An official State of Texas website.
Revision 02-6; Effective July 1, 2002
A—841 General Eligibility Information
Revision 15-4; Effective October 1, 2015
TP 07
Some TP 08 household members may be eligible for transitional Medicaid, TP 07.
An eligibility determination for TP 07 is based on whether a parent or caretaker relative is certified for TP 08, Parents and Caretaker Relatives Medicaid, in Texas for three of the six months before the first month of ineligibility. If a parent or caretaker relative certified for TP 08 coverage is eligible for transitional Medicaid, his or her children will be eligible as well. Each individual will be certified on an individual transitional Medicaid EDG for the duration of the certification period.
Example: The household composition consists of mother, father, and two mutual children. The mother and father each are certified on an individual TP 08 EDG in Texas for three of the six months before the month of ineligibility and each child on an individual Children's Medicaid EDG. The father has an increase in income that makes him ineligible for TP 08. The father is then certified on an individual TP 07 EDG. The mother and the two children will be certified on individual TP 07 EDGs, each with the same certification period as the father.
When a TP 07 EDG has been created, other eligible household members receive a new TP 07 EDG. See A-846.1, Parents and Caretaker Relatives Enter or Already Live in the Home, and A-846.2,Child Enters or Already Lives in the Home.
A household member is not eligible for TP 07 if the member was ineligible for TP 08 because the individual committed fraud during any of the six months before the TP 07 EDG was opened. The fraud must be determined by a court or through a hearing. If the TP 07 EDG was opened before the fraud determination was known:
- the household member is disqualified using advance adverse action notice procedures, and
- transitional child care staff must be notified that the member should not have received transitional benefits because of Medicaid fraud.
TP 08 households denied for any reason (such as failure to keep an appointment) may request TP 07 during the adverse action time frame and have their eligibility determined. For example, a household who failed to keep their appointment because of a new job may be eligible for TP 07.
Individuals may request Medicaid on TP 08 any time after denial. These individuals and their household members may also request TP 07 if they become employed.
The number of months of transitional coverage is 12 months.
A—841.1 Multiple Changes That Cause TP 08 Ineligibility
Revision 15-4; Effective October 1, 2015
TP 08
If two or more changes (when one is new or increased earned income) cause the income to increase from less than the FPIL for TP 08 to more than the FPIL for TP 08 for the same month, and the household has not been notified that members are eligible for TP 07, advisors follow the steps below:
| Step | Action |
|---|---|
| 1 |
If all other case factors remain the same, is the household income increased to above the FPIL for TP 08 because of new or increased earnings?
|
| 2 |
Is the income increased to above the FPIL for TP 08 as a result of a change other than new or increased earnings?
|
| 3 |
Does the family meet the income limits for the Medical Program EDGs for which they are certified?
|
| 4 |
Is the income increased to above the FPIL for TP 08 when all changes are considered? Yes. The family is eligible for TP 07 if the members meet the other eligibility requirements. |
Changes reported in a timely manner do not stop the denial of the TP 08 EDG and creation of the TP 07 after the household is notified of transitional Medicaid eligibility, even when both changes affect the same month.
Exceptions: The EDG is denied if the household:
- moves out of Texas;
- no longer meets the household composition requirement as specified in A-841.3, Eligibility Criteria During Transitional Medicaid Coverage; or
- reports a change that makes the household ineligible before the first month of transitional Medicaid eligibility.
A—841.2 Notice to Clients
Revision 15-4; Effective October 1, 2015
TP 08
When TIERS denies a TP 08 EDG and creates a TP 07, TIERS generates Form TF0001, Notice of Case Action, to notify the household:
- that their TP 08 and their children on associated TP 43, TP 44 and TP 48 EDGs are denied;
- the date their TP 07 benefits will end; and
- about the transitional Medicaid eligibility and reporting requirements. Note: If the individual is in the office, the advisor may explain the reporting requirements.
A—841.3 Eligibility Criteria During Transitional Medicaid Coverage
Revision 15-4; Effective October 1, 2015
TP 07
Certified members remain eligible for transitional Medicaid if the:
- household continues to live in Texas, and
- EDG meets one of the following household composition requirements.
| The transitional EDG includes an eligible child. Note: For transitional Medicaid, an eligible child is a child who meets all of the following requirements:
|
OR | A parent or caretaker relative cares for a child who receives:
|
The noncomplying adult who is certified for TP 07 is denied when the advisor receives notice that the legal parent failed to cooperate with third-party resource (TPR) requirements or has been found guilty of a Medicaid intentional program violation.
