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Revision 16-4; Effective October 1, 2016
A—851 Eligibility Criteria for Medicaid when Receiving Alimony or Spousal Support
Revision 21-2; Effective April 1, 2021
TP 20
People denied TP 08 because of new or increased alimony or spousal support may be eligible for TP 20. TP 20 eligibility determinations are based on a parent or caretaker relative certified for TP 08. Household members are eligible for TP 20 for four months following the last month of TP 08 eligibility if:
- the modified adjusted gross income before receipt of alimony or spousal support was at or below the income limit for TP 08;
- new or increased alimony or spousal support income caused the person’s MAGI household income to exceed the income limit for the household's size; and
- 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 of ineligibility.
If the household is eligible, a separate transitional Medicaid EDG will be created for each parent or caretaker relative and each child.
When a change in new or increased alimony or spousal support is reported, verified, and processed timely, the first month a person may receive TP 20 is the month after the adverse action period expires (or should have expired if the change was not reported, verified, or processed timely).
A person may receive less than four months of TP 20 coverage if the change of new or increased alimony or spousal support is not reported or processed timely.
Note: If a divorce or separation agreement that includes alimony was executed or last modified after Dec. 31, 2018, alimony received is not counted in the person’s household budget.
Related Policy
Determining the First Month of TP 07 Medicaid, A-842.1
Determining the Three of Six Months Eligibility Requirement, A-842.2
Alimony (Spousal Support) Received, A—1326.17
Changes Decreasing Benefits, B-643
A—851.1 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 spousal support) cause the income to increase above the Federal Poverty Income Limits (FPIL) for TP 08 for the same month, and the household has not been notified that members are eligible for TP 20, advisors follow the steps below:
| Step | Action | |
|---|---|---|
| 1 | If all other case factors remain the same, is the household income increased to above FPIL for TP08 because of new or increased alimony/spousal support? |
|
| 2 | Is the income increased to above FPIL for TP 08 as a result of a change other than new or increased alimony/spousal support? |
|
| 3 | Does the household meet the income limits for the Medical Program EDGs for which they are certified? |
|
| 4 | Is the income increased to above the FPIL for TP08 when all changes are considered? | Yes. The household is eligible for TP 20 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 20 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 TP 20 eligibility.
Related Policy
Multiple Changes that Cause TP 08 Ineligibility, A-841.1
A—852 Eligibility Criteria During Transitional Medicaid Coverage
Revision 16-4; Effective October 1, 2016
TP 20
Certified members remain eligible for Medicaid if the household continues to:
- live in Texas; and
- receive alimony/spousal support.
The legal parent who is certified for TP 20 when the advisor receives notice that the legal parent failed to cooperate with child/medical support or TPR requirements or has been found guilty of a Medicaid intentional program violation is denied.
A—853 Automated Process
Revision 16-4; Effective October 1, 2016
TP 08
If the Office of the Attorney General (OAG) receives a new or increased alimony/spousal support collection that is greater than the TP 08 income limits, TIERS determines whether the TP 08 EDG should be denied and a TP 20 opened, or whether the TP 08 EDG should be denied. If either is appropriate, TIERS notifies the individual on Form TF0001, Notice of Case Action.
A—854 Denial of TP 20
Revision 16-4; Effective October 1, 2016
TP 20
Recipients terminated from TP 20 must be retested for eligibility for any other Medical Programs, as explained in A-2342.1, Retesting Eligibility.
A—855 Reinstatement of Denied TP 20 Coverage
Revision 16-4; Effective October 1, 2016
TP 20
Certain households whose TP 20 EDGs are denied before the end of their eligibility period has expired may have transitional Medicaid coverage reinstated. Reinstate eligible household members for the remainder of the original TP 20 Medicaid period if:
- their original transitional Medicaid end date has not expired;
- their TP 20 EDG was denied because the members moved out of Texas; and
- they:
- do not wish to apply for other medical coverage; or
- are not eligible for other medical coverage.
Follow procedures in A-845, Reinstatement of Denied Transitional Coverage, to reinstate TP 20 coverage.
A—856 Special Household Composition Policies for Transitional Medicaid
Revision 16-4; Effective October 1, 2016
A—856.1 Parents and Caretaker Relatives Enter or Already Live in the Home
Revision 16-4; Effective October 1, 2016
TP 20
Advisors follow the procedures below if the household requests TP 20 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 20 EDG for the individual if the person is a caretaker relative or second parent who:
- was disqualified on the TP 08 or transitional EDG but has complied with the eligibility requirement for which the member was disqualified (for example, child/medical support, TPR); or
- is a returning absent parent/second parent in the home.
A—856.2 Child Enters or Already Lives in the Home
Revision 16-4; Effective October 1, 2016
TP 20
Advisors follow the procedures in the chart below:
- when the TP 20 household reports that a child who is not receiving TP 20 or TP 43, TP 44, TP 45, or TP 48 is in the home;
- when denying a TP 08 EDG and creating a TP 20 EDG; or
- upon review of another Medical Program case for a child who lives with a TP 20 recipient.
Advisors must continue an other-related child's separate Medical Program EDG.
| If a child who is not receiving TP 43, TP 44, TP 45, TP 48 or TP 20 … | 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:
If the child is eligible, then:
If the child is not eligible or the household does not provide the information/verification, then:
|
A—856.3 Minor Parents Certified as Children
Revision 16-4; Effective October 1, 2016
TP 20
See A-240, Medical Programs, for household composition rules.
A—857 Reapplication for TP 08
Revision 16-4; Effective October 1, 2016
TP 20
A household receiving transitional Medicaid may reapply for TP 08. If the household is eligible, the advisor must:
- deny the TP 20 EDG;
- create the applicable Medical Program EDG; and
- send Form TF0001, Notice of Case Action, to the household.