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Understanding MassHealth Transitional Medical Assistance (TMA)

February 14, 2019

Please review the following update from MassHealth and the Health Connector.

Transitional Medical Assistance, or TMA, is a federal requirement in which MassHealth will provide 12 calendar months of extended eligibility to MassHealth Standard members who would otherwise be ineligible due to an increase in earned income that would result in a household MAGI determination over program guidelines.  The 12-month period begins on the effective date of the increase in earned income.  Members will receive a letter letting them know of their TMA period, with a TMA change form to be completed and returned to MassHealth. At the end of the TMA period, members will receive a new notice with additional information, informing them of the benefit they are now eligible for.

If members are not eligible for a MassHealth benefit at the end of their TMA period, they may qualify for a subsidized or non-subsidized health plan through the Health Connector program.  

  • If the household is eligible for ConnectorCare or a subsidized QHP with APTCs, their MassHealth benefits will last until the end of the month following the date of the program determination (the last date of the TMA benefit).  During this time, members will have the opportunity to enroll in a plan to ensure they do not experience any gaps in their coverage.
  • However, if the member is eligible for a non-subsidized Qualified Health Plan (QHP) through the Health Connector, their MassHealth benefits will extend for 14 days past the date of the program determination (the last date of the TMA benefit).

For example, if a household's TMA period starts on 2/1/18 it will end on 1/31/19. On 1/31/19, a program determination will be performed.

If the household is eligible for a subsidized QHP (either ConnectorCare or a QHP with APTC's), they will continue to have MassHealth benefits through 2/28/19.

Beginning on 2/1/19 the consumer will be able to shop and enroll in a Health Connector plan that starts as early as 3/1/19. 

However, if the household is determined eligible for a non-subsidized Health Connector Plan, their MassHealth benefits will end on 2/14/19. 

How does Health Safety Net (HSN) work for a person moving from TMA into a ConnectorCare plan?

  • On the first date of the new program determination for HSN + ConnectorCare, 90 days of HSN eligibility will begin.

For example: If TMA ends on 2/28; the consumer will have access to 90 days of HSN beginning on March 1. 

Note: The above information is NOT new policy or operation for the TMA program, but clarification on the TMA end date.

 Please keep the following in mind:

  • Consumers who are moving from TMA to a Health Connector plan, will only be able to enroll in coverage after the 12-month TMA period ends. 
  • Once the 12-month TMA period ends, a program determination will be performed to check if the individual is eligible for a Health Connector plan (either subsidized or unsubsidized)
    • The individual can shop and enroll in coverage and make any payments (if necessary) by the 23rd of the month. 

Remember, the Health Connector's Special Enrollment Period (SEP) is for 60 days.  If the consumer does not enroll by the 23rd of the additional month of TMA, they will have a gap in coverage.  They may still have HSN benefits but must choose a later start date for their Health Connector plan, which always begin on the 1st of the month.