Subchapter C. ELIGIBILITY PROVISIONS FOR EMC
UNDER THE CATEGORICALLY NEEDY PROGRAM
FOR TANF-RELATED CATEGORIES
POLICY Sec.
140.401. Policy.
140.402. Definitions.
GENERAL ELIGIBILITY REQUIREMENTS
140.421. Conditions of eligibility.
INCOME REQUIREMENTS
140.431. Income eligibility limits.
140.432. Applicable income.
TYPES OF INCOME NOT COUNTED
140.441. Income not counted.
TYPES OF EARNED INCOME COUNTED
140.451. Gross earned income.
140.452. Income from self-employment.
INCOME DEDUCTIONS
140.481. Deductions from earned income.
RESOURCE REQUIREMENTS
140.491. Resources.
VERIFICATION REQUIREMENTS
140.501. Verification of income and child care costs.
BENEFIT COVERAGE
140.511. Category designation.
140.512. Eligibility begin date.
140.513. Eligibility end date.
140.514. Additions to the budget group.
140.515. Deletions to the budget group.
REPORTING REQUIREMENTS
140.521. Reporting requirements.
NOTICE, APPEAL AND FAIR HEARING
140.531. Notice, appeal and fair hearing.
RESTITUTION
140.541. Restitution.
OTHER EXTENDED MEDICAL COVERAGE
140.551. Extended categorically needy medical benefits due to collection of support.
POLICY
§ 140.401. Policy.
(a) The Department provides EMC for up to 12 months under the Categorically Needy Program to AFDC/AFDC-U families whose Cash Assistance is discontinued due to new employment, increased hours of employment, increased income from employment or loss of the 4-month $30 and one-third disregard or the 8-month $30 disregard.
(b) Initial coverage under EMC shall be continuous from the date of the AFDC/AFDC-U closing, regardless of the earned income amount. A separate application is not required for EMC benefits. A recipient will be given notice of EMC eligibility or ineligibility, the reporting requirements and conditions of continued EMC eligibility in conformance with section 303 of the Family Support Act (42 U.S.C.A. § § 602, 606, 1396r and 1396s).
(c) EMC continues for the first 6 months regardless of income or employment as long as the budget group includes a child who meets the AFDC age requirements.
(d) EMC continues for the second 6 months as long as:
(1) Average gross monthly earned income, less child care costs, does not exceed the allowable Federally established percentage of the Federal Poverty Income Guidelines updated annually by the Department of Health and Human Services and published in the Federal Register.
(2) The specified relative maintains employment in every month during this extended EMC period.
(3) The budget group includes a child who meets the AFDC age requirements.
Source The provisions of this § 140.401 adopted October 16, 1992, effective upon publication and apply retroactively to April 1, 1990, 22 Pa.B. 5164.
§ 140.402. Definitions.
The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise:
Budget group—Recipients living together who received AFDC/AFDC-U at the time the Cash Assistance case was closed.
EMC—Extended medical coverage.
Gross earned income—Earned income of the recipients who are included in the EMC budget group and received AFDC/AFDC-U at the time of the Cash Assistance closing and LRRs who return to the home during the EMC 12-month period. The term does not include earned income in § 181.261 (relating to gross earnings of a child).
Source The provisions of this § 140.402 adopted October 16, 1992, effective upon publication and apply retroactively to April 1, 1990, 22 Pa.B. 5164.
GENERAL ELIGIBILITY REQUIREMENTS
§ 140.421. Conditions of eligibility.
Eligibility for EMC is based on the following:
(1) A family shall meet the appropriate eligibility conditions in this chapter. The specific eligibility conditions which shall be met are the following:
(i) Chapter 148 (relating to MA residence provisions for categorically needy NMP-MA and MNO-MA).
(ii) Chapter 149 (relating to citizenship and alienage).
(iii) Chapter 155 (relating to enumeration).
(iv) Chapter 255 (relating to restitution and reimbursement).
