The CAO must determine the refugee's eligibility for Modified Adjusted Gross Income (MAGI) MA, TANF and SSI related Non-Money Payment (NMP) and Medically Needy Only (MNO) MA before determining eligibility for Refugee Medical Assistance (RMA). See the Medical Assistance Eligibility Handbook for program requirements and procedures.
Reminder: The CAO will contact the VOLAG/RA to determine if it is providing assistance to the refugee. Consent of the client for the contact is not required.
NOTE: If the refugee meets all requirements, the CAO will authorize MA retroactively for medical care if they were eligible when the medical services were received.
If the refugee does not meet the age, specified relative, and deprivation requirements for TANF-related MA or MAGI MA and is not aged, blind, or disabled, the CAO will determine eligibility for RMA.
Reminder: A refugee who is pregnant may be eligible for MAGI MA. The CAO must accept self-attestation of pregnancy unless there is a reason to question an applicant's statement.
The CAO will apply the requirements and procedures contained in the Medical Assistance Eligibility Handbook with the following modifications:
Eligibility for RMA is limited to those refugees who:
Possess a qualifying immigration status;
Have been in the US 12 months or less from Date of Entry
Granted Asylum - For those granted asylum the 12-month time period begins as of the date they are granted asylum; use that as Date of Entry
Victims of trafficking - the 12-month time period begins the date they are certified victims of trafficking by HHS/ACF; use that date as Date of Entry
Be a resident of Pennsylvania;
Be ineligible for all other Medicaid Benefits, for children this includes CHIP;
NOTE: States cannot require that applicants for RCA/RMA provide social security numbers. Under the Privacy Act of 1974, States are prohibited from denying an individual any right, benefit, or privilege provided by law because of the individual's refusal to disclose his or her social security number unless disclosure is required by federal statute. For RCA/RMA disclosure of a social security number is not required by federal statute. Authorizing RCA/RMA should not be denied or delayed pending enumeration for SNAP.
Not be enrolled as a full-time student in higher education as an undergraduate or post-graduate (Exception: If they are a professional in need of professional refresher training or other recertification services to qualify to practice their profession in the US. The training must meet all criteria:
Be part of their Employment Development Program (EDP)
Be under one year in duration
Specifically intend to assist the refugee to become relicensed in their profession
If completed can realistically expect to result in relicensing
45 CFR 400.100(a)(5) 45 CFR 400.81(b) 45 CFR 400.94
The CAO will apply the TANF related requirements and exclusions of the Medical Assistance Eligibility Handbook, Chapter 340, Resources, to determine the refugee's resource eligibility. The CAO will consider resources as follows:
Those actually available on the date of application. The CAO will not consider resources owned by the refugee or the refugee's legally responsible relative if the resource remains in the country of origin.
Those actually made available from the VOLAG/RA, sponsor, or other community group.
Reminder: The CAO will not deem the resources of the VOLAG/RA or sponsor to determine the refugee's eligibility for RMA. The CAO will consider only those resources actually made available to the refugee.
The CAO will apply the TANF related requirements and exclusions of the Medical Assistance Eligibility Handbook, Chapter 350, Income, to determine the refugee's income eligibility.
NOTE: The TANF earned income incentive deduction is applied for RMA when determining the refugee's net income. Total net monthly income, with the earned income incentive deduction must be less than or equal to the appropriate MA income limit for the refugee to receive RMA benefits.
The CAO will not deem the income of the VOLAG/RA or sponsor to determine the refugee's eligibility for RMA. The CAO will consider only the income actually made available to the refugee.
A refugee who is a full-time undergraduate or post-graduate college student is not eligible for RMA unless the refugee or the college program meet the following criteria:
The refugee is eligible as an Unaccompanied Refugee Minor. See Section 730.22.
The refugee is a professional in need of professional refresher training and other recertification services to qualify to practice his profession in the US. The education must meet all of the following:
Is approved as part of the employment plan developed for the refugee by the designated employment service provider.
Does not exceed one year's duration, including time enrolled before the refugee's application for benefits.
Is specifically intended to assist the refugee in becoming relicensed in his/her profession and, if completed, can realistically be expected to result in relicensing.
NOTE: A full-time student who does not meet the above criteria may qualify for PC, if under age 21, or PD or TD under regular requirements. The CAO will not assign a refugee program status code to the budget.
A refugee is considered to be Chronically Needy during the time they are receiving Nonmoney Payment RMA. The CAO will determine the Chronically/Medically Needy status at the end of RMA time eligibility
With Medicaid expansion, most refugees should qualify for regular Medicaid programs or CHIP (for children) after their arrival to Pennsylvania. Evaluate eligibility for all other Medical Assistance categories before authorizing RMA.
Individuals may qualify for RMA:
If they do not initially qualify for Medicaid and meet RMA eligibility criteria;
OR if they lose their Medicaid coverage due to increases in earned income and have been in the US for 12 months or less;
Initial application:
The CAO must screen each application received. The screening interview may be done face-to-face, by telephone, or by mail. It is utilized to gather appropriate information and make the client aware of pending verification to facilitate timely processing.
The CAO will determine expedited SNAP eligibility on the day the application is received, as well as whether it is potential RCA or TANF application and route the application appropriately.
Closing Medicaid recipient for income:
Close Medicaid category sending appropriate advance and appeal notices. Authorize RMA via NCE for the remainder of the eight month eligibility period. Income does not affect RMA eligibility.
When doing an NCE for RMA, make sure to complete a manual ACA referral before the end of eligibility.
The refugee who loses their eligibility for RCA and MA, to include RMA due to increased income is eligible for RMA until the end of their 12-month refugee assistance time limit.
The CAO will extend MA benefits for both RMA and RCA recipients as follows:
1. Explore possible third party medical resources available through employment enter information on the TPL screen.
2. If loss of RMA, or MA continue MA eligibility in the RMA category. If the refugee is receiving RCA at the time of ineligibility, close RCA and authorize RMA in the RMA category PC 02.
3. The system will enter a future close date for the end of the 12-months or the end of the RCA or RMA period, whichever comes first.
4. Provide the refugee with an Advance Notice advising of the closure and the need to report changes during the extended period.
5. Once the refugee period expires, review for other MA. Do not assign a refugee program status code to the budget.
Reissued September 20, 2023, replacing August 3, 2023