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VA Medicaid - Extended LIFC

NOTE: Extended LIFC Medicaid is sometimes called (incorrectly) "Transitional" Medicaid because it often is available at the same time as TANF/VIEW Transitional Benefits and because federal policy refers to this Medicaid program as "Transitional". Prior to July 2003, Virginia did have a Medicaid program called "Transitional" that was different from Extended Medicaid as described in this topic.

Medicaid recipients may be eligible for an extended period of Medicaid coverage when the family meets all the requirements for the Low Income Families with Children (LIFC) covered group except income.

4-Month Extension

LIFC families who received Medicaid in 3 of the last 6 months and who become ineligible for Medicaid due to increased income from child and/or spousal support may be eligible for a 4-month extension.

6-Month Extension

LIFC families who received Medicaid in 3 of the last 6 months and who become ineligible for Medicaid due entirely to an increase in countable earned income may be eligible for 6 months of extended Medicaid, with a possible extension of 6 more months.

Countable earnings could increase because of a new job, a raise in the rate of pay, an increase in hours worked, or loss of the time-limited $30 plus 1/3 or $30 Earned Income Exclusions.

In situations where an earned income case has simultaneous income changes that cause LIFC Medicaid ineligibility, such as new or increased earned income plus an increase in support, the eligibility worker must determine if the case would have been ineligible due to the increase in countable earnings alone. This requires that the eligibility worker recalculate the LIFC income eligibility only considering the increased earned income or loss (expiration) of the disregards.

·      If the family would have been ineligible for one of these reasons, it will be considered the reason for LIFC Medicaid ineligibility and the family is eligible for the Medicaid extension.

·      If, however, the family would have continued to be eligible for LIFC Medicaid if the only change had been increased earnings or expiration of the disregards, the other changes which occurred simultaneously will be the reason for LIFC Medicaid ineligibility. The family would not be eligible for the Medicaid extension.

Entitlement to Medicaid under this extension period terminates at the end of the first month in which the family unit ceases to include a child under age 18 or under age 19 if in school or in which the family unit with Employer-based health insurance fails to comply with the Health Insurance Premium Payment (HIPP) program requirements.

Second 6 Months

Month 4: To continue receiving Medicaid after the first 6 months of Extended Medicaid, the family must return a completed "Medicaid Extension Earnings Report" for the first 3 months (with earnings and child care cost verifications attached) by the 21st of the fourth month of Extended Medicaid. (DSS must notify the family of this requirement during the third month.)

If the first 3-month period's report is not received by the 21st day of the fourth month, Medicaid will be canceled effective the last day of the sixth month in the extension period.

Month 7: DSS must receive the second 3-month Extension Earnings Report (for months 4, 5 and 6) by the 21st of the seventh month.

The family will continue to be eligible for extended Medicaid coverage unless:

·      No child under age 18, or under age 19 if in school, lives with the family;

·      The family disenrolls from a group health plan that DMAS has determined cost-effective or fails to pay the premium to maintain the group health plan;

·      The caretaker/relative had no earnings in one or more of the previous three months (unless the lack of earnings was due to the caretaker/relative's involuntary lay-off, the business closed, the caretaker/relative's illness or injury, or other good cause such as serious illness of child in the home that required the caretaker/relative's absence from work); or

·      The family unit's average gross monthly earned income (earned income only; unearned income is not counted) less costs for child care that was necessary for the employment of the caretaker/relative, during the preceding three-month period exceeds the 185% Federal Poverty Level (FPL) appropriate to the family unit size.

NOTE: "Gross monthly earned income" for this purpose includes all of the family unit's earned income before any disregards (including WIA earned income, children's earned income, etc.) Subtract from gross earned income the actual monthly cost of child care that if not provided would prevent the caretaker/relative from being employed. No other disregards are allowed.

If the family is not entitled to further Medicaid coverage, each family member's eligibility for Medicaid under another covered group must be determined and enrollment changed to the appropriate group before canceling coverage on the last day of the 8th extension month.

If the family is ineligible because of excess income, DSS cancels Medicaid coverage and places the family members who meet a medically needy covered group on spenddown.

Month 10: DSS must receive the third 3-month Extension Earnings Report (for months 7, 8 and 9) by the 21st of the tenth month. If the report is not received on time, Medicaid is cancelled on the last day of the eleventh month unless the family establishes good cause for failure to report on time.

If the report is not received on time, the DSS determines the children's eligibility for Medicaid under another covered group before canceling coverage.

If the report is received on time, the family continues to be eligible for Medicaid unless one of the four conditions listed above (under Month 7) exists.

Month 12: DSS must complete a re-determination of the family's Medicaid eligibility before the cut-off at the end of the 12th month.

NOTE: Children must first be evaluated for Medicaid eligibility in the covered group for Child Age 1-6 or Child Age 6-19. If eligible, they should be enrolled. If ineligible, the child must be evaluated for the Extended Medicaid. If ineligible for Extended Medicaid, the child must be evaluated for FAMIS. If ineligible for FAMIS, the family must be given an opportunity for a medically needy determination prior to the worker taking action to cancel the Medicaid coverage.

Back to:

VA Medicaid Eligibility

VA Medicaid Covered Groups

VA Medicaid Overview

VA Benefit Information System Welcome and Introduction

Source

Information for this topic was drawn from Chapter M1520 of the Department of Social Services (DSS) Medicaid Manual.

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