If another-related caretaker failed to cooperate with TPR requirements or was found guilty of a Medicaid intentional program violation, the advisor must:
- change the status to payee, or
- deny the transitional Medicaid EDG if the other-related caretaker is the only person on the EDG.
The advisor must not:
- count unearned income of household members when determining continued eligibility for households certified for transitional Medicaid; or
- deny a transitional Medicaid EDG because of new or increased income of a household member, unless reported in the seventh or tenth month Medicaid Status Report.
A—842 TP 07 Transitional Medicaid
Revision 15-4; Effective October 1, 2015
TP 08
TP 08 certified members are eligible for TP 07 if:
- at least one of the group members was eligible for and received TP 08 in Texas for three of the six months before the first month of ineligibility; and
- the denial is because:
- a certified parent, certified caretaker relative, or disqualified legal parent began receiving or had an increase in gross earned income; or
- of the earnings of a new or returning absent parent who is added to the certified group because the household meets incapacity or deprivation criteria.
A—842.1 Determining the First Month of TP 07 Medicaid
Revision 15-4; Effective October 1, 2015
TP 08
The first TP 07 month is the month the change is effective (when reported and acted on timely) when new or increased earnings cause a certified parent or caretaker relative on TP 08 to be over the FPIL for TP 08.
Determine the first month of TP 07 eligibility using the following chart:
| Step | Action |
|---|---|
| 1 |
The first month of TP 07 is the first month after adverse action expires when the change is reported, verified, and processed timely (or should have expired if the change was not reported, verified, or processed timely). Note: The first month can be no later than the first month of overpayment as described in B-752.1.2, Errors After Certification, but may be earlier based on the date the notice of adverse action expires (as described in A-2343.1, How to Take Adverse Action if Advance Notice Is Required). |
| 2 |
Was at least one household member eligible for and did that member receive TP 08 in Texas for at least three of the six months prior to the month identified in Step 1? (See A-842.2, Determining the Three of Six Months Eligibility Requirement.) If yes, continue to Step 3. If no, deny the EDG. |
| 3 | Designate the month from Step 1 as the first month of TP 07 eligibility. |
Individuals who appeal the advisor's decision to deny the TP 08 EDG often receive TP 08 while the appeal is pending. If the hearing officer sustains the advisor's decision, the months the client received continued benefits during the appeal process are counted as TP 07 months.
A—842.2 Determining the Three of Six Months Eligibility Requirement
Revision 20-1; Effective January 1, 2020
TP 08
Advisors must determine whether at least one household member was eligible for and received TP 08 in Texas for three of the six months before the first month of ineligibility.
Advisors must count any month when at least one household member was eligible for and received benefits. Advisors must include any month that someone in the household received TP 08.
Advisors must not count any month benefits were:
- issued but the household was not eligible;
- not issued;
- received in another state;
- prior Medicaid coverage; or
- Medicaid only for the application month due to certification in a later month.
TP 08 with Other Household Members on a Medical Program
Advisors must determine whether at least one TP 08 household member was eligible for and received Medicaid in Texas for three of the six months before the first month the income increase is effective.
Advisors must count any month when at least one household member was eligible for and received Medicaid through:
- TP 08, TP 20, TP 40, TP 43, TP 44, TP 45, TP 48, or TP 56 and spend down was met;
- SSI, including SSI Medicaid only;
- federal, state, or local foster care; or
- adoption assistance.
Advisors must not count any months Medicaid benefits were:
- certified but the household member was not eligible;
- received in another state; or
- prior Medicaid benefits.
A—842.3 Automatic Denial of TP 07
Revision 15-4; Effective October 1, 2015
TP 07
Recipients terminated from TP 07 must be retested for eligibility for any other Medical Programs, as explained in A-2342.1, Retesting Eligibility.
A—843 Reserved for Future Use
Revision 20-2; Effective April 1, 2020
A—844 Transitional Medicaid Reporting Requirements for TP 07
Revision 15-4; Effective October 1, 2015
TP 07
Individuals receiving TP 07 coverage are required to report the following changes during the 4th, 7th and 10th months of the transitional period:
- Changes in the household members' gross monthly earnings, and
- Changes in the household composition.
Form H1146, Medicaid Report, is computer-generated and is sent to the household at cutoff in the 3rd, 6th and 9th months. Form H1146:
- informs the household of the availability of continuing transitional coverage,
- provides information about the change reporting requirements, and
- provides a way to report the required information.
Advisors use Form H1146-M, Medicaid Report (Manual), to replace TIERS-generated forms that the household reports are lost or destroyed.
