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DE Medicaid - Transitional

Families that lose their Medicaid eligibility under the Low Income Families with Children - Section 1931 covered group because of earnings, may be eligible for up to 12 months of Transitional Medicaid.

Initial Eligibility

Your family must have received Medicaid under Section 1931 in three of the six months immediately preceding the month your family became ineligible for Medicaid under Section 1931. You must have received Medicaid in Delaware. Eligibility is not transferable from another State.

You must have become ineligible for Section 1931 Medicaid because of an increase in countable income that is caused by an increase in countable earnings. The increase in countable earnings can result from an actual increase in the amount your family earns, or it can result from a decrease in your time-limited earned income disregards. (See Earned Income Disregards for TANF. These disregards are used in determining Section 1931 eligibility.)

NOTE: You would not be eligible for Transitional Medicaid if your earnings did not actually increase, but your income exceeds one of the Standard of Need limits because of a decrease in dependent care costs or a decrease in family size.

Three-Step Initial Eligibility Determination Process

If your earnings increase and you become financially ineligible, but there are other changes as well, then DSS uses a three-step process to determine eligibility for Transitional Medicaid:

1. Determine if the increase in earnings (or loss of the disregards) would have resulted in loss of 1931 eligibility if all other factors in the case remained the same (i.e., there was no other change in income, no change in family composition, no change in dependent care costs, etc.).

If yes, the family is eligible to receive Transitional Medicaid.

If no, go to step 2.

2. Determine if events other than the increase in earnings (or loss of the disregards) would have resulted in loss of 1931 eligibility if the earnings or disregards had stayed the same.

If yes, the family is not eligible to receive Transitional Medicaid.

If no, go to step 3.

3. Determine if the family is ineligible for 1931 when all changes are considered.

If yes, the family is eligible for Transitional Medicaid. The increase in earnings (or loss of the disregards) was essential to the loss of 1931 eligibility. Without that increase, the family would not have lost 1931 eligibility.

If no, the family is still eligible for 1931.

First Six Months - Eligibility

For the first 6 months, there is no limit on the amount of income that you and your family may have and still be financially eligible for Medicaid under this covered group.

The only requirement during the first six months is that there continues to be a child living in your home. (The child must meet the criteria for Section 1931 eligibility.)

Second Six Months - Eligibility

During the second 6 months you will remain financially eligible for Medicaid coverage if all three of the following conditions exist:

·      You continue to have a child living in your home. The child must meet the criteria for Section 1931 eligibility.)

·      The earned income of caretakers minus any childcare expenses needed for caretakers to work does not exceed 185% FPL. The earned income of a dependent child is not counted.

NOTE: Actual childcare expenses may be disregarded. The expenses are not subject to a specific limit, but they must be reasonable.

·      To continue to receive Medicaid throughout the second six-month period a caretaker relative must be employed during each month unless good cause exists.

See also:

DE Medicaid - Covered Groups

DE Medicaid - Eligibility

DE Medicaid - Application Procedures

DE DSS - Change Reporting Requirements

DE DSS - Contact Information

Source:

DSS Policy Manual (Sects. 15200.1)

DSS Administrative Notice A-06-2005, February 22, 2005

Back to:

DE Medicaid - Overview

DE Division of Social Services - Overview

DE Benefit Information System Overview

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