Eligibility Online Manual
M1204B 12 Month Extended Medicaid
Purpose: This section will assist in determining whether individuals are eligible for 12 Month Extended Medicaid benefits.
Current Policy Effective Date: October 1, 2022
Date Last Reviewed: September 21, 2022
Previous Policy: January 1, 2014
POL M1204B: DETERMINING ELIGIBILITY FOR 12 MONTH EXTENDED MEDICAID
1. Adults Must Have Child(ren) In Assistance Unit
Adults must be a caretaker relative in the household of a child under the age of 18.
2. Assistance Unit Must Have Received Family MAGI Benefits
The assistant unit must have received Family MAGI benefits for at least three months within the six previous months.
3. Applicants Must Be Over Income Standard
The caretaker relative must have increased wages due to:
Increased hours of employment.
Returning to work.
4. Applicants Do Not Have Resource Test
5. Applicants Do Not Have To Cooperate with Child Support
6. Benefits Begin The Month After Family MAGI Benefits End
7. Clients Must Be Reviewed
Adult clients must be reviewed every six months when income exceeds 185% FPL. Refer to Section M906 to calculate income.
Clients must be reviewed at the end of 12 months when income is below 185% FPL for all assistance unit members. Refer to Section M906 to calculate income.
Clients must be reviewed for the Family MAGI program when income change is reported any time during the 12 month period. Refer to Section M1204 for information on Family MAGI.
Refer to Section M1403 for information on reviewing eligibility.
Clients must be reviewed for other Medicaid program eligibility before closing cases.
8. Clients May Receive Benefits For 12 Months
Benefits end in the seventh month for individuals age 19 or older when the income level is exceeded. Benefits must continue for the child(ren) for the remaining months of the 12-month eligibility period.
9. New Assistance Unit Members May Be Reviewed For Eligibility
Individuals born into, adopted into, or returning to a family after extended medical benefits began may be eligible for benefits. Individuals are eligible if their income added to the assistance unit’s income would not have impacted eligibility, when the unit was Family MAGI eligible.
10. Clients May Lose Benefits
The case will close on the first day of the next month when any of the following occur:
Client does not complete review.
Eligible child leaves home.
Eligible child turns 18.
Client moves out of state.
Client determined no longer eligible.
12-month period ends and client is no longer eligible.
11. Clients May Have Benefits Suspended
Clients who are reported as incarcerated in a jail or prison will have benefits suspended until they are released.
Defining Group: Social Security Act § 1925
Social Security Act § 1902(e)(12)
Income: Social Security Act § 1931
Reviewing Eligibility: 42 CFR 435.916
1. Resource Transfer Provisions Do Not Apply.
Send 15 day closure notice when an adverse action has occurred.