163 EXTENDED MEDICAL ASSISTANCE DUE TO INCREASED CHILD OR SPOUSAL SUPPORT (MAM)

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Continue medical assistance for 4 months for all individuals in an assistance group (AG) who become ineligible for the MAGI categories of categorically needy medical assistance because of increased child or spousal support regardless of their income level. Extend medical assistance only if there are no changes in program criteria or nonfinancial criteria which make the individual ineligible at the same time as the increase in child or spousal support income.

• The AG must have received categorically needy medical assistance during any 3 of the 6 months prior to the month in which the case closed.

• The reason for the termination of categorically needy MAGI medical assistance must be due in whole or in part to increased child or spousal support income.

Exception: An individual who is determined by a court to have fraudulently received categorically needy MAGI medical assistance in any of the 6 months immediately preceding the closing of a categorically needy MAGI medical assistance case due to increased child or spousal support is not eligible for 4-month extended medical assistance (EMA). Other AG members are also ineligible for 4-month EMA. The penalty stays with each individual from the original AG whether they remain in the same AG or move to another AG. If a penalized individual moves into another AG, the new AG is not penalized-only the original penalized individual.

References: He-W 882.04; 42 CFR 435.115(f)-(h); 45 CFR 233.20(a)(15); 42 USC 1396u-1(c)(1)