Extended Medical Coverage EMC is a special Nonmoney Payment (NMP) Medical Assistance (MA) category. Individuals living together and included in the TANF C or U budget groups or TANF-related NMP for the Family (NMP-F) (PC 03 or PC/PU27) budget groups at the time of the TANF or TANF-related NMP-F closing will be members of the EMC budget group. The EMC budget group may include essential persons. The categories for EMC are PC or PU71.
Note: GA-related MA recipients are not eligible for EMC.
Note:A household that received out-of-state TANF or TANF-related NMP-F benefits cannot use that time to qualify for EMC in Pennsylvania. The family must get TANF or TANF-related NMP-F while living in Pennsylvania to qualify for EMC in Pennsylvania.
Example: A mother and two children have received TANF for the past four months. The family’s family size allowance (FSA) is $403. The mother works part-time and gets a partial TANF monthly payment. The mother’s employer increases her hours of work. She now earns $960 a month and is no longer eligible for TANF, as her income minus the 50% work incentive is more than the FSA. The caseworker figures that her childcare expense will be $20 a month under Child Care Works. (Copayments for child care are not an allowable deduction for TANF.) The family is eligible for TANF-related NMP-F (PC27) on the basis of approved deductions of $120 for work and personal expenses, the 50% work incentive, and the actual childcare costs.
|
$960 |
|
|
-120 |
|
|
Income after deduction |
$840 |
|
50% work incentive |
-420 |
|
Net income before child care costs |
$420 (over FSA for TANF) |
|
Actual child care costs |
-20 |
|
Net income |
$400 (under FSA, eligible for TANF-related NMP-F) |
Individuals who get MA as TANF (C or U) or TANF-related NMP-F in categories PC03 or PC/PU27 may be eligible for up to twelve months of EMC if TANF or TANF-related NMP-F is stopped because of:
A new job.
More hours at a job.
More income from a job.
NOTE: Individuals who lose eligibility for TANF or TANF-related NMP-F because of more hours or income from employment can qualify for EMC. Other budget group members stay eligible for TANF or TANF-related NMP-F
Example: A two-individual TANF budget group (grandmother and grandson) becomes ineligible because of the grandmother’s income. The grandmother is approved for EMC, and the grandson becomes a one-person TANF grant.
For automatic MA coverage because of an increase of support income, see Section 338.43.
Individuals are not eligible for EMC if their TANF or TANF-related NMP-F budget closes for any other reason.
Example: A budget group getting TANF, TANF-related NMP-F, Social Security and earned income loses its eligibility because of an increase in Social Security benefits. Because of the increase in unearned income, the budget group is not eligible for EMC.
Budget group: Recipients living together who were getting TANF or TANF-related NMP-F when the cash assistance or MA budget was closed.
Gross earned income: Earned income of the recipients included in the EMC budget group who were getting TANF-related NMP-F when the cash assistance or MA budget was closed and legally responsible relatives (LRRs) who return to the home during the 12-month EMC period. Earned income related to the gross earnings of a child is excluded.
The notice rules in Chapter 377, Notices, and the appeal and fair hearing rules of the Supplemental Handbook, Chapter 870, Appeal and Fair Hearing, apply to EMC applicants and recipients. 55 Pa. Code § 140.531
Updated February 14, 2012, Replacing March 28, 2008