South Carolina Department of Health and Human Services

Medicaid Policy And Procedures Manual

CHAPTER 205 – Low Income Families, Transitional, Refugee Assistance Program

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205.01Low Income Families (LIF) Introduction (Eff. 10/01/05)

205.02Definitions (Eff. 10/01/05)

205.02.01Child (Eff. 10/01/05)

205.02.02Family (Eff. 10/01/05)

205.02.03Caretaker Relative (Eff. 10/01/05)

205.02.04Stepparents (Eff. 10/01/05)

205.02.05Earned and Unearned Income (Rev. 12/01/07)

205.03Joint Custody (Rev. 01/01/11)

205.04LIF Eligibility Criteria (Rev. 03/01/12)

205.04.01Budget Group Considerations (Rev. 07/01/10)

205.04.02Home Living Arrangements (Eff. 07/01/06)

205.04.03Temporary Absence from Home (Eff. 10/01/05)

205.04.04Out-of-Home Living Arrangements (Eff. 10/01/05)

205.04.05Income Determination Requirements (Eff. 10/01/05)

205.04.06Income Limits (Eff. 03/01/11)

205.04.07Individuals Whose Income is Considered (Rev. 05/01/09)

205.04.08Income Received from Shared Living Arrangements (Eff. 10/01/05)

205.05LIF Budgeting (Eff. 03/01/11)

205.05.01Net Countable Income (Eff. 03/01/11)

205.05.02Earned Income Disregards (Rev. 06/01/13)

205.05.03Allocation to Children Outside the Budget Group (Eff. 10/01/13)

205.05.04Stepparent Income (Eff. 10/01/13)

205.05.05Minor Parent Income (Eff. 10/01/13)

205.05.06Treatment of Income and Deductions of Disqualified Budget Group Members (Eff. 03/01/11)

205.05.07Retroactive Coverage (Eff. 03/01/11)

205.05.08Annual Reviews (Rev. 11/01/13)

205.05.09LIF Budgeting Examples (Eff. 10/01/13)

205.06Transitional Medicaid Assistance (Rev. 08/01/09)

205.06.01Extended and TMA Eligibility Periods (Rev. 09/01/09, Eff. 01/01/09)

205.06.01AExtended LIF Period: Up to 12 months (Rev. 01/01/12)

205.06.01BTransitional Medicaid Period 1: Up to 6 months (Eff. 01/01/09)

205.06.01CTransitional Medicaid Period 2: Up to 6 months (Eff. 01/01/09)

205.06.02Transitional Medicaid Assistance (TMA) Screen (Rev. 05/01/09, Eff. 01/01/09)

205.06.03Reporting Gross Monthly Earnings For TMA Periods One and Two (Eff. 10/01/12)

205.06.04Calculating Income Received from Quarterly Reports (Rev. 01/01/12)

205.06.05Effective Date of Eligibility (Eff. 12/01/08)

205.06.06Transitional Medicaid Assistance Quarterly Reports (Rev. 05/01/09, Eff. 01/01/09)

205.06.07Terminations (Eff. 12/01/08)

205.06.08SSI Individuals (Renum. 12/01/08)

205.06.09Adding New Members to an Existing TMA Budget Group (Rev. 11/01/11)

205.06.10Transitional Medicaid Assistance Budgeting Examples (Eff. 10/01/13)

205.06.114-Month Extension on Medicaid Benefits Due to Receipt of Child Support Payments (Eff. 12/01/08)

205.07Refugee Assistance Program (RAP) Introduction (Rev. 03/01/11)

205.07.01Eligibility Criteria (Eff. 03/01/11)

205.07.02Budget Group Considerations (Rev. 06/01/08)

205.07.03Case Processing Procedures (Eff. 10/01/12)

205.07.04Budgeting (Rev. 06/01/08)

205.07.05Retroactive Coverage (Rev. 09/01/12)

205.07.06Changes in Income (Rev. 05/01/09)

205.07.07Closure Procedures (Rev. 05/01/09)

205.07.08RAP Eligibility Determination Flow Chart (Rev. 10/01/10)

205.07.09RAP Budgeting Examples (Rev. 06/01/08)

205.01Low Income Families (LIF) Introduction(Eff. 10/01/05)

Congress enacted welfare reform legislation in 1996. The purpose of the legislation was to give states maximum flexibility in administering the Temporary Assistance for Needy Families (TANF) program. The TANF program, previously known as the Aid to Families with Dependent Children (AFDC) program, is now called Family Independence (FI) in South Carolina.

