Redetermination Due to Loss of TMC Eligibility

Complete an ex parte review to determine if there is enough information available to determine ongoing eligibility. If the information is not available, attempt to make direct contact with the client by telephone to obtain the missing information. If the client cannot be reached or is unable to provide the needed information, then send an MC 355 request for information detailing what information and/or verifications are needed to make a determination of ongoing eligibility, allowing 30 days for the client to respond.

Reminder: To be considered verified, information must be within 90 days.

Note: Other health coverage may be available through the employer and the client may qualify for the Health Insurance Premium Payment Program (HIPP).

If the...	Then...
Client does not provide the necessary information within 30 calendar days,	For Initial TMC, discontinue the case at the end of the initial 6-month period with a 10-day NOA. For Additional TMC, discontinue the case as soon as a 10-day NOA can be issued.
Incomplete information is provided within the 30-day timeframe,	Attempt to contact the client by phone or by sending an additional MC 355. Allow an additional 30 calendar days for the client to provide the requested information/verification. For Initial TMC, discontinue the case at the end of the initial 6-month period with a 10-day NOA. For Additional TMC, discontinue the case as soon as a 10-day NOA can be issued.
Requested information is received AFTER the case is discontinued, but within 90 days from the discontinuance date,	The EW must evaluate continued MC eligibility using the information received and rescind the discontinuance action if eligibility exists.
Information is available or the client provides the information, and the client is determined to be eligible for MAGI MC,	Transfer the individuals to the appropriate aid code(s), and send the appropriate NOA to inform the client of the new MC program.
Client is NOT eligible for MAGI MC,	If linkage exists, review for non-MAGI eligibility. If linkage does not exist, approve other healthcare coverage programs.
Client provides information and is determined to be eligible for MC with a SOC,	A 10-day NOA is required. I f there is no time for a 10-day NOA, allow aid code 38 for one month and then transfer to SOC MC. Note: Aid code 38 for one month is not appropriate if the client provides information early enough to send a 10-day SOC NOA.
	Review for CCHIP or APTC coverage as appropriate.

Redetermination Due to Loss of TMC Eligibility

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