2170 Four Months Extended Medicaid

Georgia State Seal

Georgia Division of Family and Children Services
Medicaid Policy Manual

Policy Title:

Four Months Extended Medicaid

Effective Date:

February 2020

Chapter:

2100

Policy Number:

2170

Previous Policy Number(s):

MT 47

Updated or Reviewed in MT:

MT-58

Requirements

Four Months Extended Medicaid (4MEx) provides 4 months of Medicaid coverage for a Parent/Caretaker with Child(ren) AU that becomes ineligible due to the receipt of spousal support.

Basic Considerations

4MEx is available to an AU that becomes ineligible for Parent/Caretaker with Child(ren) because of new or increased spousal support income OR new or increased spousal support income concurrent with changes, other than earned Modified Adjusted Gross Income (MAGI) income, that cause Parent/Caretaker with Child(ren) ineligibility.

Due to the Tax Cuts and Jobs Act of 2017, alimony is no longer considered a deduction or income as of 01/01/2019. Divorces and separations finalized before 01/01/2019, alimony is included as income and can be allowed as a deduction.

An AU with earned MAGI income that becomes ineligible for Parent/Caretaker with Child(ren) because of concurrent increases of spousal support and earned MAGI income should receive TMA. In this instance, the months of TMA and 4MEx would run concurrently.

The AU must have correctly received Parent/Caretaker with Child(ren) in three of the six months preceding the first month of Parent/Caretaker with Child(ren) ineligibility. Refer to 2162 Parent/Caretaker with Children for criteria for correctly receiving Parent/Caretaker with Child(ren). 4MEx would begin the month following the expiration of timely notice.

Parent/Caretaker with Child(ren) ineligibility may be a result of an increase in spousal support and a concurrent change. If the concurrent change alone caused Parent/Caretaker with Child(ren) ineligibility, the AU is ineligible for 4MEx.

“Spousal Support” is court-ordered payment from an estranged spouse or former spouse to the other spouse for support under the terms of a court order or settlement agreement following a divorce. Payments may be in one lump sum, or in a series of monthly payments. Alimony is also termed “spousal support” or “maintenance”.

Increased spousal support is defined as any of the following:

  • the initial receipt of spousal support

  • an increase in the amount of spousal support received

  • the receipt of an additional spousal support payment.

If the AU receives a back payment of spousal support, the lump sum is budgeted as income in the month of receipt unless the accumulation is because of an administrative procedure or error. Refer to 2051 Verification.

Spousal support may be received directly from the divorced spouse or another source such as Clerk of the Court.

Reporting

The AU must report the increase in spousal support within 10 days of receiving the income. If the AU fails to report the change within 10 days of receipt of the increase, the eligibility worker (EW) must determine when the change should have been effective based on the 10 day reporting requirement.

The EW must make the change as soon as possible, but no later than 10 days after the report. If Parent/Caretaker with Child(ren) ineligibility results from the increase in spousal support income, 4MEx eligibility begins the first month following the expiration of timely notice.

Ongoing Eligibility

Once 4MEx eligibility is established, the AU does not have to continue to receive spousal support in each of the four months to remain eligible.

If an A/R loses 4MEx because he/she moves out of state, but returns to Georgia within the same 4 month period, he/she may resume 4MEx for any remaining months.

A notice is sent at the beginning of the four month extended period specifying the months of eligibility under 4MEx. Ensure that the months of 4MEx are determined correctly by GA Gateway and the AU receives appropriate notice.

An AU that becomes eligible for Parent/Caretaker with Child(ren) during the 4MEx eligibility period has the option of receiving Parent/Caretaker with Child(ren) or 4MEx. If the AU elects to receive Parent/Caretaker with Child(ren) and subsequently becomes ineligible, Medicaid cannot be reinstated for the remainder of the original 4MEx period. However, if the reason for Parent/Caretaker with Child(ren) ineligibility would again qualify the AU for 4MEx, a new 4MEx eligibility period may be established.

Procedures

Follow the steps below to establish Medicaid eligibility for the AU under 4MEx.

  1. Determine the amount of spousal support, the date of first receipt and the date reported by the AU. Refer to 2051 Verification.

  2. Determine Parent/Caretaker with Child(ren) ineligibility because of spousal support income; or spousal support income in combination with other MAGI income; or other concurrent change, but not the other MAGI income or concurrent change alone.

  3. Establish that the AU correctly received Parent/Caretaker with Child(ren) in three of the six months preceding the first month of ineligibility for Parent/Caretaker with Child(ren).

  4. Terminate Parent/Caretaker with Child(ren) and approve 4MEx for the AU effective the month following the expiration of timely notice by entering the new or increased income in GA Gateway and allowing the case to cascade to Four Months Extended.

  5. Notify the A/R of the change, specifying the four months of Medicaid eligibility under 4MEx and the individuals covered. GA Gateway will issue the notice.

  6. At the end of the four month eligibility period, complete a Continued Medicaid Determination (CMD) and notify the AU. Refer to 2052 Continuing Medicaid Determination.

Use the following chart to determine the action to be taken because of changes in the AU during the Four Months Extended Medicaid time period.

CHART 2170.1, CHANGES IN AU DURING FOUR MONTHS EXTENDED MEDICAID
IF THEN discontinue 4MEx for AND reinstate 4MEx effective

the individual whose MAGI income qualified the AU for 4MEx leaves the home

OR

the only child in the AU leaves the home

the entire AU and complete a CMD. Refer to 2052 Continuing Medicaid Determination.

If the only child leaves the home, provide a copy of the Medicaid Certification to the adult with whom the child is now living while a CMD is being completed. Use the existing case number during this time.

the month the individual returns, only if there are months remaining in the original 4MEx time period.

any other AU member leaves the home

the individual leaving the AU

the month the individual returns to the AU, only if there are months remaining in the original 4MEx eligibility period.

the entire AU leaves Georgia

the entire AU

the month the AU returns to the state, only if there are months remaining on the original 4MEx eligibility period.

the only child in the AU reaches age 19

the entire AU and complete a CMD. Refer to 2052 Continuing Medicaid Determination.

N/A