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Medi-Cal Update 2025-4 Transitional Medi-Cal (TMC)
Transitional Medi-Cal (TMC) Policy Clarification and Guidance
| Date | References | Clerical | Implementation |
| 04/11/25 | ACWDL 21-27, MEDIL I 23-33E | N/A | Immediately |
Background
Transitional Medi-Cal (TMC) is a consumer protection program which provides continued eligibility for individuals discontinued from certain aid codes solely due to an increase in earnings, a loss of earned income disregards, or increased hours of employment.
Changes
The purpose of this update is to provide guidance on who may qualify for a TMC eligibility determination and guidance for when an individual loses their eligibility for TMC. References to restricted-scope TMC aid codes have also been removed from the guidance in Chapter 26.
The acronym PCMC refers to the MAGI Parent/Caretaker Relative Medi-Cal coverage group receiving aid code M3.
Families are eligible to receive Initial TMC benefits for a period of up to six months following the month in which they lose eligibility for CalWORKS (CW), Parent/Caretaker Relative Medi-Cal Coverage (PCMC), or Mandatory Children's group coverage if they meet all of the following criteria:
- An adult was eligible for and received a federal cash grant or PCMC in at least 3 of the 6 calendar months immediately before the month that ineligibility was determined. (The months do not need to be consecutive.)
- Discontinued solely due to increased earnings, a loss of earned income disregards, or increased hours of employment.
- Have a dependent child in the household under the age of 18, or if age 18, enrolled in school and expected to graduate by their 19th birthday. A dependent child may include a child who is receiving SSI/SSP or Adoption Assistance.
It is important to note that TMC eligibility is dependent on the parent or caretaker's eligibility. If a child's parent or caretaker relative is not eligible for a TMC evaluation, a child receiving Medi-Cal under one of the Mandatory Children's Group aid codes would also not be eligible for TMC.
When an individual loses their eligibility for TMC, the SB 87 process must be followed to determine ongoing eligibility. The required steps of the SB 87 process are:
- Case Review: Attempt an ex parte review to obtain the information needed by reviewing all available data sources without involving the client. If there is not sufficient information available, then continue to Step 2.
- Direct Contact: Attempt to make direct contact with the client by telephone to obtain missing information or verifications. If the client cannot be reached or is unable to provide enough information, then continue to Step 3.
- Medi-Cal Request for Information: Send an MC 355 request for information detailing what information and/or verifications are needed to determine ongoing eligibility and allow 30 days for the client to respond to the request. If after 30 days, there is not enough information, then take appropriate action.
The following topics in the Medi-Cal Handbook have been revised to reflect this policy clarification:
Redetermination Due to Loss of TMC Eligibility
Aid Code after TMC Discontinuance
Other Programs
This information only affects the Medi-Cal Program.
Department of Employment & Benefits Services
Contact Person(s): Megan Turney, SSA BPIS, 408-755-7540