This legislation intended to de-link Medicaid from TANF. The legislation provides that an individual who receives a TANF cash assistance award is no longer automatically eligible for Medicaid. However, states were given options on the criteria that could be used to determine Medicaid eligibility for TANF-related groups.

The South Carolina Medicaid program selected the option to make the Medicaid eligibility for TANF cash assistance and related Medicaid Only groups as close to the TANF criteria as possible. There are a few differences between Medicaid and TANF criteria, which are noted at the appropriate place in this chapter. For Medicaid purposes, these related Medicaid Only groups are called Low Income Families (LIF).

205.02Definitions(Eff. 10/01/05)

The following definitions apply to Low Income Families program, Transitional Medicaid, 4-Month Extension, and the Refugee Assistance Program.

205.02.01Child(Eff. 10/01/05)

For an applicant/beneficiary to be categorically eligible as a child, he must be under the age of 19. For Low Income Families (LIF), a child must be under the age of 18 or under the age of 19 if he is a full-time student in a secondary school, which must be verified by the Medicaid eligibility worker. The secondary school includes high school or schools with equivalent levels of vocational or technical training such as a GED.

205.02.02Family(Eff. 10/01/05)

A family includes the following individuals living in the household:

  • Individuals whose needs and income were included in the eligibility determination at the time LIF benefits were terminated;
  • Individuals who were under a sanction and had their income, but not their needs, included in the eligibility determination;
  • Individuals whose needs and income would be taken into account in determining eligibility for the parent or caretaker relative’s budget group if the family were applying for the current month; and
  • A child born after LIF benefits were terminated, or a child or parent who returns home after the benefits were terminated. Such a child or parent is included in the family for the purposes of Transitional Medicaid benefits.

Note: Individuals such as Supplemental Security Income (SSI) recipients are not considered a part of the budget group.

205.02.03Caretaker Relative(Eff. 10/01/05)

A caretaker relative is a relative who is considered a caretaker of the children involved. There may be more than one caretaker in the family.

205.02.04Stepparents(Eff. 10/01/05)

A stepparent is excluded from the budget group if there is no child-in-common with the spouse. In determining eligibility for LIF and the initial Transitional Medicaid period, the stepparent’s income, less disregards, is used to establish if the natural parent’s needs are included in the budget group. If the natural parent’s needs were excluded during the initial Transitional Medicaid period due to stepparent income, the natural parent’s needs must be added to the budget group for the last six months of Transitional Medicaid.

205.02.05Earned and Unearned Income(Rev. 12/01/07)

Earnings consist of the earned income of all family members before the application of any disregards other than those required by another federal law. Earned income of children under age 18 (age 18 to 19, if in a secondary school and school attendance is verified) is not counted in the eligibility determination; however, all unearned income is counted.

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205.03Joint Custody(Rev. 01/01/11)

Eligibility may be established even though the child(ren) resides with both parents due to joint legal custody, court-ordered visitation, or informal agreement between the parents. In such cases, the first step to determine eligibility is to determine whether the child is living in the home of the applying parent.

