16 Del. Admin. Code § 15000-15110
This section describes the eligibility requirements for the Transitional Group in accordance with Section 1925 of the Social Security Act. Transitional Group eligibility is an extended eligibility period of up to twelve months for a family who becomes ineligible due to an increase in earned income or hours of employment. Transitional Group eligibility is divided into two periods of six months each.
The twelve-month extension period shall be rescinded when federal authorization or the allocation of federal funding is discontinued and shall include an extension period of four consecutive months described in Section 15110.10.
An individual must meet the general eligibility requirements described in Section 14000.
An individual must have received Medicaid under Section 15100 Parent/Caretaker Relative Group in three of the six months immediately preceding the month of ineligibility under such section.
A parent or caretaker relative is considered to have received Medicaid in any month Medicaid was correctly provided. This does not include Medicaid provided:
| * | in error; |
| * | pending a hearing if the agency's action is upheld and the Medicaid provided is recoverable as an overpayment; or |
| * | for a month of ineligibility because of administrative notice requirements. |
Medicaid must have been received in Delaware for three out of the six months.
The family must become ineligible for Medicaid because of an increase in earned income or hours of employment of the parent or caretaker relative.
This happens when:
| * | an increase in earned income makes the family ineligible; or |
| * | an increase in other income when combined with an increase in earned income causes ineligibility. The parent or caretaker relative whose earnings cause ineligibility must meet the three out of six months requirement in Section 15110.2. |
The increase in earned income or hours of employment must have a causative effect on the loss of eligibility. The following steps are used to determine if an increase in earned income (or other factor) had a causative effect.
If yes, the family is eligible for the Transitional Group.
If no, go to step 2.
If yes, the family is not eligible for the Transitional Group.
If no, go to step 3.
If yes, the family is eligible for the Transitional Group. The increase in earned income or hours of employment was essential to the loss of eligibility. Without that increase, the family would not have lost eligibility.
If no, eligibility continues under the Parent/Caretaker Relative Group.
The parent or caretaker relative must continue to have a dependent child, as defined in Section 15100.1 living in the home.
When the only child no longer meets the age requirement, the parent or caretaker relative is no longer eligible for the Transitional Group. When one child turns age 18 or 19, but there is another child in the family, the child who turns age 18 or 19 is no longer considered a member of the Transitional Group family unit. The rest of the family remains eligible for the Transitional Group.
Transitional Group coverage is provided to all individuals who were included in the family at the time the family became ineligible. This includes a dependent child under the Children Group described in Section 15300. A recipient of SSI is not included in the family unit. Family members who enter the household or family members who were absent but return may be found eligible. An individual who enters the family unit (including a child born to the family during the transitional period) may be eligible for Transitional Group coverage if that individual would have been included in the parent or caretaker relative's family unit if the household were applying in the current month.
The earned income of an individual who has entered or returned to the family unit is included in the gross earnings test and that individual is counted when determining the family size. The earned income of a dependent child, regardless of student status, is not counted.
Transitional Group eligibility begins with the month of ineligibility under the Parent/Caretaker Relative Group due to an increase in earned income or hours of employment. A family who is not timely in reporting the start of employment or an increase in earned income or hours of employment could have the extension period reduced. The family must be notified they are eligible for the Transitional Group and the reasons why coverage under the Transitional Group could be terminated.
The family will receive Transitional Group coverage without any reapplication for the first six months. To continue to receive Transitional Group coverage throughout the first six-month period there must be a dependent child living in the home. Eligibility will be terminated if the family is found to have received Medicaid fraudulently in the preceding six months. A conviction for fraud must be made by a court of competent jurisdiction.
To continue to receive Medicaid during the second six-month period, the following eligibility conditions described in Section 15110.8.1, Section 15110.8.2, and Section 15110.8.3 must be met.
There must be a dependent child living in the home.
The parent or caretaker relative must be employed during each month unless good cause exists.
Good cause includes the following:
The family's gross monthly earned income minus the monthly costs of necessary dependent care must not exceed 185% of the federal poverty level (FPL). The FPL is effective each July for the Transitional Group. There are no limits on necessary dependent care costs. All unearned income and the earned income of a dependent child is excluded.
A family may receive twelve months of Transitional Group coverage even if eligibility is re-established under the Parent/Caretaker Relative Group. The clock on the twelve-month period does not stop running when eligibility for Medicaid under this group is re-established. The twelve months of Transitional Group eligibility run concurrently with months of eligibility under the Parent/Caretaker Relative Group.
If eligibility is lost under the Parent/Caretaker Relative Group for non-work reasons, the Transitional Group extension period is unaffected. If eligibility is lost again under the Parent/Caretaker Group for earned income, a new Transitional Group period may begin.
This section applies if the twelve-month extension period described above is not re-authorized. A family may receive up to four months of Transitional Group coverage provided the requirements described in Section 15110.2, Section 15110.3, and Section 15110.4 are met. There is no income test throughout the four-month period.
16 Del. Admin. Code § 15000-15110