IMA POLICY MANUAL
PART I: INTRODUCTION
Federal Medicaid rules require that the District's Medicaid program provide Early Periodic Screening Diagnosis and Treatment (EPSDT) services to children receiving Medicaid. EPSDT services – called Health Check in the District – include medical, dental, vision, and hearing screening and all medical services deemed necessary to treat to prevent health problems in these areas. Immunizations are also considered an EPSDT service.
MAA is responsible for ensuring that Medicaid providers offer these services to children under age 21, or under age 22 in the case of a child receiving SSI due to a disabling medical condition.
IMA is responsible for informing Medicaid applicants and recipients, including those who are deaf, blind, non-English speaking, and/or functionally illiterate of the Health Check services and of the assistance MAA can provide in scheduling EPSDT appointments and assisting with transportation to and from EPSDT appointments. IMA must inform all Medicaid applicants and recipients of these services in writing and orally, at application, recertification, and when adding a child to the group.
TEMPORARY ASSISTANCE TO NEEDY FAMILIES (TANF) 2.3
The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 ended the federal entitlement of individuals to cash assistance under the Aid to Families with Department Children Program (AFDC), formerly authorized under Title IV-A of the Social Security Act. This law replaced AFDC with the Temporary Assistance Needy Families (TANF) block grant. The District uses this block grant to operate a cash assistance program for poor families with children. The District calls this program 'TANF.' The District's TANF program includes requirements for recipients to participate in work or other activities that will lead to paid employment. The program is intended to reduce dependence on public assistance and enhance individual and family economic self-sufficiency.
PRWORA and District law impose a lifetime limit of 60 months on receipt of cash benefits funded with federal TANF funds. Subject to some exceptions, federal TANF funds cannot be used to provide cash assistance to a family that has received assistance for 60 months. In addition, in order to receive TANF cash benefits, an adult recipient, unless exempt, must be engaged in work-related activities, including work experience, job training, and subsidized and unsubsidized employment for a defined number of hours each week (see Chapter 1: Work Requirements in Part V). Failure to participate in work activities can lead to a reduction in the family's TANF grant. Individuals are exempt from work requirements only in special circumstances, such as disability, incapacity or illness, lack of appropriate child care, caring for a disabled child, or advanced age. Additional exemptions, exclusions, and restrictions apply (see Section 1.6: Exemptions from Work Requirements in Part V).
TANF benefits include a cash grant provided electronically through electronic benefits transfer (EBT) cards. EBT allows beneficiaries to use a magnetic-striped plastic card, similar to an automated teller machine (ATM) or debit card, to withdraw their benefits electronically at an ATM. Recipients can also access benefits at stores equipped to accept EBT benefits as payment. When a TANF recipient uses an EBT card, the TANF benefits are deducted automatically from the beneficiary's account. The District's EBT card is called the Capital Access card, and it also allows eligible beneficiaries to access FS benefits electronically at grocery stores and markets equipped to accept EBT benefits as payment.
Cash benefits provided are calculated based on the number of eligible individuals in the group, group income with certain allowed deductions, and other benefits received. In order to be eligible for TANF, countable assets held by the group must be less than the applicable asset limit.
Non-exempt TANF recipients are required to participate in work activities which generally include job readiness training, job placement, subsidized employment, vocational education, and work experience programs. Participants in such programs as well as recipients combining work and welfare receipt are eligible for child care subsidies for children younger than age 13. These subsidies are provided by the Office of Early Childhood Development (OECD).
A head of household who is applying for TANF may be provided with cash assistance under the Diversion Payment Program (DPP) (see Section 3.7: Diversion Payment Program (DPP) in Part VIII) instead of receiving a TANF grant. DPP is used to resolve an immediate short-term financial need which, if resolved, will allow the applicant to continue in current employment or accept already offered new employment. During the intake, the SSR should assess whether an applicant is an appropriate candidate for DPP.
If the applicant indicates during the initial interview or subsequent discussions, but prior to TANF approval, that employment could be retained or obtained if a work-related crisis can be quickly resolved, then the SSR should inform the applicant of the program and encourage the use of DPP rather than TANF. A month for which DPP is received does not count toward the TANF 60-month time limit.
An individual may not apply for DPP. It is the responsibility of the SSR to consider if DPP is appropriate, discuss it with the applicant, and, if appropriate, recommend DPP over TANF.
The District's state-only program, POWER, is also available for TANF customers unable to meet TANF work requirements due to a physical or mental incapacity. POWER provides locally-funded cash assistance to these families.
Eligibility Criteria 2.3.2
TANF benefits are available to District families with a minor child or pregnant women when the group income is below the income-eligibility standard which varies by group size. Federal and District law deny assistance to the following individuals:
- certain groups of immigrants;
- individuals convicted in the last ten years of receiving benefits in two or more states; and
- unmarried teen parents not living in an approved adult-supervised setting and who have not been given an exemption from this requirement.
