coverage.
If the caretaker and second parent are both insured, a system- generated letter will notify them of the ending date of TMA and the reason that they are ineligible for extended coverage. This letter will be sent at payroll closing in the 11th month of TMA eligibility. It will list active children on the case, and inform the caretaker that the children's eligibility for MC+ is being explored. If the children are already on a separate MC+ case, the letter will state their coverage has not changed.
A report of children active on TMA cases to be extended or closed by the system will be sent to the caseworker. The report will list children on cases that were extended in the twelfth month. On cases to be closed, it will list children in the 11th and 12th month of TMA eligibility.
Children active on TMA cases that are extended will remain on the case as a “T” LOC. Since children are not eligible for the extension, they must be moved to an MC+ (C7) case by the caseworker.
If the TMA case is being closed the children's eligibility for MC+ should be explored. A new application is not required. Make the eligibility determination based on the income last reported and the child's insurance status. The children should be eligible, unless income is above the non-CHIP limit and they are insured. If eligible, send the family an approval letter (IM- 32MC). If ineligible, send a denial letter (IM-33MC). The family should be notified as soon as possible, but no later than 10 days after the report is received.