TMC Overview

TMC is a consumer protection program. This program is for individuals who become ineligible for CalWORKs (CW), parent/caretaker relative MAGI MC, and child MAGI MC aid codes due to increased earnings or a decrease in income disregards. TMC may provide up to 12 months of zero share of cost (SOC) MC coverage.

• CW aid codes: 30, 33, 35, 3E, 3G, 3H, 3L, 3M, 3P, 3R, 3U.
• Parent/Caretaker Relative MAGI MC aid codes: M3, M4.
• Children MAGI MC aid codes: M5, M6, P5, P6, P7, P8, P9, P0, T1, T2, T3, T4, T5, T6, T7, T8, T9, 2C.

When an individual is discontinued from CW due to increased earnings or a decrease in income disregards, he/she must first be evaluated for MAGI MC and then CEC before a TMC evaluation can be completed. If there is no tax filing household information available, the EW must contact the client to collect this information.

For the purposes of this chapter only, the acronym PCMC will be used to identify the parent/caretaker relative and children MAGI MC coverage group who would be potentially eligible for TMC if they were discontinued due to increased earnings or a decrease in income disregards from their respective programs.

Who Qualifies for TMC

Qualifying Criteria

Families are eligible to receive Initial TMC (aid code 39/3T) benefits for a period of up to 6 months following the month in which they became ineligible for CW/PCMC if they were:

• 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.)

          AND

• Discontinued from a federal cash grant or PCMC because of increased earned income from employment of a parent/caretaker relative of a child who is in or added to the CW AU, including parents of an SSI child.

Note: In the case of a two-parent household, TMC eligibility may be due to the earnings of either parent.

If the EW becomes aware within 30 days of the CW discontinuance that the family could have been determined ineligible for cash aid for the above reasons, TMC must be established effective the first of the month following the date of CW ineligibility. This applies to any reason for discontinuance, as long as the family proves that the discontinuance could have been based on the qualifying reasons for TMC.

Example:Example: 

Non-Qualifying CalWORKs Discontinuance Reasons

TMC is not available to individuals who are discontinued from CW for the following reasons. This includes, but is not limited to:

• Marriage or the reuniting of spouses.
• The increased earnings or a decrease in income disregards of a child in the AU.
• An increase in a stepparent contribution. 
• The return of an unmarried absent parent to the home which ends deprivation.
• The stepparent's ability to meet the needs of the parent.
• The increased earnings or a decrease in income disregards of a parent who was:
• Receiving SSI, or
• A caretaker stepparent.

Note: Discontinuance from CW solely due to the receipt of State Disability Insurance (SDI) does not make individuals eligible for TMC. The TMC regulations do not consider receipt of SDI as an “increase in hours or earnings from employment,” therefore, there is no eligibility for TMC.

Definitions/Who Qualifies for TMC

The following CW definitions apply when determining who is eligible for TMC:

Terminology	Definition
Client	An individual is considered to be a CW/PCMC client if he/she: Received CW/PCMC (including zero basic grant, under $10). Is eligible for but not receiving CW/PCMC because of an administrative reason, such as: A determination is pending for the amount of the cash grant, or An overpayment is being adjusted, or A change of the client's representative payee.
	Note: Individuals sanctioned by CW for failure to participate in CalWORKs Employment Services (CWES) activities or failure to pursue child/spousal support are eligible for TMC, and if otherwise eligible, considered clients of CW. Sanctioned individuals should first be evaluated for MAGI MC before TMC. Received a PCMC aid code.
Family	“Family” for purposes of establishing TMC means: All the members of a family unit in which the caretaker relative was eligible for and received CW/PCMC in 3 of the last 6 months, OR Individuals who were members of the CW/PCMC family unit during the month the family was determined to be ineligible. Family members who enter the home during the Initial or Additional 6-month TMC period.
Caretaker Relative	For TMC purposes, a caretaker relative is the individual in the home responsible for the care and control of a dependent child, and must be one of the following: The father, mother, brother, sister, half-brother, half-sister, uncle, aunt, first cousin, nephew, niece or any such individual of a previous generation with the prefixes grand, great, great-great. The stepfather, stepmother, stepbrother or stepsister. The spouse of a individual specified above, even after the marriage has been terminated by death or dissolution.
Child	A child, for purposes of establishing TMC is under 18 years old, or is an 18-year-old who meets the CW age requirements and is in school or a vocational program and expected to graduate before 19 years old. Individuals who do not meet the CW definition of a child are not eligible for TMC unless they met the definition of a child when Initial TMC was approved. If a child should become an adult during the TMC period, he/she may remain on TMC unless he/she is the youngest child in the home. In that case, the entire family is discontinued from TMC, and must be evaluated for other MC programs.

Ineligible Individuals

The following individuals are NOT eligible for TMC:

• A Supplemental Security Income (SSI) client.
• An In-Home Supportive Services (IHSS) client.
• Parents or mutual children with no linkage or the father of an unborn with no other children.
• Individuals who were discontinued from CW due to loss of deprivation when a parent/spouse with earnings returns home.
• Individuals discontinued from CW or PCMC due to the change in the treatment of state disability insurance payments from unearned to earned income, since this is not considered actual earnings from employment.
• Individuals who were convicted of fraud at any time during the last 6 months in which the family received cash-linked MC.
• Individuals who do not meet the CW definition of a child (over 18 years old and not enrolled in school and expected to graduate by 19 years old).

