States encouraged to maintain health benefits for temporary census workers

The Acting Director of the Center for Medicaid and CHIP Services (CMCS) encouraged states, to the extent permitted under the law, to exclude temporary income from employment in the 2020 Decennial Census when determining eligibility for public benefit programs. A new bulletin provides guidance on existing flexibility under state plans for modified adjusted gross income (MAGI) based systems and non-MAGI based systems. This includes the option of submitting a state plan amendment (SPA) to CMS (CMCS Bulletin, July 3, 2019).

Census workers and health benefits

The Census provides low-income individuals with an opportunity for employment and skills training. Many of these workers are eligible for Medicaid or in a household with Medicaid or CHIP eligible individuals. One element of successful recruiting efforts by the Census Board is ensuring the continued availability for Medicaid and CHIP coverage for workers and their families. During previous censuses, state Medicaid and CHIP agencies have been encouraged to ensure that temporary census workers and their families do not lose eligibility due to temporary census income. Previously, states were able to disregard temporary census income for all Medicaid and CHIP eligibility groups, but a move to a MAGI-based methodology no longer permits the use of income disregards. The bulletin describes existing authorities that may be used to exclude or minimize the impact from temporary census employment.

Existing State Plan Options

Under section 1902(e)(14)(D) of the Social Security Act, for non-MAGI populations, states may disregard in whole or in part, temporary census income and many states have already elected to disregard temporary census income for multiple eligibility groups in their state plan. States wishing to apply disregards of temporary census income for the first time or wish to add or modify the non-MAGI groups affected must submit an SPA to CMS.

Under MAGI-based methodologies, temporary census income is taxable as employment income and Medicaid and CHIP regulations prohibits the use of income disregards and this prohibition cannot be waived. States may elect under 42 C.F.R. §435.603(h)(3) to use a reasonable method for determining a prorated portion of reasonably predictable changes (RPC) to income as they do for fluctuating income such as from seasonal work or self-employment. States with approved RPC methodology for seasonal work may include temporary census income within its scope such that a new SPA submission would not be necessary. States that do not have an existing state plan authority to implement an RPC methodology may elect to do so through an SPA, although the methodology cannot be limited only to temporary census income.

Parents and Other Caretaker Relatives may retain specific coverage protections due to increased earned income through Transitional Medical Assistance (TMA). TMA is a required eligibility protection that states must apply, even under increased earnings due to temporary census employment. If census employment income triggers a transition to TMA, the Medicaid agency would redetermine the individual’s eligibility when census employment ends.

CMS is offering technical assistance on the options and requirements included in the informational bulletin as well as assistance on submitting the required state plan amendments.