17-1717.1

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1717.1-1
HAWAII ADMINISTRATIVE RULES
TITLE 17
DEPARTMENT OF HUMAN SERVICES
SUBTITLE 12
MED-QUEST DIVISION
CHAPTER 1717.1
TRANSITIONAL MEDICAL ASSISTANCE
Subchapter 1 	General Provisions
§17-1717.1-1 	Purpose
§17-1717.1-2 	General requirements
§§17-1717.1-3 to 17-1717.1-7 	(Reserved)
Subchapter 2 	Eligibility Requirements
§17-1717.1-8 	Purpose
§17-1717.1-9 	Basic requirements
§17-1717.1-10 	Categorical requirements
§17-1717.1-11 	Extension periods
§17-1717.1-12 	Income requirements
§17-1717.1-13 	Asset requirements
§§17-1717.1-14 to 17-1717.1-18 	(Reserved)
Subchapter 3 	Freedom of Choice, Enrollment,
Benefits and Disenrollment
§17-1717.1-19 	Purpose
§17-1717.1-20 	Freedom of choice
§17-1717.1-21 	Enrollment into a participating
health plan
§17-1717.1-22 	Benefits
§17-1717.1-23 	Disenrollment from a health plan
§§17-1717.1-24 to 17-1717.1-28 	(Reserved)

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Historical Note: 	This chapter is based substantially
upon repealed subchapter 6 of chapter 17-1726. 	[Eff
12/03/01; am 05/10/03; am 04/30/10; 	R 09/30/13]
SUBCHAPTER 1
GENERAL PROVISIONS
§17-1717.1-1 	Purpose. 	This chapter establishes
and describes the provisions of transitional medical
assistance for a pregnant woman, or parent or caretaker
relative, to include a qualified non-citizen, living
with a child under age nineteen or an individual who is
under age twenty-one and in receipt of foster care,
kinship guardianship or adoption assistance, who
becomes ineligible for medical assistance as a result
of increased earned income, or collection or increased
collection of spousal support payments under section
1925 of the Social Security Act. 	[Eff 	09/30/13]
(Auth: 	HRS §346-14; 42 CFR §435.112) (Imp: 	HRS §346-
14; 42 CFR §435.112, Section 1925 of the Social
Security Act)
§17-1717.1-2 	General requirements. 	The
confidentiality, administrative appeal, fraud, medical
assistance recovery, application processing,
eligibility review, and adverse action provisions
described in subtitle 12 shall pertain to the household
who applies or is eligible under this chapter.
[Eff 	09/30/13] 	(Auth: 	HRS §§346-14, 346-44; 42
C.F.R. §§431.200, 431.206, 431.221, 431.230, 431.300,
435.112, 435.201, 435.907, 435.916, 455.1) (Imp: 	HRS
§§346-14, 346-44; 42 C.F.R. §§431.200, 431.206,
431.221, 431.230, 431.300, 435.112, 435.201, 435.907,
435.916, 455.1)
§§17-1717.1-3 to 17-1717.1-7 	(Reserved).

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SUBCHAPTER 2
ELIGIBILITY REQUIREMENTS
§17-1717.1-8 	Purpose. 	This subchapter describes
the eligibility requirements for participation in
transitional medical assistance for a household
consisting of a pregnant woman or parent or caretaker
relative with a child(ren) described in Section 1925 of
the Social Security Act subject to federal
authorization. 	[Eff 	09/30/13] 	(Auth: 	HRS §346-14;
42 CFR §§435.112, 435.201) (Imp: 	HRS §346-14; 42 CFR
§§435.112, 435.201)
§17-1717.1-9 	Basic requirements. 	The household
shall meet the basic eligibility requirements, which
include but are not limited to, citizenship, qualified
non-citizen status, state residency, verification of
identity, not residing in a public institution and the
provision of a social security number, as described in
chapter 17-1714.1. 	[Eff 	09/30/13] 	(Auth: 	HRS §346-
14; 42 C.F.R. §§435.112, 435.400, 435.910) (Imp: 	HRS
§346-14; 42 C.F.R. §§435.112, 435.400, 435.910)
§17-1717.1-10 	Categorical requirements. 	(a) A
pregnant woman, or parent or caretaker relative with a
child(ren) under age nineteen or an individual who is
under age twenty-one and in receipt of foster care,
kinship guardianship or adoption assistance who
continues to reside in the household shall be eligible
under this chapter when the household received medical
assistance in at least three of the six months
preceding the month the household became ineligible for
the Pregnant Women Group, or the Parents or Caretakers
Relative Group as follows:
(1) 	Due to an increase in earned income, the
household is eligible to receive an initial
six months in accordance with section 17-
1717.1-11(a); and
(2) 	An additional six months of coverage in
accordance with section 17-1717.1-11(b); or