Procedure:
  1. If a child resides in the home of each parent for short alternating periods, such as every other day, week, months, eligibility is determined based on the needs, income, and resources of the parent who maintains at least 51% custody. The time the child spends with the other parent is considered a visit. The application for assistance must be filed by the parent who has primary custody. If the non-custodial parent applies, deny the application using Reason Code 054, “You have not met eligibility rules,” and explain the custodial parent must apply.
  1. If the child resides in the home of each parent for extended periods of time, such as three or more months, eligibility is based on the needs, income, and resources of the parent with whom the child resides at the time of application.
  1. If both parents claim 50% custody, explain that the needs, income, and resources of both are counted in order to determine eligibility since neither has primary custody. The first step is to determine eligibility for the family using the budget workbook. Also, determine if one or both parents are applying.
MEDS Procedure:
(One Parent is Applying)
  • Determine if the non-applying parent is a budget group member in a pending or active budget group in another MEDS household.
  • If not, include both parents and the child(ren) in the MEDS household and take a new application in MEDS, including both parents and the child(ren). The parent that is not applying will be coded as N/A on the Household Member Detail screen (HMS06). On ELD01, the budget group count must account for both parents and the child(ren) and the countable income must reflect the amount used in the budget workbook. Make and Act on Decision to approve or deny the budget group.
  • If the non-applying parent is already in a MEDS household, the applying parent and child(ren) will be in a different MEDS household. Take a new application in MEDS with the applying parent and child(ren). The budget group count entered on ELD01 must account for one parent and the child(ren).
  • If the budget workbook indicated that the family meets the income requirements, enter $0.00 in the countable income field on ELD01 and document the NOTES screen with the actual income. Make and Act on Decision to approve the budget group.
  • If the budget workbook indicated that the family does not meet the income requirements, enter the income used in the budget workbook in the countable income field on ELD01. Make and Act on Decision to deny the budget group.
  • The Notes Screen in MEDS must be annotated as to the action that was taken and the reason(s) why.
(Both Parents are Applying)
  • The parents must be in separate MEDS households. One household will contain one parent and the child(ren) while the other household will contain the other parent.
  • In the household containing a parent and child(ren), take a new application in MEDS including the parent and child(ren). The budget group count entered on ELD01 must account for the one parent and the child(ren).
  • If the budget workbook indicated that the family meets the income requirements, enter $0.00 in the countable income field on ELD01 and document the NOTES screen with the actual income. Make and Act on Decision to approve the budget group.
  • If the budget workbook indicated that the family does not meet the income requirements, enter the income used in the budget workbook in the countable income field on ELD01. Make and Act on Decision to deny the budget group.
  • In the household with the other parent, take a new application in MEDS consisting only of the other parent. The budget group count entered on ELD01 should be 1.
  • If the budget workbook indicated that the family meets the income requirements, enter $0.00 in the countable income field on ELD01 and document the NOTES screen with the actual income. Make and Act on Decision to approve the budget group.
  • If the budget workbook indicated that the family does not meet the income requirements, enter the income used in the budget workbook in the countable income field on ELD01. Make and Act on Decision to deny the budget group.
  • The Notes Screen in MEDS must be annotated as to the action that was taken and the reason(s) why. For reference purposes, the household numbers of both budget groups must also be listed on the Notes Screen.
Note: The Medical Support Referral Form, DHHS Form 2700 ME, is required for #1 or #2; however, it is not required for #3.

205.04LIF Eligibility Criteria(Rev. 03/01/12)

Eligibility criteria for the Low Income Families program include the following:

  • Child(ren) whose parent(s) are sanctioned (that is removed from the FI case) for failure to comply with the work requirement. In this situation, the child(ren) continues to receive Medicaid but the adult who refused to comply with the work requirement does not. The adult that is under a work sanction is not eligible to be included in the budget until the work sanction is cured. The Department of Social Services (DSS) is the only agency that can cure the sanction.
  • Parents and child(ren) who meet Family Independence (FI) income eligibility criteria.
  • A family (parents and children) with little or no income as long as the parent is not under a work requirement sanction, and the family meets eligibility criteria.

Note: South Carolina does not recognize same sex marriages.

The basic eligibility requirements for the Low Income Families program are:

  • Income limits must be less than or equal to TANF.(Refer to MPPM 103.03.)
  • A dependent child must be living in the home.

An individual must also meet the following non-financial requirements that are referenced in MPPM Chapter 102.

  • IdentityMPPM 102.02
  • State ResidencyMPPM 102.03
  • Citizenship/AlienageMPPM 102.04
  • Enumeration/SSNMPPM 102.05
  • Assignment of Rights to Medical SupportMPPM 102.07
  • Applying for and Accepting other BenefitsMPPM 102.08

If the parent of a deemed baby applies for LIF during the baby’s first year, the custodial parent must comply in completing the DHHS Form 2700 ME, Medical Support Referral for Low Income Families (LIF) Cases, if there is an Absent Parent. If the custodial parent does not sign the DHHS Form 2700 ME, the deemed baby remains in Category 12 and eligibility for the deemed baby cannot be terminated until the deemed period is over.