Advisors must not require verification for the transitional Medicaid EDG. Exception: Advisors must require appropriate verifications to determine whether a new household member is eligible to be added to the EDG. See A-846.1, Parents and Caretaker Relatives Enter or Already Live in the Home, and A-846.2, Child Enters or Already Lives in the Home.
Note: If the household does not return Form H1146, no action is required.
A—844.1 Staff Action on the Fourth Month Medicaid Report
Revision 21-1; Effective January 1, 2021
TP 07
Use the following procedures to process Form H1146-M, Medicaid Report, for the fourth month. Take action on the household members' other EDGs and cases if the reported information affects those benefits.
| If the household returns Form H1146 and Form H1146 indicates … | then … |
|---|---|
| the household still meets the household composition requirements in A-841.3, Eligibility Criteria During Transitional Medicaid Coverage, | take no action on the transitional Medicaid case. |
| a child who is not receiving TP 43, TP 44, TP 45, TP 48, or transitional Medicaid is in the home, | see A-846.2, Child Enters or Already Lives in the Home. |
| a child left the home, | see A-846.3, Household Member Leaves the Home. |
| a returning absent parent or stepparent, | see A-846.1, Parents and Caretaker Relatives Enter or Already Live in the Home. |
| a household member certified for TP 07 reports a pregnancy, | explore TP40 eligibility for the pregnant household member. |
| the household no longer meets the household composition requirements in A-841.3, |
|
|
shorten the transitional Medicaid coverage to end after the sixth month. Note: If the medical coverage is shortened because the parent or caretaker relative did not have earnings for a complete month, inform the household that they can show good cause. They must show good cause within 13 days. (See A-844.4, Good Cause Determinations.) |
* See A-844.3, 185% FPIL Test, for budgeting policies.
Related Policy
Eligibility Criteria During Transitional Medicaid Coverage, A-841.3
185% FPIL Test, A-844.3
Good Cause Determinations, A-844.4
Parents and Caretaker Relatives Enter or Already Live in the Home, A-846.1
Child Enters or Already Lives in the Home, A-846.2
Household Member Leaves the Home, A-846.3
A—844.2 Staff Action on the Seventh and Tenth Month Medicaid Reports
Revision 21-1; Effective January 1, 2021
TP 07
Use the following procedures to process Form H1146-M, Medicaid Report, for the seventh and tenth months. Take action on the household members' other EDGs and cases if the reported information affects those benefits.
| If the household returns Form H1146 and Form H1146 indicates … | then … |
|---|---|
| the household no longer meets the household composition requirements in A-841.3, Eligibility Criteria During Transitional Medicaid Coverage, | deny the EDG and send Form TF0001, Notice of Case Action. |
|
If the EDG is denied and the household is not eligible for another type of Medical Program, send Form H1010, Texas Works Application for Assistance – Your Texas Benefits, along with Form TF0001. HHSC must act on received information (earnings) that makes the household ineligible for transitional Medicaid even if the information is received outside of the reporting period (i.e., changes); however, eligibility can only be terminated at the end of the seventh or tenth month. Note: If the denial is because the parent or caretaker relative did not have earnings for a complete month, inform the household that they can show good cause. They must show good cause within 13 days. (See A-844.4, Good Cause Determinations.) |
| the household continues to be eligible, | take no action. |
| a child who is not receiving TP 43, TP 44, TP 45, TP 48, or transitional Medicaid is in the home, | see A-846.2, Child Enters or Already Lives in the Home. |
| a child left the home, | see A-846.3, Household Member Leaves the Home. |
| a returning absent parent or stepparent, | see A-846.1, Parents and Caretaker Relatives Enter or Already Live in the Home. |
| a household member certified for TP 07 reports a pregnancy, | explore TP40 eligibility for the pregnant household member. |
* See A-844.3, 185% FPIL Test, for budgeting policies.
Note: A denial notice (Form TF0001) will be sent to the household at the end of their 12 months of transitional Medicaid.
Related Policy
Eligibility Criteria During Transitional Medicaid Coverage, A-841.3
Good Cause Determinations, A-844.4
Parents and Caretaker Relatives Enter or Already Live in the Home, A-846.1
Child Enters or Already Lives in the Home, A-846.2
Household Member Leaves the Home, A-846.3
A—844.3 185% FPIL Test
Revision 15-4; Effective October 1, 2015
TP 07
Advisors use the following policies and procedures to determine whether the household's earnings are at or below the 185 percent FPIL when processing Medicaid reports.
Advisors must include all members of the individual’s MAGI household composition when determining the MAGI income.
Exceptions:
- Advisors must not count the earnings of a child who is exempt according to A-1341, Income Limits and Eligibility Tests.