(2) AFDC/AFDC-U recipients whose Cash Assistance is discontinued may be eligible for up to 12 months of EMC under the NMP-MA Program beginning with the day following the closing date of Cash Assistance if Cash Assistance was discontinued for one or more of the following reasons:
(i) New employment.
(ii) Increased hours of employment.
(iii) Increased income from employment.
(iv) Termination of the 4-month $30 and one-third disregard or the subsequent 8-month $30 disregard.
(3) The recipient received AFDC/AFDC-U payment in at least 3 of the 6 months immediately preceding the month Cash Assistance was discontinued. Receipt of AFDC/AFDC-U is also counted under the following circumstances:
(i) When the budget group is eligible for a payment but is not issued a check because of the $10 minimum check requirement.
(ii) When the AFDC/AFDC-U payment is withheld due to excess income in a budget month that results in a 1-month suspension.
(4) The recipient has not received AFDC/AFDC-U fraudulently during any month in the 6 months immediately preceding the month Cash Assistance was discontinued. Fraudulently received AFDC/AFDC-U means that an adjudication of fraud determined by a court must have occurred.
Source The provisions of this § 140.421 adopted October 16, 1992, effective upon publication and apply retroactively to April 1, 1990, 22 Pa.B. 5164.
INCOME REQUIREMENTS
§ 140.431. Income eligibility limits.
Gross monthly earned income, less child care costs, may not exceed the allowable Federally established percentage of the Federal Poverty Income Guidelines for the appropriate family size in Appendix A. Revisions to the percentage that is required by Federal law or regulation will be published as a notice in the Pennsylvania Bulletin, recommending codification in Appendix A.
Source The provisions of this § 140.431 adopted October 16, 1992, effective upon publication and apply retroactively to April 1, 1990, 22 Pa.B. 5164.
§ 140.432. Applicable income.
The earned income of budget group members who were part of the AFDC/AFDC-U budget group at the time the Cash Assistance case was closed, including the earned income of an LRR who returns to the household, is considered when determining EMC eligibility.
Source The provisions of this § 140.432 adopted October 16, 1992, effective upon publication and apply retroactively to April 1, 1990, 22 Pa.B. 5164.
TYPES OF INCOME NOT COUNTED
§ 140.441. Income not counted.
The following income is excluded:
(1) Unearned income including income exempt in § § 181.262—181.264 (relating to educational loans, grants and work-study income; other types of income not counted for the TANF and GA categories; and income and benefits not counted by Federal and State statutes for the TANF and GA categories).
(2) The Earned Income Tax Credit (EITC) received as an advance monthly payment or year-end payment.
(3) Earned income in § 181.261 (relating to gross earnings of a child).
Source The provisions of this § 140.441 adopted October 16, 1992, effective upon publication and apply retroactively to April 1, 1990, 22 Pa.B. 5164.
TYPES OF EARNED INCOME COUNTED
§ 140.451. Gross earned income.
Gross earned income, including wages, tips, salaries, commissions and bonuses from employment is counted as earned income.
Source The provisions of this § 140.451 adopted October 16, 1992, effective upon publication and apply retroactively to April 1, 1990, 22 Pa.B. 5164.
§ 140.452. Income from self-employment.
Profit from self-employment is determined in accordance with § 140.52 (relating to profit from self-employment).
Source The provisions of this § 140.452 adopted October 16, 1992, effective upon publication and apply retroactively to April 1, 1990, 22 Pa.B. 5164.
INCOME DEDUCTIONS
§ 140.481. Deductions from earned income.
(a) An employed recipient whose income is used to determine eligibility for EMC is entitled to a deduction from earned income for dependent care expenses. Dependent care shall be needed to enable a budget group member to retain employment. A dependent care expense is the work-related cost of care of dependent children or incapacitated persons living in the home of the recipient. The allowable child care costs are actual payments made by the recipient, excluding payments received under the Transitional Child Care (TCC) provision.