205.04.01Budget Group Considerations(Rev. 07/01/10)

The budget group is determined based on the relationship and living arrangement of the individuals applying for Medicaid. Budget groups are held to the following Medicaid rules:

  • Parents are responsible for their minor children and spouses are responsible for each other.
  • Stepparents are not responsible for their stepchildren.
  • South Carolina does not recognize same sex marriages.
  • If a man and woman who are not related by blood live in the same household but do not allege that they are married to each other or to anyone else, obtain statements from both parties as to whether they hold themselves out to the community as husband and wife. If they agree that they hold themselves out as husband and wife and each is free to marry, accept their statements and consider them married. If they disagree, and there is no evidence to the contrary, do not consider them as married.
  • A stepparent who is the sole caregiver of a child can receive LIF (such as the parent dies or moves out of the home, and the child is left with the stepparent who is now the sole caregiver.)
  • Family members that receive Supplemental Security Income (SSI) or are Medicaid eligible under a SSI-related category as an individual (such as ABD,TEFRA, SLMB, Working Disabled) are not included in the budget group, and his/her needs, income and resources are excluded.

The budget group consists of the following types of individuals who live in the same household:

  • Natural or adoptive parents and their minor children (including deemed infants);
  • Children up to age 18 who are related by blood or adoption;
  • Children from ages 18 to 19 who are related by blood or adoption and who are full-time students in a secondary school (Note: school attendance must be verified); or
  • Any blood relative(s) who are caretaker relatives of children for whom assistance is requested. An adult may be included in the budget group only if he is related to the child(ren) by blood or adoption. This includes sibling, aunt, uncle, cousin, cousin once removed, and grand, great grand, regardless of whether the relationship is by blood or by adoption. It includes the spouse of anyone previously mentioned, even if the marriage has ended due to death or divorce.

The parent or caretaker relative may opt to leave a child out of the budget group. The excluded child's needs and unearned income would not be counted in the LIF BG. There must be at least one Medicaid eligible child in the budget group, a child under age 19 receiving Supplemental Security Income (SSI), or a child under age 19 eligible in an SSI-related Medicaid category.

Note: The child that is left out of the LIF BG cannot be covered in another FI related category of assistance. Medicaid does not allow an individual to be left out of the BG under one category of assistance and become eligible under a less restrictive group.

Examples of Budget Groups:
  • Children and their natural or adoptive parents (including deemed infants)
  • Children and a caretaker relative other than a parent
  • Caretaker relative with dependent children and other children related by blood or adoption
  • Dependent children only
  • Caretaker relative only when all children receive SSI

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205.04.02Home Living Arrangements(Eff. 07/01/06)

The following chart describes individuals in different types of living arrangements and how such arrangements are treated when determining the budget group composition.

LIVING ARRANGEMENT / TREATMENT
Parent is in and out of the home where the caretaker relative and the children reside. / Include the caretaker relative in the BG if requested. Exclude the parent.
Parent lives in the home with the children and a caretaker relative who has legal custody of the children. / Include parent in the BG. Exclude the relative with legal custody.
Both parents are in the home with their minor child(ren). / Include both parents and their children in the BG.
Stepparent in the home, child(ren) in common (Refer to MPPM 205.05.03.) / Include the stepparent in the BG.
Stepparent in home, no child(ren) in common / Exclude the stepparent from the BG; count his income, less disregards, to determine whether to include natural parent.
Stepparent in home, each parent has own child(ren), no child(ren) in common / Treat each a separate budget group since there is no blood relationship
Minor parent is living with her parents and siblings. (Refer to MPPM 205.05.04) / Include all in the BG. If entire family is not eligible, determine amount of parents’ income to consider available to minor parent.
Child/minor parent in foster care receiving Regular Foster Care or Title IV-E payments. / Exclude minor parent, income, and foster care board payment in determining eligibility for the child.
Child living with adoptive parent(s) / Include both parents and child, if adoption finalized.Exclude parents, if not finalized.
A child receiving SSI, foster care payments or subsidized adoption payments living with parents and children / Exclude the child, his income, and SSI, subsidized adoption and foster care payment.
Ineligible or unverified alien/citizenship status / Count the needs and income, less disregards, of the non-citizen parent as well as the needs of the non-citizen siblings. If not legally responsible, disregard income and needs. The unverified alien member is not eligible for Medicaid.
Parent or child who fails to meet citizenship and/or identity requirements / If parent/child fails to meet requirements for citizenship and/or identity, include parent/child’s needs and income, less disregards; however, the parent/child is not eligible for Medicaid.

205.04.03Temporary Absence from Home(Eff. 10/01/05)