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MEDICAID FOR WORKING FAMILIES

Linda Lowe
Georgia Legal Services Program
August 2004

You and your family may be able to get Medicaid even if you work! These programs can help you keep health care coverage for your family for a period of time while you are working.

Medicaid, You, and Your Family

Medicaid is a government health insurance program for low income families.  Whether you and your family can get Medicaid depends on your household's monthly income.  Since 1997, you no longer have to be receiving TANF (AFDC) to get Medicaid. This means that you can apply for Medicaid even if you do not get TANF.  There are many types of Medicaid that you may be able to get.  This brochure tells you about

• Low Income Medicaid for Parents and Children
• Transitional Medical Assistance.

When you or another adult in your family start working, your monthly household income will increase.  If this happens, you may still be able to get Medicaid.  The Department of Family and Children Services (DFCS), or Welfare Office, must try to put you and your family on another type of Medicaid Program before cutting you off Medicaid or before denying your Medicaid application.  If you or someone in your household starts working, you and your family may be able to get Medicaid under the Medicaid Programs described in this document.

What Medicaid Can We Get Even If I Start Working?

● LOW INCOME MEDICAID.  You may still qualify for Low Income Medicaid even if you start working.  You should not be cut off Medicaid automatically when you get a job.  

Remember, your monthly income must be low enough for you to get Medicaid.  When DFCS figures what your monthly income is, DFCS must subtract certain amounts, or deductions, to make your countable monthly income lower.  The following deductions (and a few others) can make you eligible for Low Income Medicaid, even if you start working. 

• DFCS must take a $50 deduction if you receive child support.* 
• DFCS must take an "earned income deduction" when you start working, so you may continue to get Medicaid for one year after you start working.  
• DFCS must take a deduction for child care, or money you pay for someone to babysit your child(ren).  Be sure to tell your caseworker if you pay for child care or babysitting, including child care through DFCS.

*NOTE:  If you are on Medicaid and your child support starts or increases, DFCS must not count the child support for 4 months.  This means that you should get Medicaid for at least 4 more months.  

What If We Can No Longer Get Low Income Medicaid?

If you can no longer get Low Income Medicaid because of your monthly income, you and your family may still be able to get Medicaid for another  year.  You can apply for this Medicaid even if you are not now on Medicaid.  You must have received Low Income Medicaid for 3 out of the last 6 months to get Transitional Medical Assistance.

■ TRANSITIONAL MEDICAL ASSISTANCE.  You and your family may stop getting Low Income Medicaid because your monthly income from work is too high, even when DFCS takes deductions.  If this happens, you should be able to receive Transitional Medical Assistance for up to one year.  For the first six months, there is no income limit.  During the second six months, your income would need to be below 185% of the federal poverty level.  You will need to file reports on your income in the 4th, 7th, and 10th months to keep the second six months of coverage.  Also, your family must continue to include a child under age 18.

WHAT IF WE ARE CUT OFF  MEDICAID, DENIED MEDICAID, OR NOT ALLOWED TO APPLY FOR MEDICAID?

If DFCS/Welfare Office cuts off your Medicaid, denies you Medicaid, or does not let you apply for Medicaid, you have the right to APPEAL by asking for a FAIR HEARING.  By making an APPEAL, you will be able to go before a Judge and ask the Judge to change the decision by DFCS.  To APPEAL, fill out the Fair Hearing form DFCS sends you with your Summary Notification Letter.  Or, you can write a letter to DFCS asking for a FAIR HEARING.  Be sure to tell the reasons why you think DFCS made a mistake.    Be sure to put today's date and your telephone number on the form or letter.  You must turn in the form or letter to the DFCS office.  Keep a copy of the form or letter for yourself.  Be sure that whoever takes the form or letter at the DFCS office signs and dates your copy, so you can show you appealed.

IF YOU ARE NOW ON MEDICAID, YOU MUST MAKE YOUR APPEAL WITHIN 10 DAYS OF THE DATE ON THE SUMMARY NOTIFICATION LETTER TO KEEP YOUR MEDICAID WHILE THE APPEAL IS GOING ON.  Otherwise, your deadline to make an APPEAL is 30 days from the date on the Summary Notification Letter.  You have the right to have an attorney or other person represent you at the Fair Hearing.  You have the right to look at your DFCS file.          

• Apply for Medicaid at your local DFCS/Welfare Office.  Re-apply for Medicaid if you missed your APPEAL deadline.

REMEMBER: If you can no longer receive the type of Medicaid you are now on, for whatever reason, DFCS MUST see if you can be put on another type of Medicaid Program BEFORE deciding you cannot receive any Medicaid at all.  If you or someone else in your household gets a job, DFCS must see if you are still eligible for

■ Low Income Medicaid, or
■ Transitional Medical Assistance

This document is intended for informational purposes only and is not intended to serve as a substitute for legal advice and counsel from an attorney.  If you are having a problem with your Medicaid, you should immediately consult an attorney for advice about your particular situation.