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(3) 	Due to the collection or increased collection
of spousal support payments, the household is
eligible to receive four months of coverage
in accordance with section 17-1717.1-11(c).
(b) 	A new household member may be added to the
transitional medical assistance household when there is
increased income from employment or increased hours of
employment. 	If eligible, a new household member shall
be added to the household as of the month of request
and not extend beyond the date when the rest of the
household is terminated.
(c) 	The time-limited extension periods for
transitional medical assistance coverage under section
17-1717.1-11 shall be rescinded when federal
authorization or the allocation of federal funding is
discontinued and shall encompass only the following:
(1) 	An extension period of four consecutive
calendar months when the household was
terminated under the provisions of chapters
17-1716 or 17-1717, because of increased
earnings or hours of employment; and
(2) 	The household received assistance in at least
three of the six months immediately preceding
the month in which the household became
ineligible for chapters 17-1716 or 17-1717.
[Eff 	09/30/13](Auth: 	HRS §346-14; 42 C.F.R.
§435.112) (Imp: 	HRS §346-14; 42 C.F.R.
§435.112)
17-1717.1-11 	Extension periods. 	(a) 	Initial
six-month period for transitional medical assistance:
(1) 	Shall be extended to a household who is
terminated solely because of increased income
from employment or increased hours of
employment of the household;
(2) 	Received assistance at least three of the
six-months immediately preceding the month in
which the household became ineligible in the
Pregnant Women Group, or the Parents or
Caretakers Relative Group; and
(3) 	Shall include a child as defined in this
chapter, or eligibility shall terminate at
the end of the first month in which the

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household ceases to include the child.
(4) 	The department shall notify the household of
the option to receive an additional six-month
period of transitional medical assistance
during the third and sixth month of this
initial six-month period.
(5) 	Shall terminate at the end of the sixth month
period when the household fails to meet the
reporting requirements of section 17-1717.1-
12(a), unless the household establishes good
cause for failure to report timely. 	Failure
to submit timely due to physical or
psychiatric limitations may constitute good
cause.
(b) 	Additional six-month period for transitional
medical assistance:
(1) 	Shall be extended to a household when the
household received transitional medical
assistance during the entire initial six-
month period according to subsection (a); and
(2) 	Shall include a child as defined in this
chapter, or eligibility shall terminate at
the end of the first month in which the
household ceases to include the child.
(3) 	The department shall notify the household of
the reporting requirements of section 17-
1717.1-12(b)(1) during the third month of the
additional six-month transition period.
(4) 	Shall terminate when the household fails to
meet the reporting requirements of section
1717.1-12(b), unless the household
establishes good cause for the failure to
report timely. 	Failure to submit timely due
to physical or psychiatric limitations may
constitute good cause, or the household had
no earnings in one or more of the previous
months, unless the lack of earnings was due
to involuntary loss of employment, illness,
or other good cause.
(c) 	Four-month period for transitional medical
assistance:
(1) 	Shall be extended to a household for a period
of four consecutive months when the household
is terminated from the Pregnant

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Women Group, or Parent or Caretaker Relatives
Group because of the collection or increased
collection of spousal support payments under
Title IV-D of the Social Security Act; and
(2) 	Received assistance in at least three of the
six-months immediately preceding the month in
which the household became ineligible for the
Pregnant Women Group, or the Parent or
Caretaker Relatives Group.
(3) 	Shall begin on the date the household became
ineligible for assistance and terminated from
the Pregnant Women Group, or Parent or
Caretaker Relatives Group.
(4) 	When eligibility for the household is
terminated retroactively, the four month
period shall begin retroactively with the
first month in which eligibility through the
Pregnant Women Group, or Parents or
Caretakers Relative Group was erroneously
received.
(d) 	When a household is determined ineligible
or exhausts the extension period for transitional
medical assistance, the department shall initiate and
ensure timely determination of continued eligibility
under provisions of this chapter or if terminated,
eligibility under other applicable chapters shall be
considered. 	[Eff 	09/30/13] 	(Auth: 	HRS §346-14; 42
C.F.R. §435.112) (Imp: 	HRS §346-14; 42 C.F.R.
§435.112)
§17-1717.1-12 	Income requirements. 	(a) The
initial six-month period of transitional medical
assistance:
(1) 	The household income shall not be considered
in the determination of eligibility for
participation.
(2) 	The household shall report to the department,
no later than the twenty-first day of the
fourth month of the initial six-month period,
on the household:
(A) 	Gross monthly earned income for each of
the first three months of the initial
six-month period; and