Note: They would remain eligible for TMC if they were a child before entering TMC unless they are the youngest child in the home. In that case, the entire TMC family must be discontinued.

• Individuals who were not eligible for CW and whose income and resources were not counted when determining other family members who were receiving CW (such as a non-needy caretaker relative).
• Individuals who receive assistance under RCA/ECA (aid codes 01 or 08).

Adding an Individual to Existing TMC

In addition to the individuals who were included in the CW or PCMC family unit at the time the family lost eligibility, family members who enter the home during the initial 6-month period or additional 6-month period may be eligible for TMC.

These individuals include:

• Newborn or adopted children.
• Individuals who would have been eligible for CW or PCMC if they had been in the home in the month the family was determined to be ineligible (i.e. absent parent returns home).
• Individuals under CW sanction for failure to cooperate with work requirements or child/spousal support, whose income but not needs were included in the CW AU.
• Other CW sanctioned or ineligible individuals (such as undocumented, fleeing felons, or whose 48-month time limit has expired) whose income, but not needs, were included in the CW AU.
• Individuals in the family who were terminated from SSI due to increased earnings or a decrease in income disregards from other family members on CW or PCMC.
• Optional TMC members.

 

Reminder: Any earned income of the above added individuals must be counted when calculating the family’s earned income if he/she wants to receive TMC. Individuals added to the TMC case only receive TMC for the remainder of the family’s TMC period. Adding a new individual with earnings during the TMC period may cause the family to have earned income over 185% FPL which may cause the family to be ineligible for Additional TMC.

 

Note: For Non-MAGI MC cases, TMC clients are included as "ineligible individuals" in the MFBU when determining the SOC for other family members.

Individuals Leaving the Home

TMC continues for families even if the parents or spouses separate or divorce or children leave the home in either the Initial or Additional TMC period; however, the remaining TMC family must continue to reside in California and must include a child.

Reminder: The family size is reduced when determining the average earned income during the additional 6-month TMC period since the individual who left is no longer included in the MFBU. If the individual who left the home had earned income, then it should no longer be counted in the budget. If the family size changed during the previous 3-month period, use the current family size.

Non-MAGI MC MFBU Composition

Individuals receiving TMC are ineligible members of the MFBU of those individuals who are not eligible for TMC when determining MC eligibility for those family members. However, their non-covered MC healthcare costs could be used to reduce other family members’ or responsible relatives’ SOC.

Optional TMC Members

An individual who is not receiving or requesting MC benefits (i.e. absent parent returns home during the TMC period) is NOT required to be included, and his/her income is NOT counted, and is NOT considered in the family size for the 185% FPL determination. However, if optional members choose to be included during the TMC period, he/she must be added; he/she cannot later be excluded.

Reminder: An absent parent must be added into CalSAWS, whether or not he/she is requesting aid. After the TMC period, the income MUST be counted.

Return to CalWORKs

If a family returns to CW or PCMC during any of the TMC periods and is then terminated due to another reason which does not meet the TMC criteria:

• The family is eligible for the remainder of the original TMC period if they are otherwise eligible.
• The months of zero SOC MC which they received when they returned to CW or PCMC are counted as if TMC were received in those months for purposes of determining the remaining months of the original TMC period.
• They are evaluated for a new Initial TMC period if they meet the requirements of TMC when terminated.

ExampleExample

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EW Procedures

EWs must follow these procedures when determining eligibility for TMC:

1. Determine if the discontinuance of CW/PCMC is due to increased hours of employment or increased employment related earnings of the parent/caretaker relative.

REMINDER: TMC is not available due to marriage or the reuniting of separated spouses/unmarried parents.

2. Review the case information to determine if the family was eligible for and received CW or PCMC in 3 out of the last 6 months. The 3 months do not have to be consecutive.
3. Set up the initial 6 months of TMC on aid code 39/3T if both steps (1 & 2) above apply.
4. The TMC Approval NOA will be automatically generated by CalSAWS when TMC is approved.
5. The case may be transferred no earlier than the first working day of the 2nd month following the month of CW/PCMC discontinuance.

• This is to allow for the possibility of a restoration of CW benefits, should there be an erroneous CW discontinuance, e.g., the client reports an expected increase in hours, yet remains working less than 100 hours per month.
• If CW was erroneously received before the actual discontinuance, the TMC case may be transferred within the first month following the CW discontinuance. Complete any appropriate overpayment referrals.
• If only one month of Initial TMC (aid code 39/3T) eligibility remains, the EW must determine eligibility or ineligibility for Additional TMC (aid code 59/5T) before transferring the case.

ExampleExample

TMC Informing Flyer

The “Request for Transitional Medi-Cal (TMC) or Four Month Continuing Medi-Cal” (MC 325) form contains information about the TMC program and a section for clients to provide information on increased earnings or a decrease in income disregards or child support and request TMC benefits. The MC 325 must be provided to:

• CW and PCMC applicants when MC eligibility is approved,
• CW clients discontinued for failure to complete an annual redetermination (RD) or submit a complete SAR 7, and
• PCMC discontinued for increased income.

Related Topics

Termination of TMC

Redetermination Due to Loss of TMC Eligibility