- See A-240, Medical Programs, and A-1341 for exceptions to household composition and countable income.
- When a person is disqualified because of failure to cooperate with child/medical support or TPR requirements, or is found guilty of a Medicaid intentional program violation, the person is not included in the household size.
| If the person who fails to cooperate is … | then … |
|---|---|
| a certified legal parent, | count the person’s earnings. |
| an "other relative" caretaker who is the parent or stepparent of a child on the case, | count the person’s earnings. |
| an "other relative" caretaker who is not a parent or stepparent to a child on the case, | do not count the person’s earnings. |
A—844.4 Good Cause Determinations
Revision 15-4; Effective October 1, 2015
TP 07
Good cause for the caretaker relative not having earnings in one or more of the report months includes:
- involuntary loss of employment,
- illness,
- actively looking for work but unable to find a job, and
- other reasons beyond the household's control.
A—845 Reinstatement of Denied Transitional Coverage
Revision 15-4; Effective October 1, 2015
TP 07
Certain households whose transitional Medicaid EDGs are denied before the end of their original eligibility period may have transitional Medicaid coverage reinstated. Advisors must reinstate eligible household members for the remainder of their original transitional Medicaid period if:
- the original transitional Medicaid end date has not expired;
- the TP 07 was denied — for example, members:
- were recertified for TP 08; or
- moved out of Texas;
- the household does not want to apply for TP 08 or is not eligible for TP 08 (at application, review, or change); and
- there is a dependent child in the household certified for Medicaid.
Note: Individuals requesting reinstatement of TP 07 transitional Medicaid must have remained continuously eligible for transitional Medicaid during the months the TP 07 EDG was denied. Exception: A household that moved out of Texas must meet all of the eligibility criteria except residence.
A—845.1 Advisor Action on Reinstatements
Revision 15-4; Effective October 1, 2015
TP 07
Advisors must count the months of absence from transitional Medicaid as if the family had actually received transitional Medicaid.
Advisors use the following table to determine the MED:
| If the member ... | then enter the day ... |
|---|---|
| remained in Texas during the transitional Medicaid denial period and did not receive other Medicaid coverage, | following the denial date. |
| moved out of the state, | the member returned to Texas and was no longer eligible for Medicaid in another state (see A-822, Medicaid Coverage for New State Residents). |
| was certified for TP 08 or another Medical Program, | following the denial date on the other TP 08 or other Medicaid EDG. |
To reinstate denied transitional Medicaid, advisors must:
- Determine which mode to use. If the case status is denied and there is:
- no active EDG, use Reopen mode.
- an active EDG, use Complete Action mode.
- On the Program Summary page, select Reactivation from the Program Action drop-down menu.
- On the Program Details page, enter the Reactivation Date and select the appropriate Reactivation Reason.
- From the Program – Individuals Summary display, select the person(s) requesting aid.
- Change Aid Requested to Yes. Note: The Date Requested is defaulted to the previous date for individuals who were on the EDG when it was terminated.
- Continue through Data Collection.
- In Disposition, choose Administrative TMA Reinstatement as the reason for eligibility.
Notes:
- Advisors must not open a new application. If a new application was created, it is denied as filed in error.
- When processing the reinstatement, any members who are no longer in the household are removed.
- Advisors send Form TF0001, Notice of Case Action, to notify the household of their continued eligibility.
Advisors must obtain information on household composition and earnings for the months the household did not receive TP 07 and is required to report on Form H1146, Medicaid Report.
| If the household missed the … | then obtain information on months … |
|---|---|
| fourth month Medicaid report, | one, two, and three. |
| seventh month Medicaid report, | four, five, and six. |
| tenth month Medicaid report, | seven, eight and nine. |
| If the household was … | then … |
|---|---|
| certified for Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), or any of the Medical Programs, | use case information, requesting additional information from the household only if necessary. |
| not certified, | obtain the necessary information. |
Advisors determine whether the individual was continuously eligible for TP 07 Medicaid using:
- A-844.1, Advisor Action on the Fourth Month Medicaid Report, for the fourth-month Medicaid Report;
- A-844.2, Advisor Action on the Seventh and Tenth Month Medicaid Reports, for the seventh- and tenth-month Medicaid Reports; and
- A-844.4, Good Cause Determinations, to determine good cause for no earnings.
A—846 Special Household Composition Policies for Transitional Medicaid
Revision 13-2; Effective April 1, 2013
A—846.1 Parents and Caretaker Relatives Enter or Already Live in the Home
Revision 15-4; Effective October 1, 2015
TP 07
Advisors must follow the procedures below if the household requests TP 07 benefits for a caretaker, returning absent parent, stepparent, or second parent in the home.