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(B) 	Cost for childcare that is necessary for
the employment of the household for each
of the first three months of the initial
six-month period.
(b) 	The additional six-month period of
transitional medical assistance:
(1) 	The household shall report to the department,
not later than the twenty-first day of the
first and fourth month of the additional six-
month period, on the household:
(A) 	Gross monthly earned income for each of
preceding three months; and
(B) 	Cost for childcare that is necessary for
the employment of the household for each
of the preceding three months.
(2) 	The reported household monthly earnings
according to paragraph (1) shall be used to
determine the countable income for the
household of applicable size and shall not
exceed one hundred eighty-five per cent of
the federal poverty level for the additional
six-month period.
(c) 	The four-month period of transitional medical
assistance household income shall not be considered in
the determination of eligibility for participation.
[Eff 	09/30/13] 	(Auth: 	HRS §346-14; 42 C.F.R.
§§435.112) (Imp: 	HRS §346-14; 42 C.F.R. §§435.112)
§17-1717.1-13 	Asset requirements. 	Assets shall
not be considered in the determination of eligibility
for participation in transitional medical assistance.
[Eff 	09/30/13] 	(Auth: 	HRS §346-14; 42 C.F.R.
§§435.112, 435.603) (Imp: 	HRS §346-14; 42 C.F.R.
§§435.112, 435.603)
§§17-1717.1-14 to 17-1717.1-18 	(Reserved).
SUBCHAPTER 3
FREEDOM OF CHOICE, ENROLLMENT, BENEFITS AND
DISENROLLMENT

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§17-1717.1-19 	Purpose. 	This subchapter addresses
and refers to the provisions of freedom of choice,
enrollment, benefits and disenrollment for an
individual eligible in accordance with this chapter.
[Eff 	09/30/13] 	(Auth: 	HRS §346-14; 42 C.F.R.
§§430.25, 431.10, 431.40) (Imp: 	HRS §346-14; 42 C.F.R.
§§430.25, 431.10, 431.40)
§17-1717.1-20 	Freedom of choice. 	When relocation
results in the non-service of the health plan in which
the household was enrolled, they shall be provided a
choice of health plan and a provider as described in
chapter 17-1720.1. 	[Eff 	09/30/13] 	(Auth: 	HRS §346-
14; 42 C.F.R. §§430.25, 431.51, 438.52) (Imp: 	HRS
§346-14; 42 C.F.R. §§430.25, 431.51, 438.52)
§17-1717.1-21 	Enrollment into a participating
health plan. 	(a) 	An individual eligible in
accordance with this chapter, with the exception of an
individual identified in section 17-1735.1-2(a), shall
continue to be enrolled in the selected health plan as
a recipient in accordance with chapter 17-1720.1,
except for the provision of section 17-1717.1-20.
(b) 	An individual participating in transitional
medical assistance shall not participate in the annual
health plan open enrollment period.
[Eff 	09/30/13] 	(Auth: 	HRS §346-14; 42 C.F.R.
§§430.25, 431.10) (Imp: 	HRS §346-14; 42 C.F.R.
§§430.25, 431.10)
§17-1717.1-22 	Benefits. 	(a) 	An individual
eligible in accordance with this chapter who is
enrolled in a health plan shall be provided a standard
benefits package by a participating health plan and
other services when appropriate as described in chapter
17-1720.
(b) 	An individual identified in section 17-
1735.1-2(a) shall be provided coverage under the fee-
for–service provisions as described in chapter 17-1737.
[Eff 	09/30/13] 	(Auth: 	HRS §346-14; 42 C.F.R.
§§430.25, 431.40, 438.6) 	(Imp: 	HRS §346-14; 42 C.F.R.

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§§430.25, 431.40, 438.6)
§17-1717.1-23 	Disenrollment from a health plan.
An enrollee shall be disenrolled from a health plan
under the provisions as described in section 17-1720.1.
[Eff 	09/30/13] 	(Auth: 	HRS §346-14; 42 C.F.R.
§430.25) (Imp: 	HRS §346-14; 42 C.F.R. §430.25)
§§17-1717.1-24 to 17-1717.1-28 	(Reserved).