HAR §17-1717.1-10. Categorical requirements

(a) A pregnant woman, or parent or caretaker relative with a child(ren) under age nineteen or an individual who is under age twenty-one and in receipt of foster care, kinship guardianship or adoption assistance who continues to reside in the household shall be eligible under this chapter when the household received medical assistance in at least three of the six months preceding the month the household became ineligible for the Pregnant Women Group, or the Parents or Caretakers Relative Group as follows: (1) Due to an increase in earned income, the household is eligible to receive an initial six months in accordance with section 17- 1717.1-11(a); and (2) An additional six months of coverage in accordance with section 17-1717.1-11(b); or UNOFFICIAL 1717.1-4 (3) Due to the collection or increased collection of spousal support payments, the household is eligible to receive four months of coverage in accordance with section 17-1717.1-11(c). (b) A new household member may be added to the transitional medical assistance household when there is increased income from employment or increased hours of employment. If eligible, a new household member shall be added to the household as of the month of request and not extend beyond the date when the rest of the household is terminated. (c) The time-limited extension periods for transitional medical assistance coverage under section 17-1717.1-11 shall be rescinded when federal authorization or the allocation of federal funding is discontinued and shall encompass only the following: (1) An extension period of four consecutive calendar months when the household was terminated under the provisions of chapters 17-1716 or 17-1717, because of increased earnings or hours of employment; and (2) The household received assistance in at least three of the six months immediately preceding the month in which the household became ineligible for chapters 17-1716 or 17-1717. [Eff 09/30/13](Auth: HRS §346-14; 42 C.F.R. §435.112) (Imp: HRS §346-14; 42 C.F.R. §435.112) 17-1717.1-11 Extension periods. (a) Initial six-month period for transitional medical assistance: (1) Shall be extended to a household who is terminated solely because of increased income from employment or increased hours of employment of the household; (2) Received assistance at least three of the six-months immediately preceding the month in which the household became ineligible in the Pregnant Women Group, or the Parents or Caretakers Relative Group; and (3) Shall include a child as defined in this chapter, or eligibility shall terminate at the end of the first month in which the UNOFFICIAL 1717.1-5 household ceases to include the child. (4) The department shall notify the household of the option to receive an additional six-month period of transitional medical assistance during the third and sixth month of this initial six-month period. (5) Shall terminate at the end of the sixth month period when the household fails to meet the reporting requirements of section 17-1717.1- 12(a), unless the household establishes good cause for failure to report timely. Failure to submit timely due to physical or psychiatric limitations may constitute good cause. (b) Additional six-month period for transitional medical assistance: (1) Shall be extended to a household when the household received transitional medical assistance during the entire initial six- month period according to subsection (a); and (2) Shall include a child as defined in this chapter, or eligibility shall terminate at the end of the first month in which the household ceases to include the child. (3) The department shall notify the household of the reporting requirements of section 17- 1717.1-12(b)(1) during the third month of the additional six-month transition period. (4) Shall terminate when the household fails to meet the reporting requirements of section 1717.1-12(b), unless the household establishes good cause for the failure to report timely. Failure to submit timely due to physical or psychiatric limitations may constitute good cause, or the household had no earnings in one or more of the previous months, unless the lack of earnings was due to involuntary loss of employment, illness, or other good cause. (c) Four-month period for transitional medical assistance: (1) Shall be extended to a household for a period of four consecutive months when the household is terminated from the Pregnant UNOFFICIAL 1717.1-6 Women Group, or Parent or Caretaker Relatives Group because of the collection or increased collection of spousal support payments under Title IV-D of the Social Security Act; and (2) Received assistance in at least three of the six-months immediately preceding the month in which the household became ineligible for the Pregnant Women Group, or the Parent or Caretaker Relatives Group. (3) Shall begin on the date the household became ineligible for assistance and terminated from the Pregnant Women Group, or Parent or Caretaker Relatives Group. (4) When eligibility for the household is terminated retroactively, the four month period shall begin retroactively with the first month in which eligibility through the Pregnant Women Group, or Parents or Caretakers Relative Group was erroneously received. (d) When a household is determined ineligible or exhausts the extension period for transitional medical assistance, the department shall initiate and ensure timely determination of continued eligibility under provisions of this chapter or if terminated, eligibility under other applicable chapters shall be considered. [Eff 09/30/13] (Auth: HRS §346-14; 42 C.F.R. §435.112) (Imp: HRS §346-14; 42 C.F.R. §435.112)