TMC Status Report

This section covers status report (MC 176 TMC) requirements for both Initial TMC (39/3T) and Additional TMC (59/5T).

TMC Program

Status Report

Initial TMC

(aid code 39/3T)
  • Individuals receiving Initial TMC (aid code 39/3T) must submit a quarterly status report by the 21st day of the 4th month.
  • The MC 176 TMC covers the previous 3-month period, including any month(s) that the family erroneously received CW.
  • The MC 176 TMC does not meet CF reporting requirements.
  • The MC 176 TMC submitted in Month 4 of Initial TMC is used to determine eligibility for Additional TMC (59/5T).
    • Additional TMC can be established if a complete and correct MC 176 TMC is received before the last day of Initial TMC eligibility, and the family’s net non-exempt earned income does not exceed 202% FPL.

Example 1: CW discontinued timelyExample 1: CW discontinued timely

CW is discontinued timely on 7/31 and aid code 39/3T is established 8/1. The first quarterly status report will be generated in October and is due no later than 11/21. The report months are August, September and October.

Example 2: Establishing Initial TMC periodExample 2: Establishing Initial TMC period

The EW learns from the SAR 7 submitted 8/10 that the parent became fully employed 7/9. The family is ineligible for CW in July and August. Establish Initial TMC (aid code 39/3T) as of 7/1. The first status report will be sent at the end of September and is due 10/21. The report months are July, August and September.

Additional TMC (aid code 59/5T)
  • Once Additional TMC eligibility has been established, status reports (MC 176 TMC) are due by the 21st day of:
    • The first month of Additional TMC (month 7 of ongoing TMC eligibility), and
  • The 4th month of Additional TMC (month 10 of ongoing TMC eligibility).
  • Additional TMC can be continued if:
    • A complete and correct status report is received before the effective date of discontinuance.
    • The family is otherwise eligible (e.g., income is at or below 202% FPL).
    • The Additional TMC period has not expired. (Aid code 59/5T can only be received for a maximum of 6 months.)
    • The EW determines that the family has good cause for failure to meet the reporting requirements. (Apply as applicable.)

Good Cause Determinations

A client may have good cause for not meeting the reporting requirements during either the Initial or Additional 6-month TMC period. Good cause exists only when the client cannot reasonably be expected to fulfill his/her reporting responsibilities due to factors beyond his/her control. The burden of proof is on the client.

The following criteria must be met when determining if good cause exists.

  • A good cause determination must only be granted if the request is made by the parent, caretaker relative, or an authorized representative.
  • The client must make a clear written or verbal request for an opportunity to give an explanation for not meeting the reporting requirements.
  • Or, instead of a request, the EW must determine that one of the following reasons for good cause exists:
    • The client has a mental or physical condition which prevents or interferes with timely and/or complete reporting.
    • The delay in reporting or failure to report is due to county error.
    • The EW establishes that there are other extenuating circumstances.

Reminder: The good cause determination must be documented on the Journal page.

Incomplete TMC Status Reports

When a TMC status report is incomplete and additional information is needed to determine ongoing TMC eligibility:

  • Follow ex parte process.
  • Follow the specific TMC program reporting requirements.
    • The Initial TMC (39/3T) status report is due by the 21st day of the 4th month, but TMC benefits cannot be stopped until the end of the 6th month, even when the status report is not received or not complete.
    • The Additional TMC (59/5T) status reports are due by the 21st day of the 1st and 4th months. If the TMC status report is not received, the EW must not terminate benefits until a timely and adequate discontinuance NOA can be provided to the client.

Reminder: The 90-day cure period applies to late TMC reports.

Status Report Verification Requirements

Status reports must include all information and the following verifications for EACH of the 3 months included in the report period.

  • Gross income of all family members, including:
    • The earned income of all family members living in the home who were members of the AU during the month the family became ineligible for CW/PCMC,
    • Earnings of family members who are not eligible for TMC and are receiving MC under another program such as MAGI MC or Non-MAGI MC (except Public Assistance (PA) (i.e. SSI/SSP) or Other PA),
    • Any parent(s) who returns to the home and is added during the TMC period, and
    • Any non-exempt earnings of children.
  • The actual amount of child care paid by the parent/caretaker relative and not reimbursed. (Do not allow child care which will be reimbursed by another source.)
  • The other health coverage premium, in order to be allowed as an earnings deduction.