(b) Dependent care services will not be considered as needed when an unemployed biological or adoptive parent, specified relative or legal guardian of the child is in the home, unless one of the following applies:
(1) The biological or adoptive parent, specified relative or legal guardian is physically or mentally incapable of providing child care.
(2) The biological or adoptive parent, specified relative or legal guardian is involved in employment related activities, such as education, training and job search.
(3) The child is at risk because of suspected child abuse.
Source The provisions of this § 140.481 adopted October 16, 1992, effective upon publication and apply retroactively to April 1, 1990, 22 Pa.B. 5164.
RESOURCE REQUIREMENTS
§ 140.491. Resources.
Resources are not considered when determining eligibility.
Source The provisions of this § 140.491 adopted October 16, 1992, effective upon publication and apply retroactively to April 1, 1990, 22 Pa.B. 5164.
VERIFICATION REQUIREMENTS
§ 140.501. Verification of income and child care costs.
Verification of gross monthly earned income, child care costs and household composition shall be submitted in the 4th, 7th and 10th months of the 12-month EMC period.
Source The provisions of this § 140.501 adopted October 16, 1992, effective upon publication and apply retroactively to April 1, 1990, 22 Pa.B. 5164.
BENEFIT COVERAGE
§ 140.511. Category designation.
A person eligible for EMC is eligible for the full scope of categorically needy medical benefits in the PC or PU categories.
Source The provisions of this § 140.511 adopted October 16, 1992, effective upon publication and apply retroactively to April 1, 1990, 22 Pa.B. 5164.
§ 140.512. Eligibility begin date.
The eligibility begin date for EMC is the day following the termination date of TANF Cash Assistance. If the Cash Assistance should have been closed prior to the actual closing date, the EMC begin date is the day following the date AFDC/AFDC-U should have been closed.
Source The provisions of this § 140.512 adopted October 16, 1992, effective upon publication and apply retroactively to April 1, 1990, 22 Pa.B. 5164.
§ 140.513. Eligibility end date.
Eligibility for EMC ends under the following conditions:
(1) During the first 6 months:
(i) When the budget group no longer includes a child. Eligibility ends effective the first Medical Assistance Identification (MAID) Card issuance deadline date that can be met with the appropriate notice.
(ii) When the only child in the budget group exceeds the AFDC age requirements in accordance with § 145.43 (relating to requirements). Eligibility ends effective the first MAID card issuance deadline date in the month following the month the child exceeded the age requirement.
(2) During the second 6 months:
(i) When the average gross monthly earned income for the previous 3 months, less allowable child care costs, exceeds the allowable Federally established percentage of the Federal Poverty Income Guidelines for the appropriate family size. Eligibility ends effective the first MAID card issuance deadline date that can be met with the appropriate notice.
(ii) When a specified relative in the EMC budget group does not maintain employment in each of the previous 3 months and the lack of employment was not due to involuntary loss of employment, illness or good cause as set forth in § 165.52 (relating to good cause). Eligibility ends effective the first MAID card issuance deadline date that can be met with the appropriate notice. The condition of maintaining employment is met if one of the following applies:
(A) The specified relative worked in each of the 3 previous months and is employed or working at the end of the last month of the quarter.
(B) If unemployed in any of the 3 previous months, the specified relative received a definite job offer and will begin work within the first month of the next quarter.
(3) When the budget group fails to report the information required under § 140.521 (relating to reporting requirements) necessary to determine continued EMC eligibility. Eligibility ends effective the first MAID card issuance deadline date that can be met with the appropriate notice.
(4) When the 12-month EMC eligibility period expires and the budget group has received 24 semimonthly MAID cards. Eligibility ends effective the first MAID card issuance deadline date that can be met with the appropriate notice.
Source The provisions of this § 140.513 adopted October 16, 1992, effective upon publication and apply retroactively to April 1, 1990, 22 Pa.B. 5164.
§ 140.514. Additions to the budget group.
Additions may be made to the EMC budget group as follows:
(1) A newborn can be added any time in the 12-month period.
