Family Transitional Medicaid (TMA) Policy
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Defines eligibility, qualifying events, coverage duration, reporting, household composition changes, and administrative processes for Transitional Medicaid for families after closure of non‑medically needy ACA Medicaid in Montana.
No material clinical or coverage changes in this revision.
TMA Eligibility and Continuation Criteria
TMA eligibility and continuation criteria
Eligibility for TMA and conditions for continuing coverage
From qualifying event requirements
Qualifying event must be based on earned income
Qualifying child defined separately (under age 19, citizenship/status requirements)
Must not be eligible for other Medicaid
TMA available to all family members in assistance unit; exception for court‑determined fraud within prior six months
Failure to timely report income is not fraud
ALL of the following
- There is a qualifying child in the home
- The family maintains Montana residency
- Parent/specified caretaker relative cooperates with Program Compliance Medicaid reviews and with Third Party Liability (TPL) requirements (HIPPS, trauma questionnaires, providing health insurance information and insurance questionnaires); children's Medicaid is not closed for parent noncooperation
- Reporting requirements are met (regular ten‑day change reporting)
System and worker actions referenced for administrative processing
System and Worker Actions; Reporting & Verification
System and worker actions at case closure
CHIMES will automatically close the TMA case at the end of the six-month period and send a closure notice. Workers must complete an ex parte review prior to the effective date of closure; a task will be created for this review. After auto-closure CHIMES will recalculate eligibility, and the worker must send timely notices and request any additional information/documentation needed to determine eligibility for other coverage. If the case manager has enough information to open another Medicaid coverage group, open it without requesting more information unless a premium applies; if a premium-based program (e.g., ACA Adult Medicaid) is available, confirm the enrollee’s desire to pay. Provide timely and adequate notice when transitional benefits are terminated.
- CHIMES auto-closes TMA at the end of 6 months and sends a closure notice (ensure cases are not left pending).
- Complete ex parte review prior to closure; a task will be created for the worker.
- CHIMES will automatically recalculate eligibility after closure; worker must request any additional information/documentation and send appropriate notices.
- If sufficient information exists to open other Medicaid coverage, open it without further information unless a premium is required; if premium applies, confirm enrollee wants to pay.
Reporting and verification requirements
Households must report changes within ten days. Income changes reported during the TMA period only require verification if the family is requesting other Medicaid coverage (because TMA has no income limit). Job loss during the six-month TMA period does not end coverage. If more information is needed to determine other coverage at termination, the case manager must immediately notify the household what is needed and when it is due; if provided before the effective date of closure, a new application is not required.
- TMA households are subject to regular ten-day change reporting requirements.
- Income changes during TMA need verification only when the family is requesting other Medicaid coverage (no income verification for continued TMA).
- Job loss during the TMA period does not affect ongoing TMA coverage.
- If additional information is needed to open other coverage, notify household immediately; if information is provided before closure effective date, open coverage without a new application.
Qualifying Adult, Child, and Events
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