Title 16
15000 AFDC-TANF Related Programs
15300 Prospective (Child Support Extension)
The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), P.L. 104-193, repealed the AFDC program and replaced it with a program of block grants to states for Temporary Assistance for Needy Families (TANF). Prior to PRWORA, a family’s eligibility for Prospective Medicaid was linked to receipt of AFDC. Under PRWORA, a family’s eligibility for Prospective Medicaid is linked to receipt of Medicaid under “Low Income Families with Children under Section 1931. (See DSSM 15120)
Medicaid eligibility is extended for four consecutive months to families who become ineligible for Medicaid under Section 1931 because of a new or increased collection of child or spousal support under title IV-D of the Social Security Act.
15300.1 Collection of Support
Regulations require that the collection of support made by absent parents and spouses be paid directly to the IV-D agency; the Division of Child Support Enforcement (DCSE). Medicaid recipients occasionally receive child or spousal support directly. Extended Medicaid coverage will be provided when collections of child or spousal support that are received by the assistance unit are turned over to the DCSE. Support payments that are not forwarded to the DCSE do not constitute a "collection" under title IV-D; therefore, the family would not be eligible for prospective Medicaid. The amount of support ordered is not material when establishing eligibility for prospective Medicaid. Eligibility is based on the amount of support collected.
15300.2 Eligibility Determination
At the time the family becomes ineligible for Medicaid under Section 1931, determine whether the family meets the following three requirements.
15300.2.1 Three Out of Six Months Requirement
The family must have correctly received Medicaid under Section 1931 in three of the six months immediately preceding the month the family became ineligible for Medicaid under Section 1931.
15300.2.2 New or Increased Child or Spousal Support
The family must have lost eligibility for Medicaid under Section 1931 wholly or partly as a result of new or increased child or spousal support collections under title IV-D.
The family is eligible for the child support extension if the collected support exceeds 185% of the standard of need or the standard of need. The standard of need for Medicaid under Section 1931 is the same as the TANF standard of need. The collection of support must actually cause or actively contribute to ineligibility for Medicaid under Section 1931, even if there are other factors that also contribute to ineligibility or could simultaneously cause it.
15300.2.3 Child Living in the Home
The family must continue to have a child living in the home that meets the age requirement for Medicaid under Section 1931; that is, an individual under age 18 or under age 19, and who is still a full-time student in high school, GED, or equivalent program and will graduate prior to his or her 19th birthday. Emancipated minors are considered adults.
15300.3 First Month of Prospective Medicaid
Families are eligible for prospective Medicaid beginning with the month of ineligibility for Medicaid under Section 1931 due to a new or increased collection of support. The month of ineligibility for Medicaid under Section 1931 is the month in which the family’s income exceeds either 185% of the standard of need or the standard of need. The standard of need for Medicaid under Section 1931 is the same as the TANF standard of need.
If a family's ineligibility for Medicaid under Section 1931 is a result of the collection or increased collection of support and employment or increased earnings, review the file to determine which factor caused the ineligibility. If the collection of support was the determining factor, the family will qualify for four months of continued coverage. If it is determined that earnings caused the ineligibility, the family will qualify for up to 12 months of continued coverage under transitional Medicaid. If a family is eligible for extended Medicaid under Transitional Medicaid as a result of earned income and is also simultaneously eligible for extended Medicaid as a result of the support collection, the family is eligible for up to 12 months of extended Medicaid. The periods of extended Medicaid run concurrently.
15300.4 Composition of Family Unit
All members of the family unit who were eligible for Medicaid under Section 1931 are eligible for the four months continued coverage. In addition, family members who enter or return to the household are eligible for prospective Medicaid if that individual would be included in the assistance unit if the family were now applying for Medicaid under Section 1931. If a member of the family is added to an existing assistance unit that is receiving Medicaid under Section 1931 and the mother receives an increase in support the same month the member is added, that member is entitled to four months of continued Medicaid. A child born to the family during the four- month period will also be covered through the end of the four month period. Remember a child born to a Medicaid mother is deemed eligible for one year.
15300.4.1 Family Members Under a TANF Sanction
Family members under an TANF sanction are eligible for Medicaid under Section 1931 and may be found eligible for the four month extension.
15300.5 Termination of Eligibility
A person or family who becomes ineligible during the four-month period for reasons other than the collection or increased collection of support (such as a child who attains age 18 or a family member who leaves the household) will not be entitled to continued coverage beyond the date of ineligibility.
Prospective Medicaid ends for any individual family member who moves to another state. Coverage ends the month following the month the individual moves to the new state. Eligibility can be reinstated if the individual returns during the four-month period. For example, if the family moved to another state in March, the first month of prospective Medicaid, and moved back in May, the family would again be eligible for prospective coverage in May and June.
There is no requirement that a member of the family be employed throughout the four- month period.
