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TANF Continued Medical Benefits - Oklahoma

Medical benefits are continued when a Temporary Assistance for Needy Families (TANF) benefit is closed due to the receipt of child or spousal support, or new or increased earnings of the caretaker relative.

Conditions for Continued Medical Benefits (CMB).

The medical assistance coverage is of the same amount, duration, and scope as if the assistance unit continued receiving TANF. To be eligible for CMB the assistance unit must meet all of the following requirements:

· At least one member received TANF in at least three of the six months immediately preceding the month of case closure.

· The assistance cannot have been received fraudulently as determined by Family Support Services Division, Overpayment Section, in any one of those six months.

· The assistance unit must include a dependent child who meets the age and relationship requirements for TANF and whose needs are included in the TANF assistance unit at the time of closure, unless the only eligible child is a Supplemental Security Income (SSI) recipient.

Closure due to child support or spousal support.

Medical benefits are continued if the TANF closure is due to the receipt of new or increased child support or payments for spousal support in the form of alimony. The medical benefits are continued for four months.

Closure due to new or increased earnings of caretaker relative.

Medical benefits are continued if the closure is due to the new or increased earnings of the caretaker relative. The caretaker relative's needs must be included in the assistance unit at the time of closure. The caretaker relative who is the natural or adoptive parent is required to cooperate with Child Support Enforcement Division during the period of time the family is receiving CMB. If the caretaker relative changes during the CMB period, the assistance unit loses its CMB coverage.

Eligibility.

Medical benefits may be continued for a period up to 12 months. This period is divided into two six-month periods with eligibility requirements and procedures for each period.

· Initial six-month period. The assistance unit is eligible for CMB if:

o an eligible child remains in the home;

o the caretaker relative remains the same; and

o the assistance unit remains in the state.

· Additional six-month period. Medical benefits are continued for the additional six month period if:

o an eligible child remains in the home;

o the caretaker relative remains the same;

o the assistance unit remains in the state;

o the assistance unit was eligible for and received CMB for each month of the initial six month period;

o the assistance unit has complied with reporting requirements in (4) of this subsection;

o the assistance unit has average monthly earned income that does not exceed the standard which is based on 185% of the Federal Poverty Level; and

o the caretaker relative had earnings in each month of the three-month reporting period, unless the lack of earnings was due to an involuntary loss of employment, illness, or other good cause.

· Income eligibility. The unearned income and resources of the assistance unit are disregarded in determining eligibility for CMB. There is no earned income test for the initial six-month period. The assistance unit's medical benefits are not continued for the additional six-month period if the assistance unit's countable earnings exceed the standard. The only deduction allowed is the cost for approved child care necessary for the employment of the caretaker relative. The child care deduction is averaged for the same three-month reporting period. There is no maximum amount for this deduction. The earnings of all assistance unit members are used in determining the earned income test. The earnings of additional family members are considered only if that member is a natural or adoptive parent. The needs of all individuals whose earnings are considered are included in determining the household size for the income test. The earned income of a full time student included in the assistance unit is disregarded the same as in TANF rules.

· Eligible child. When the TANF benefit is closed and CMB begins, the assistance unit must include an eligible child whose needs were included in the TANF benefit at the time of closure, unless the only eligible child is a SSI recipient. After the CMB begins, the assistance unit must continue to include an eligible child. However, age is the only requirement an eligible child must meet. This means that the eligible child does not have to meet the deprivation factor once CMB begins.

· Additional members. After the CMB begins, family members who move into the home cannot be added to the CMB coverage. This includes siblings and a natural or adoptive parent(s). If the additional member is in need of medical services, an application for services under the regular Medical Assistance Program is completed. If an assistance unit member included in the CMB leaves the home and then returns, that member may be added back to the CMB coverage if all conditions of eligibility are met. A child under the age of one year whose mother is included in the CMB coverage, is added to the assistance unit if the child is deprived of parental support.

· Third party liability. The assistance unit's eligibility for CMB is not affected by a third party liability. However, the assistance unit is responsible for reporting all insurance coverage and any changes in the coverage. The social services specialist must explain the necessity for applying benefits from private insurance to the cost of medical care.

· Termination of CMB. The CMB coverage is discontinued any time the assistance unit fails to meet the eligibility requirements as shown in this Section. If it becomes necessary to discontinue the CMB coverage for the assistance unit or any member of the assistance unit, the individual(s) must be advised that he or she may be eligible for medical benefits under the regular Medical Assistance Program and how to obtain these benefits.

Reporting.

The assistance unit is required to periodically report specific information. To assist the unit, Form CM-5, Continued Medical Benefit Reply Form, is sent at the same time as the notices generated during the CMB period. Though preferred, it is not mandatory for the report form itself to be returned. The information may be reported by telephone, in an office interview, or by letter.

The assistance unit must report:

· gross earned income of the entire assistance unit for the appropriate three-month period;

· child care expenses, for the appropriate three-month period, necessary for the caretaker relative's continued employment;

· changes in members of the assistance unit;

· residency; and

· third party liability.

Receipt of medical benefits after CMB ends.

To ensure continued medical coverage, Form SC-2, Recertification of Eligibility for SoonerCare Health Benefits, is computer generated and mailed to the assistance unit during the third month of CMB for benefits closed due to the receipt of child or spousal support or the 11th month of CMB for benefits closed due to increased earnings. The assistance unit must return Form SC-2 for a medical redetermination to be made prior to the termination of the CMB benefits. When determined eligible, medical benefits continue as health benefits, not CMB.