CHAPTER 67:46:13
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TRANSITIONAL MEDICAL BENEFITS
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\r\n\r\n67:46:13:01 Definitions.
\r\n\r\n67:46:13:02 Initial eligibility\r\nfor transitional medical benefits.
\r\n\r\n67:46:13:03 TMB limited to 12\r\nconsecutive months.
\r\n\r\n67:46:13:04 Continuing\r\neligibility for TMB.
\r\n\r\n67:46:13:05\r\nto 67:46:13:10 Repealed.
\r\n\r\n67:46:13:11 Ineligibility for\r\nfraud.
\r\n\r\n\r\n\r\n67:46:13:01. Definitions. Terms\r\nused in this chapter mean:
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(1) "Parent/caretaker\r\nrelative," a Medicaid coverage group consisting of low income families\r\neligible for Medicaid under the provisions of chapter 67:46:12; and
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(2) "TMB" or\r\n"transitional medical benefits," continued medical coverage\r\nimmediately following ineligibility for parent/caretaker relative Medicaid.
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Source: 24 SDR 24, effective August 31,\r\n1997; 36 SDR 215, effective July 1, 2010; 41 SDR 7, effective July 29, 2014.
\r\n\r\nGeneral Authority: SDCL 28-6-1.
\r\n\r\nLaw Implemented: SDCL 28-6-1.
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Cross-Reference: Medicaid eligibility --\r\nParent/caretaker relative, § 67:46:12:02.
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67:46:13:02. Initial eligibility for\r\ntransitional medical benefits. An individual that becomes ineligible for\r\nparent/caretaker relative Medicaid and any dependent child in the\r\nparent/caretaker relative's household is eligible for TMB if the following conditions\r\nexist:
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(1) The individual was receiving\r\nMedicaid under the provisions of chapter 67:46:12 in the immediately preceding\r\nmonth but became prospectively ineligible because the parent/caretaker relative\r\nhad increased income from employment; and
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(2) The individual received Medicaid\r\nunder the provisions of chapter 67:46:12 in any 3 or more months during the\r\n6-month period immediately before the month in which the parent/caretaker\r\nrelative became ineligible.
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Source: 24 SDR 24, effective August 31, 1997;\r\n36 SDR 215, effective July 1, 2010; 41 SDR 7, effective July 29, 2014.
\r\n\r\nGeneral Authority: SDCL 28-6-1.
\r\n\r\nLaw Implemented: SDCL 28-6-1.
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67:46:13:03. TMB limited to 12\r\nconsecutive months. Transitional medical benefits may begin the first month\r\nthe parent/caretaker relative is ineligible for Medicaid under the provisions\r\nof chapter 67:46:12 and is limited to the 12 consecutive months immediately\r\nfollowing ineligibility for Medicaid.
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Source: 24 SDR 24, effective August 31,\r\n1997; 36 SDR 215, effective July 1, 2010; 41 SDR 7, effective July 29, 2014.
\r\n\r\nGeneral Authority: SDCL 28-6-1.
\r\n\r\nLaw Implemented: SDCL 28-6-1.
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67:46:13:04. Continuing eligibility\r\nfor TMB. Eligibility for TMB continues for 12 consecutive months if the\r\nfamily continues to reside in the state and a dependent child who was a member\r\nof the family at the time the family was determined first eligible for TMB\r\ncontinues to live with the family.
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Source: 24 SDR 24, effective August 31,\r\n1997; 36 SDR 215, effective July 1, 2010; 41 SDR 7, effective July 29, 2014.
\r\n\r\nGeneral Authority: SDCL 28-6-1.
\r\n\r\nLaw Implemented: SDCL 28-6-1.
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Cross-Reference: Definitions,\r\n§ 67:46:12:01.
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67:46:13:11. Ineligibility for\r\nfraud. If a court of law finds that a member of a Medicaid household\r\ncommitted fraud resulting in mistaken eligibility for Medicaid for one of the\r\nsix months preceding the current period of Medicaid ineligibility, all members\r\nof the Medicaid household in which the fraud was committed are ineligible for\r\ncontinued medical coverage under this chapter.
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Source: 24 SDR 24, effective August 31,\r\n1997; 41 SDR 7, effective July 29, 2014.
\r\n\r\nGeneral Authority: SDCL 28-6-1.
\r\n\r\nLaw Implemented: SDCL 28-6-1.
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