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IMA POLICY MANUAL
PART IV: NON-FINANCIAL ELIGIBILITY REQUIREMENTS
Termination of Categorical Eligibility 12.6
| MA |
If TANF or GC benefits are terminated during the benefit period (to the entire group or to a member of the group), review all MA eligibility requirements to determine whether the group or individuals within the group remain eligible. If TANF benefits were terminated due to an increase in earnings or child support do not certify the group as eligible for TMA unless all group members do not continue to qualify for Medicaid under other eligibility categories (see Section 1.3: Transitional Medicaid in Part VII.) Send a notice to inform the group members of any change in eligibility.
When TANF benefits are terminated and the SSR does not have enough information to redetermine MA eligibility, the SSR must set the Medicaid certification end date to the end of the third month following the month in which the TANF termination notice was sent. Medicaid benefits must be continued until the newly set certification period expires (unless the group provides information or the Department otherwise obtains information prior to the end of the certification period that shows the group to ineligible for MA). If the group returns the mail-in Medicaid recertification form, the Department must redetermine MA eligibility. If the form is not returned, MA eligibility will terminate.
| Ms. Carmaly's TANF grant is being terminated effective November 1 because Ms. Carmaly failed to provide the information necessary to redetermine the group's TANF eligibility. The Notice of Adverse Action for the TANF termination is sent in October. The SSR must set the Medicaid certification end date to January -- three months after the month in which the TANF termination notice was sent. ACEDS will generate a Medicaid recertification form to Ms. Carmaly. If she returns the form, IMA will redetermine the group’s Medicaid eligibility. If the form is not returned, the group's Medicaid eligibility will end January 31. |
If SSI benefits are terminated and the Department has no application on file, MA benefits are terminated. The SSR should send a termination notice and advise the group that an MA application must be submitted in order to receive benefits. If SSI benefits are terminated and an MA application is on file (that is, group applied for MA prior to SSI approval), the SSR should set a recertification date in ACEDS. ACEDS will then generate a recertification notice for the group. |
| FS |
When TANF or SSI benefits are terminated to the household or to an individual within a household or when a household adds a member that does not receive TANF or SSI during the benefit period, the household is no longer categorically eligible, unless a TANF-funded brochure was provided at the most recent application or recertification, or a TANF-funded brochure is provided to the customer when the loss of TANF or SSI benefits is determined. All FS eligibility requirements must be reviewed to determine whether the household remains eligible. A notice must be sent to inform the customer of any change in eligibility or benefit level. If still eligible, FS benefits should be continued through the existing certification period.
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| MA |
If questionable, the SSR must verify that the presumed categorically eligible individual:
Receives SSI, GC, or TANF recipients, and
Includes no persons who have been disqualified (see Section 1.5: Excluded Persons in this Part).
Do not independently verify the following items as they have already been verified under SSI, GC, or TANF:
- Assets,
- Income,
- SSNs,
- Alienage or citizenship status, or
- Residency
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| FS |
If questionable, the SSR must verify that the household:
- Meets all of the household composition requirements of Chapter 1: Group Composition in this Part,
- Includes all persons who purchase and prepare food together in one FS household whether or not they are separate cases for TANF and/or SSI purposes, and
- Includes no persons who have been disqualified (see Section 1.5: Excluded Persons in this Part).
The SSR should confirm through ACEDS or SSA records that the household contains only members that are TANF and/or SSI recipients, or confirm through case dictation that the household has received the TANF-funded brochure.
If the household is categorically eligible because all household members are receiving TANF or SSI, do not independently verify the following items for FS purposes as they have already been verified under the other programs:
- Income,
- SSNs, or
- Residency
If the household qualifies for FS under expanded categorical eligibility, you must independently verify:
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Income,
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SSNs, and
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Residency
Since no asset test is applied to categorically-eligible FS households, you do not need to verify assets. |
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