Before EMC can be approved, EMC eligibility requirements will be met. 55 Pa. Code § 140.421
Important: Before closing TANF cash or completing eligibility status changes, the CAO will look over the case record for proof of citizenship and identity. If no proof is in the case record, the CAO will change the verification code for citizenship on CAINDL to “P.” In e-CIS change the verification code for citizenship on the Individual Demographics screen.
The following EMC eligibility conditions must be met: 55 Pa. Code § 140.421(2)
Residence (Chapter 323, Residence).
Citizen/alien (Chapter 322, Citizen/Alien).
Identity (see Chapter 320, Identity).
Enumeration (Supplemental Handbook, Chapter 950, Enumeration).
Restitution (Supplemental Handbook, Chapter 910, Overpayment Recovery).
The following conditions must also be met:
TANF (C or U) payments or a TANF-related NMP-F budget for the budget group was stopped because of:
A new job.
More hours at a job.
More income from a job.
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.
NOTE: For automatic MA coverage because of an increase of support income, see Section 338.43.
The budget group received TANF or TANF-related NMP-F in at least three of the six months right before the month TANF or TANF-related NMP-F was stopped. The CAO will count the following months: 55 Pa. Code § 140.421(3)
Months in which a full or partial TANF payment was given.
Months for which TANF-related NMP-F was approved retroactively.
Months in which a TANF payment was not given because the amount was less than $10.
Months in which a TANF payment was not given because the case was suspended for one month because of too much income in the budget month.
Months in which TANF was approved but a payment was not given until the following month.
NOTE: The month of the TANF or TANF-related NMP-F closing does not count as one of the three months out of six.
The budget group has a child who meets the TANF age rules.
An SSI child is considered qualified for TANF.
Important: EMC must be stopped if the child leaves the household. If the child returns to the household within the 12-month EMC period, the household is not eligible for the remaining months of EMC. 55 Pa. Code § 140.513(1)(i)
The budget group did not get TANF or TANF-related NMP-F by fraud during the six months right before the month TANF or TANF-related NMP-F was stopped. (Fraud must be decided by a court of law.) 55 Pa. Code § 140.421(4)
A family that meets the EMC eligibility rules can get EMC no matter how much earned income they got that stopped their TANF or TANF-related NMP-F.
NOTE: If a specified relative’s SSI closes because of earnings and the family becomes ineligible for TANF or TANF-related NMP-F when the earnings are counted, the family is eligible for EMC, as long as the specified relative was eligible for SSI in three out of the last six months.
No resource rules or limits are used in deciding EMC eligibility. 55 Pa. Code § 140.491
A separate application for EMC is not needed. Coverage under EMC must start on the day after the TANF or TANF-related NMP-F closing.
If the CAO learns that the TANF-related NMP-F budget should have been closed earlier than the actual closing date, the EMC 12-month eligibility period begins the day after the TANF or TANF-related NMP-F case should have been closed.
EMC continues for the first six months no matter what the budget group’s income or employment status is, as long as the budget group includes a child who received TANF or TANF-related NMP-F. 55 Pa. Code § 140.401(c)
NOTE: If EMC ends for a pregnant woman before the end of the pregnancy or before the first birthday for an eligible child, MA continues for the pregnant woman and the eligible child. (See Section 338.421, Continuing MA Coverage.)
EMC continues for the second six months as long as: 55 Pa. Code § 140.401(d)
The budget group includes a TANF related child.
The specified relative keeps working.
The budget group’s average gross monthly earned income, minus child care costs, is not over the 185% Federal Poverty Income Guidelines (FPIG) limit for the family size in Appendix A.
NOTE: The client must turn in a semiannual reporting (SAR) form in the seventh month, reporting the income of month six only. If that month of income is over 185% of the FPIG in Appendix A, the CAO will contact the client for the amount of earned income and child care for months four and five. The CAO will then figure out the monthly average for the three months and compare it with the 185% FPIG limit.
If the CAO learns that the TANF or TANF-related NMP-F budget should have been closed earlier than the actual closing date, the EMC 12-month eligibility period begins the day after the TANF or TANF-related NMP-F case should have been closed. 55 Pa. Code § 140.512
If a budget group does not meet all of the EMC eligibility conditions, the CAO will:
Decide on the group’s eligibility for other MA categories.
If the budget group is not eligible for any other MA benefits, send a notice of ineligibility for EMC.
Make a CHIP referral as needed.
Updated February 14, 2012, Replacing April 3, 2008