What is Transitional Medicaid? How It Works, Eligibility Criteria & How To Apply

An image illustrating What Transitional Medicaid is
Learn what transitional Medicaid is, how it works, who qualifies for it, and how to apply for it/PHOTO: Files

Transitional Medicaid is a program that provides temporary health insurance coverage to low-income families who lose their eligibility for Medicaid due to increased income from employment.

It helps families make the transition from welfare to work without losing access to healthcare services.

Let’s dive in and find out what transitional Medicaid is, how it works, who qualifies for it, and how to apply for it.

What is Transitional Medicaid?

Transitional Medicaid is a type of Medicaid that is available to families who have been receiving cash assistance from the Temporary Assistance for Needy Families (TANF) program within the past six months.

TANF is a federal program that provides financial and other support to low-income families with children.

When a family leaves TANF due to increased income from work, they may lose their eligibility for Medicaid, which is a health insurance program for low-income individuals and families.

Transitional Medicaid helps bridge the gap between Medicaid and private health insurance by providing coverage for up to 12 months after the family leaves TANF.

It covers all of the benefits that regular Medicaid does, such as doctor visits, hospital stays, prescription drugs, dental care, and more.

what is transitional medicaid

How does Transitional Medicaid work?

Transitional Medicaid works by extending the Medicaid eligibility of a family for a certain period after they stop receiving TANF.

The length of the extension depends on the family’s income and the state they live in.

Generally, there are two phases of transitional Medicaid:

Phase 1: The family receives transitional Medicaid for four months, regardless of their income.

This phase is automatic and does not require any application or verification from the family.

Phase 2: The family receives transitional Medicaid for an additional eight months if their income is below 185 per cent of the federal poverty level.

This phase requires the family to report their income and expenses every month and to pay a small premium, if applicable.

The total duration of transitional Medicaid is 12 months, but some states may offer longer or shorter extensions, depending on their policies.

Who qualifies for Transitional Medicaid?

To qualify for transitional Medicaid, a family must meet the following criteria:

  • The family must have been receiving cash assistance from TANF within the past six months.
  • The family must have lost their Medicaid eligibility due to increased income from work or child support.
  • The family must have at least one child under the age of 19 or a pregnant woman in the household.
  • The family must be a U.S. citizen or a legal resident.

If a family meets these criteria, they will automatically receive transitional Medicaid for four months.

To continue receiving it for another eight months, they must also meet the following criteria:

  • The family’s income must be below 185 per cent of the federal poverty level. For a family of four, this is about $4,000 per month in 2022.
  • The family must report their income and expenses every month to their state’s Medicaid office.
  • The family must pay a premium if required by their state. The premium amount is usually based on a sliding scale, depending on the family’s income. The premium cannot exceed 3 per cent of the family’s income.

How To Apply

There is no separate application process for transitional Medicaid.

A family will automatically receive it for four months after they stop receiving TANF, as long as they are still eligible for Medicaid.

Conclusion

Transitional Medicaid is a program that helps low-income families transition from welfare to work without losing their health insurance coverage.

It provides temporary Medicaid coverage for up to 12 months after a family leaves TANF due to increased income from work.

It covers all of the benefits that regular Medicaid does, such as doctor visits, hospital stays, prescription drugs, and more.

Transitional Medicaid is a lifeline for low-income families who are moving from welfare to work.

READ ALSO: How Much Does an Insurance License Cost in the USA?

Spread the love

Leave a Comment