Advisors must add the member to the case and open a new TP 07 EDG for the individual, or change an ineligible member to eligible if the person is a caretaker or second parent who:
- was disqualified on the TP 08 or transitional EDG but has complied with the eligibility requirement for which he was disqualified (for example, TPR);
- is a returning absent parent/second parent in the home; or
- is a stepparent caretaker because the legal parent has a disability and is unable to care for the children.
A—846.2 Child Enters or Already Lives in the Home
Revision 15-4; Effective October 1, 2015
TP 07
Advisors follow the procedures in the chart below:
- when the TP 07 household reports that a child who is not receiving TP 07, TP 43, TP 44, TP 45, or TP 48 is in the home;
- when denying a TP 08 EDG and opening a TP 07 EDG; and
- upon review of another Medical Program EDG for a child who lives with a TP 07 recipient.
An other-related child's separate Medical Program EDG continues unless the caretaker needs Transitional Child Care services for the child.
| If a child who is not receiving TP 43, TP 44, TP 45, TP 48, or transitional Medicaid … | then … |
|---|---|
| is a newborn, moves in, or already lives in the home, |
obtain the appropriate information/verifications and determine if the child meets all of the following requirements:
Use information/verifications from other case records when the child is currently or has been a TANF/Medical Program or SNAP recipient. Do not consider the following criteria:
Note: Obtain information regarding a child's earned income when processing the seventh and tenth month Medicaid reports if the child's earnings are counted, following Medical Programs policy explained in A-1341, Income Limits and Eligibility Tests. If the child is eligible, then send Form TF0001, Notice of Case Action, to the household to inform the household of the child's eligibility. If the child is not eligible or the household does not provide the information/verification, then:
|
If a child who is added to the case has unpaid medical bills for any of the three months prior to the month the request is received to add the child, advisors must:
- determine and document three months prior eligibility according to Medical Programs policies and procedures in A-830, Medicaid Coverage for the Months Prior to the Month of Application; and
- assign the child an MED beginning the first prior month the child met all TP 07 eligibility requirements.
The child's MED cannot precede the:
- first month the household was eligible for TP 07 (advisors must determine a child's eligibility for another Medical Program if the individual applies for prior coverage that precedes the first month the household is eligible for TP 07); or
- date the child entered the household.
A—846.3 Household Member Leaves the Home
Revision 15-4; Effective October 1, 2015
TP 07
Follow the procedures in the chart below when the transitional Medicaid household reports that a child leaves the household.
| If a child leaves the household and the … | then … |
|---|---|
|
|
| household no longer meets the household composition requirements in A-841.3, |
|
Advisors follow normal procedures to remove a parent or caretaker relative when the household reports the person is no longer in the home.
A—846.4 Minor Parents Certified as Children
Revision 15-4; Effective October 1, 2015
TP 07
See A-240, Medical Programs, for household composition rules.
A—847 Other EDG Actions
Revision 13-2; Effective April 1, 2013
A—847.1 Changes Affecting Transitional Medicaid EDGs
Revision 21-1; Effective January 1, 2021
TP 07
For TP 07 EDGs, only take action for the following changes:
- A household member reports a pregnancy. Explore TP 40 eligibility for the pregnant household member.
- A child is born, moves in, or is already living with the certified group. Add the child to the case and open a TP 07 EDG following procedures in A-846.2, Child Enters or Already Lives in the Home.
- A parent or caretaker relative moves in or otherwise becomes eligible. Add the member to the case and open a TP 07 EDG following procedures in A-846.1, Parents and Caretaker Relatives Enter or Already Live in the Home.
- A member included in a TP 07 EDG leaves the household. Remove the member from the case following procedures in A-846.3, Household Member Leaves the Home.
- A household member is no longer eligible. Remove the member from the case. For example:
- A child no longer meets the Medical Programs age criteria.
- A child moves out of state.
Related Policy
Parents and Caretaker Relatives Enter or Already Live in the Home, A-846.1
Child Enters or Already Lives in the Home, A-846.2
Household Member Leaves the Home, A-846.3
A—847.2 Reapplication for TP 08
Revision 15-4; Effective October 1, 2015
TP 07
A household receiving TP 07 may reapply for TP 08 by submitting an application. If the household is eligible, TIERS will:
- deny the TP 07;
- certify the parent/caretaker relative on a TP 08 EDG and the child on the appropriate Children’s Medicaid EDG; and
- send Form TF0001, Notice of Case Action, to the household.
Related Policy
Minor Parents Certified as Children, A-846.4