Non-Exempt Earned Income

The family's average non-exempt earned income is used to determine eligibility for Additional TMC (aid code 59/5T).

  • Exempt earned income is not counted when calculating the family's earnings.
    • Exempt student income
    • Earnings of a child under 14 years old
    • The Earned Income Tax Credit
    • Irregular/Infrequent income
    • Earnings of an optional TMC member.
    • Unearned income is not counted in determining eligibility for Additional TMC.

Determining Average Net Non-Exempt Earned Income

Family earnings must remain at or below 202% FPL to be eligible for additional TMC. The family's average net non-exempt earned income is determined as follows:

  • The average monthly gross earnings for the previous 3-month period after deduction of any monthly child care expenses necessary for employment are compared to 202% FPL for the current family size, even if some family members are not eligible for TMC and are receiving MC under MAGI MC or Non-MAGI MC (except PA or Other PA).

Note: EWs must enter one line of income for each month requested on the report.
CalSAWS will determine the average of the three-month period.

  • Family earnings include those of a child as well as the parent(s) or parent and stepparent. Sneede rules apply.
  • Earnings disregards are not allowed when calculating net non-exempt earnings for Additional TMC (e.g., the $90 work related expense deduction).
  • Deduct the actual out-of-pocket, child care expenses (not reimbursed) paid by the parent/caretaker relative in order to remain employed. (There is no child care expense limit for Additional TMC.)
  • An individual who is not receiving MC benefits and does not wish to be added to the TMC case. For example, an absent parent returning home during the TMC period of his family is not required to be included and his/her income is not counted, nor is he/she considered in the family size.

TMC Status Report Worksheet

The “TMC Status Report Worksheet” (SCD 1638) may be used for a manual calculation. The following illustrates the process used for manual calculations:

  • The “Report Period” includes the 3 months covered by the status report.
  • The “Month Affected” is either:
    • The 1st month of Additional TMC (aid code 59/5T), or
    • The month following the month that the status report is due.
  • The number in the family includes:
    • Individuals receiving TMC, and
    • Ineligible members of the case.
  • Enter 202% FPL used for MC programs.

Does this family include at least one eligible child?

  • If yes, continue.
  • If no, discontinue TMC with a10-day NOA.

Was the parent/caretaker relative unemployed during one or more months of the report period?

  • If yes, determine if there was good cause. Good cause exists if the unemployment results from:
    • Involuntary loss of employment
    • Illness
    • Other good cause (as determined by the EW).
  • If no, continue.

Compute the family's earned income:

To determine the family's average net non-exempt earned income:

  • Include the non-exempt earnings of adults and child(ren) in the case.
  • Include the gross earnings of any other family members who are now in the home and who are not receiving TMC.
  • Subtract any health insurance premiums which are actually being paid by the family.
    • Verify the premium amount.
  • Subtract from the gross earnings, the actual amount of child care paid by the parent/caretaker relative and not reimbursed.

Important: Do not allow child care which will be reimbursed by another source.

  • Divide the quarterly total by 3.
  • After calculating the adjusted monthly income, round it to the nearest dollar before comparing to the FPL income standard. (Use the usual MC rounding rules; if the decimal number is 0.49 or less, round down, and if the decimal number is 0.50 or larger, round up).
  • If the family's average net non-exempt earned income is less than or equal to 202% FPL for the case, establish or continue Additional TMC (aid code 59/5T).

Note: Due to federal requirements, eligibility for Additional TMC is based on the average earnings that the family received in the first 3 months of Initial TMC even though there is a time lag and the income may fluctuate. 

  • If the average net non-exempt income of the household is over 202% FPL:
    • Discontinue Initial TMC (39/3T) at the end of the 6th month, or
    • Discontinue Additional TMC (59/5T) as soon as a timely and adequate NOA can be issued.
    • Evaluate eligibility under another MC and/or healthcare coverage program.

 

For additional guidance, refer to CATS Chewable Byte "How to Enter Income for TMC"

Related Topics

Overview