In most instances, the Medicaid transition for LIM AUs with an employed member will be to WTM. However, for cases in which the transition is from LIM to RSM, the $30 + 1/3 deduction is allowed in RSM if the employed BG member was included in an AU that had correctly received LIM in one of the four months immediately preceding each month of the $30 + 1/3 deduction, regardless of whether the month is retroactive, initial, or ongoing. If there is no break in Medicaid eligibility between receipt of LIM and RSM and the AU member with earnings did not receive the $30 + 1/3 deduction in LIM, that individual could be eligible for the $30 + 1/3 deduction in RSM for the next four consecutive months. After the $30 + 1/3 deduction expires, the BG will be eligible for the $30 deduction for the next eight consecutive months. For example, if the LIM AU had new earnings,
but was not eligible for TMA, then in the CMD for RSM, the $30 + 1/3 deduction
would be allowed. The chart below illustrates this transition:
If the LIM AU had begun to receive the
$30 + 1/3 deduction, but became ineligible for LIM and was not eligible
for TMA, then in the CMD for RSM, the $30 + 1/3 deduction would be continued
from the LIM case to the RSM case. The chart below illustrates the
transition:
If there is a break in Medicaid eligibility between receipt of LIM and RSM, then the individual with earnings may not be eligible for a full four months of the $30 + 1/3 deduction. If an individual does not receive four consecutive months of $30 + 1/3, then the individual does not receive the eight months of the $30 deduction. For example, if the LIM AU last received benefits
in January, reapplied in May, but was ineligible for LIM, then $30 + 1/3
could be used in RSM. To be eligible for $30 + 1/3, the AU would
have to have correctly received LIM in one of the previous four months.
The chart below illustrates this concept:
In June, this AU would not be eligible
for the $30 + 1/3 deduction as the chart below illustrates:
Note that since the AU did not use all four months of the $30 + 1/3 deduction, it is not entitled to the eight months of the $30 deduction. |