(2) A person can be added any time in the 12-month period if the person was in the budget group at the time the AFDC/AFDC-U case was closed. Eligibility for other MA Programs is reviewed for a person who was not part of the budget group at the time the AFDC/AFDC-U Cash Assistance case was closed.
Source The provisions of this § 140.514 adopted October 16, 1992, effective upon publication and apply retroactively to April 1, 1990, 22 Pa.B. 5164.
§ 140.515. Deletions to the budget group.
Deletions are made to the EMC budget group as follows:
(1) If a person leaves the household in the first 6 months of the EMC 12-month period, the person is removed effective the first Medical Assistance Identification (MAID) card issuance deadline date that can be met with the appropriate notice. Eligibility for the remaining budget group members is determined at the first quarterly review of the second 6-month period.
(2) If a person leaves the household in the second 6 months of the EMC 12-month period, the person is removed effective the first MAID card issuance deadline date that can be met with the appropriate notice. Eligibility for the remaining budget group members is determined at the next quarterly review.
(3) If a child no longer meets the AFDC age requirements and other children are in the budget group, the child is removed in the month following the month the child no longer meets the AFDC age requirements effective the first MAID card issuance deadline date that can be met with the appropriate notice. Prior to terminating EMC, eligibility for other MA Programs shall be determined for the child who is deleted.
Source The provisions of this § 140.515 adopted October 16, 1992, effective upon publication and apply retroactively to April 1, 1990, 22 Pa.B. 5164.
REPORTING REQUIREMENTS
§ 140.521. Reporting requirements.
The recipient shall report gross monthly earned income, allowable child care costs and household composition by the Monthly Reporting Form due date in the 4th, 7th and 10th months of the 12-month EMC period. The Monthly Reporting Form will be used to collect information to determine EMC eligibility. Good cause provisions as defined in Chapter 142 (relating to monthly reporting) apply for failure to report timely. Adverse action will not be taken for failure to report monthly.
Source The provisions of this § 140.521 adopted October 16, 1992, effective upon publication and apply retroactively to April 1, 1990, 22 Pa.B. 5164.
Cross References This section cited in 55 Pa. Code § 140.513 (relating to eligibility end date).
NOTICE, APPEAL AND FAIR HEARING
§ 140.531. Notice, appeal and fair hearing.
The notice provisions of Chapter 133 (relating to redetermining eligibility) and the appeal and fair hearing provisions of Chapter 275 (relating to appeal and fair hearing and administrative disqualification hearings) apply to recipients of EMC.
Source The provisions of this § 140.531 adopted October 16, 1992, effective upon publication and apply retroactively to April 1, 1990, 22 Pa.B. 5164.
RESTITUTION
§ 140.541. Restitution.
The restitution requirements in Chapter 255 (relating to restitution) apply to EMC except that there is no overpayment if the recipient reports income, child care costs and household composition accurately and timely and the CAO takes action timely.
Source The provisions of this § 140.541 adopted October 16, 1992, effective upon publication and apply retroactively to April 1, 1990, 22 Pa.B. 5164.
OTHER EXTENDED MEDICAL COVERAGE
§ 140.551. Extended categorically needy medical benefits due to collection of support.
(a) Extended categorically needy medical benefits are provided to AFDC or AFDC-U families whose assistance was discontinued as a result, wholly or partly, of the collection or increased collection of support and who received AFDC or AFDC-U in at least 3 of the 6 months immediately preceding the month in which Cash Assistance was discontinued.
(b) Categorically needy medical benefits will continue for 4 months beginning with the day following the termination date of cash eligibility. When a person’s AFDC or AFDC-U payments are discontinued and the client has failed to report changes in a timely manner, the 4 months begin with the date on which Cash Assistance was erroneously paid.
Source The provisions of this § 140.551 adopted October 16, 1992, effective upon publication and apply retroactively to December 1, 1984, 22 Pa.B. 5164.
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