IMA POLICY MANUAL
PART VII: SPECIAL MA PROCESSING
CHAPTER 1: SPECIAL MA GROUPS AND PROGRAMS
This chapter presents the policies concerning the following groups or programs and applies to MA only:
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Transitional Medicaid Assistance,
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Refugee-Related Assistance,
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Pickle Amendment (Section 503 Individuals),
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Disabled Widow(er)s,
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Early Widow(er)s (Kennelly Widow(er)s),
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Adult Disabled Children,
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Medicare Buy-In (QMBs, SLIMBs, QI-1, and QDWIs),
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Disabled Individuals Returning to Work, and
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50-64 Demonstration.
See Exhibit VII-1: Income and Asset Standards for income and asset standards for these special MA groups.
| Special MA Groups |
MA: D.C. Code 4-110(3) |
MA: 42 USC 1383c et seq; 42 USC 1396a (a); 42 USC 1396a(a)(10)(E); 42 USC 1396d(p)(1)-(2); 42 USC 1396d(s); 42 USC 1396r-6 et seq.; 42 USC 1396u-3;42 CFR 435.133-.134;42 CFR 435.137-.138 |
| Refugee Medical Assistance |
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MA: 45 CFR 400.93-.107 |
TRANSITIONAL MEDICAID ASSISTANCE (TMA) 1.3
AR: N/A
AX: TMA is not related to a recipient's losing eligibility for TANF. It is related to a recipient's losing eligibility for regular MA.
TMA is available to groups consisting of parents, caretaker relatives, and/or children under 19 when an increase in earnings or child support causes the group's income to exceed the AX income standard (200 percent of the FPL for parents, 300 percent for children.)
TMA is only available if increased earnings or child support cause the group to exceed the income standard for AX. Also, the group must have received MA for at least three of the six months prior to their income exceeding the income standard for AX.
For a group ineligible due to an increase in earnings, the group is eligible for six months of TMA, beginning the first month the agency can act on information that the customer is no longer eligible under AX standards.
For a group ineligible due to an increase in child support, the group is eligible for four months of TMA, beginning the first month the agency can act on information that the customer is no longer eligible under AX standards.
When TMA eligibility ends, the SSR should reevaluate the group's income to determine if it has fallen below AX standards. If the group's income still exceeds AX standards after the TMA eligibility period, the group is no longer eligible for MA. If the group's income has fallen below AX standards, the SSR should recertify the group for MA based on either the AR or AX standards.
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Ms. Goldman and her two daughters receive MA. Mr. Goldman begins paying child, support, which causes Ms. Goldman and her daughters to be over-income for MA. The group's income now exceeds the AX income eligibility limit for both parents and children. Ms. Goldman and her two daughters are eligible to receive TMA for four months. Because the group's income still the AX standard after the four-month period, they are no longer eligible for MA.
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Example 2 |
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A group, consisting of a mother (Ms. Baird) and her two children (John and Steve), leaves TANF. The SSR must first determine whether the group is eligible for MA under the AR or AX program types. Ms. Baird and her two children qualify for MA - she is eligible under AX, and John and Steve are eligible under AR. Eight months later, Ms. Baird's earnings increase, making all family members over-income for MA, even under the AX standards. The group is now eligible for six months of TMA. |
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Example 3 |
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Ms. Arlo and her two children receive MA. Ms. Arlo's earnings increase to an amount greater than 200% of the FPL, but less than 300%. The two children are eligible for MA through the AX program for one year. Ms. Arlo is eligible for TMA under AR for a six-month period. After the TMA period, if her income remains above 200% but below 300% of the FPL, Ms. Arlo will be over-income for Medicaid although her children remain eligible for the remainder of their twelve-month certification. | |
SR: N/A
QM: N/A
REFUGEE MEDICAL ASSISTANCE (RMA) 1.4
The Refugee Medical Assistance (RMA) program provides health insurance comparable to Medicaid to eligible immigrants who do not qualify for Medicaid due to non-financial eligibility requirements. Thus, single, non-disabled individuals and couples without children who would otherwise be ineligible for Medicaid can qualify for RMA.
The following immigrants are eligible for RMA during their first eight months in the United States:
- those who were paroled as a refugee or asylee under section 212(d)(5) of the Immigration and Nationality Act (INA);
- those admitted as a conditional entrant under section 203(a)(7) of the INA;
- those admitted as a refugee under section 207 of the INA;
- those granted asylum under section 208 of the INA; and
- those admitted for permanent residence, provided the individual previously held one of the statuses identified above.
The RMA program uses the MNIL and budgeting methodologies.
Immigrants eligible for RCA are categorically eligible for RMA.
Once an immigrant has been found eligible for RMA, s/he is not required to recertify his/her eligibility nor is s/he required to report any changes in income or resources. That is, once eligible for RMA, the immigrant remains eligible through his/her 8th month in the United States.
For more information about RMA and RCA, see Section 7.5: Refugee-Related Cash and Medical Assistance in Part IV.
COBRA ASSISTANCE PROGRAM 1.5
The District will pay health insurance premiums for certain HIV-infected residents who are eligible for COBRA coverage from a former employer. This program is administered by the HIV/AIDS Administration. Customers may call (202) 727-2500 to apply for this and other benefits for HIV-infected persons. See Section 3.5: HIV Programs in Chapter 3 of this Part.
AR: N/A
AX: N/A
SR: MA is available to former SSI recipients who receive Title II benefits (Social Security) and would be currently eligible for SSI if the Title II COLAs received since SSI eligibility ended were excluded.
To be eligible under the Pickle Amendment, the individual must:
- currently receive Title II benefits,
- have stopped receiving SSI benefits after April 1977, or
- have received both SSI and Title II benefits in the same month in any month after April 1977.
QM: N/A
AR: N/A
AX: N/A
SR: Prior to 1984, persons age 50 through 59 receiving disabled widow(er)s Title II benefits (Social Security) received less cash assistance than widow(er)s who began receiving benefits at age 60 or older. In 1983, the difference in benefit amount was eliminated. The elimination caused some persons to lose SSI or SSP eligibility and consequently MA categorical eligibility. These individuals are eligible for MA on a categorically needy basis (see Chapter 12: Categorical Eligibility in Part IV) if they meet certain criteria. A person is eligible if s/he:
- applied to MA before July 1, 1988;
- was entitled to Title II benefits (Social Security) for December 1983;
- was entitled to and received Title II benefits (Social Security) for disabled widow(er)s for January 1984;
- became ineligible for SSI/SSP the first month the increase in disabled widow(er)s Title II benefits (Social Security) was paid;
- has been continuously entitled to disabled widow(er)s benefits since the increase was received; and
- would be eligible for SSI/SSP benefits if the amount of the increase and any subsequent Title II benefit (Social Security) COLAs were disregarded.
QM: N/A
