What Does Transitional Medical Assistance Mean?

If you’re not sure what Transitional Medical Assistance (TMA) is, you’re not alone. TMA is a Medicaid program that helps low-income families transition from one health insurance coverage to another.

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What is Transitional Medical Assistance?

Transitional medical assistance, or TMA, is a Medicaid program that helps people who are transitioning from one health insurance coverage to another. TMA provides temporary health insurance coverage for people who would otherwise be uninsured.

TMA is available to people who are:
-Aged 19-64
-Not eligible for Medicaid due to income or assets
-Transitioning from one health insurance coverage to another

TMA covers:
-Inpatient and outpatient hospital services
-Physician services
-Prescription drugs
-Mental health and substance abuse services

What are the eligibility requirements for Transitional Medical Assistance?

To be eligible for Transitional Medical Assistance (TMA), you must meet the following requirements:
-You must be transitioning from Medicaid to a private health insurance plan.
-You must have been enrolled in Medicaid for at least three months prior to losing eligibility.
-You must be employed, or seeking employment, or participating in an approved education or training program.
-Your income must be at or below 133% of the federal poverty level.

What are the benefits of Transitional Medical Assistance?

Transitional Medical Assistance, or TMA, is a Medicaid program that helps people who are transitioning from one health insurance coverage to another. TMA provides temporary coverage for medical expenses, and can help people avoid gaps in their health insurance coverage.

TMA is available to people who are transitioning from certain types of health insurance coverage, including:
– Medicaid
– Children’s Health Insurance Program (CHIP)
– Medicare
– Private health insurance or job-based health insurance

People who are eligible for TMA can receive coverage for up to three months. Coverage can be extended for an additional three months if the person is still working towards getting new health insurance coverage.

How long does Transitional Medical Assistance last?

Transitional medical assistance, or TMA, is a Medicaid program that pays for health insurance for low-income adults and their children for up to 6 months after they lose coverage under a Medicaid expansion program.

The Affordable Care Act (ACA) established Medicaid expansion programs in every state to provide health insurance to low-income adults who do not have coverage through an employer or government program. However, the Supreme Court’s ruling in National Federation of Independent Business v. Sebelius (2012) made the expansion optional for states. As of January 2019, 34 states and the District of Columbia have adopted the expansion; 16 states have not.

Under the ACA, Medicaid covers adults with incomes up to138% of the federal poverty level (FPL), which is about $16,754 for an individual and $34,638 for a family of four in 2018. However, the Supreme Court’s ruling allowed states to set their own eligibility thresholds. As of January 2019, the median eligibility level among expansion states is 138% FPL; however, some states have set their threshold lower, at 100% FPL or less. A few states have adopted higher eligibility thresholds, up to 200% FPL or more.

Adults who are eligible for Medicaid under the expansion are generally entitled to continuous coverage; that is, they can remain enrolled in Medicaid as long as they remain eligible. However, some adults may experience a “coverage gap”—that is, a period when they are not eligible for either Medicaid or subsidies to purchase private health insurance through the ACA marketplace. This can happen if their income increases above the Medicaid eligibility threshold but remains below 400% FPL ($48,560 for an individual and $100,400 for a family of four in 2018), making them ineligible for marketplace subsidies.

The TMA program was created to help people who would otherwise experience a coverage gap by providing them with temporary financial assistance to purchase private health insurance through the marketplace. TMA is available in all states that have adopted the ACA Medicaid expansion; however, it is subject to annual appropriations by Congress, so its future is uncertain.

Under TMA, adults who lose Medicaid coverage due to an increase in income can receive financial assistance—in the form of a premium tax credit—to help them purchase private health insurance through the ACA marketplace for up to 6 months. Adults must have had continuous Medicaid coverage for at least 3 months prior to losing eligibility due to an increase in income in order to be eligible for TMA assistance. In addition, they must have incomes between 138% and 400% FPL ($48,560 for an individual and $100400for a familyof four in 2018). Families with children are also eligible if their children are enrolled in a state Children’s Health Insurance Program (CHIP).

TMA assistance can be used to purchase any health plan offered through the marketplace—including plans that cover pre-existing conditions—and it can be used to cover out-of-pocket costs such as deductibles and copayments. Although TMA premiums are paid directly to insurers on behalf of enrollees (similar to how subsidies are paid), enrollees are responsible for paying any balance owed on their monthly premiums directlyto insurers.

TMA assistance is available for up to 6 months; however enrollees can continue receiving premium tax credits through the marketplace if they remain income-eligible after losing TMA assistance.

What happens after Transitional Medical Assistance ends?

After Transitional Medical Assistance (TMA) ends, your family may be able to get help from another MassHealth program. Depending on your family’s income and resources, you may be able to get help from:

-Emergency Aid to the Elderly, Disabled, and Children program (EAEDC)
-Family Assistance for Needy Families program (FANF)
-Children’s Health Insurance Program (CHIP)

How can I apply for Transitional Medical Assistance?

There are four ways you can apply for Transitional Medical Assistance (TMA):
-Online
-In person
-By phone
-By mail

If you need help completing your application, a customer service representative will be happy to assist you. You can reach them by phone at 1-800-XXX-XXXX.

What documents do I need to apply for Transitional Medical Assistance?

To apply for Transitional Medical Assistance (TMA), you will need to submit:
-A completed TMA application form
-Proof of your income and assets
-A copy of your most recent tax return
-A copy of your health insurance card
-A letter from your current doctor or health care provider

How do I know if I am eligible for Transitional Medical Assistance?

There are four ways to qualify for Transitional Medical Assistance (TMA). You may qualify if you:
-Have recently left welfare and are enrolled in Medicaid
-Are pregnant
-Are a parent or caretaker relative of a minor child
-Are under 21 years old

What if I am not eligible for Transitional Medical Assistance?

If you are not eligible for Transitional Medical Assistance, you may still be eligible for other forms of medical assistance. For example, you may be eligible for Medicaid if you are a low-income individual or family. You can find out more about Medicaid eligibility here.

What are the income guidelines for Transitional Medical Assistance?

In order to quality for Transitional Medical Assistance (TMA), your total household income must be at or below 133% of the Federal Poverty Level (FPL).

If your income is above 133% FPL but you are still within 24 months of qualifying for Medicaid due to a change in your circumstances (such as losing a job), you may still be eligible for TMA.

For more information on TMA and other Medicaid programs, please visit www.healthcare.gov or www.medicaid.gov.