123.01 Initiation of Medical Assistance SR 12-04, 07/12 (FAM-A)

Medical assistance begins on the date of application if all eligibility requirements are met. Applications are made using DFA Form 800, Application for Assistance, DFA Form 800P, Application for *Children’s Medicaid (CM) and Medical Coverage for Pregnant Women (MCPW), or DFA Form 779, Application for Retroactive Medical Assistance.

Exceptions:

• *Children’s Medicaid (CM) for newborns begins on their birth date, if all eligibility factors are met on that date.

• Medical assistance for recipients of Refugee Medical Assistance and 1619 certified individuals begins on the first of the month in which all eligibility requirements are met.

• Medical assistance for an individual being added to an existing group begins on the date on which the individual meets all eligibility factors.

• In and Out medical assistance begins on the day of the month on which the spenddown is met. See Part 617, In and Out Medical Assistance.

• Medical assistance for individuals being released from a public institution begins on the date of their release.

• Medical assistance can be retroactive up to 3 months preceding the application date when permitted by policy.

• Individuals found presumptively eligible for *CM or Medical Coverage for Pregnant Women (MCPW) must be opened for benefits within 5 days of receipt of DFA Form 800P by the District Office, unless, upon review, the District Office determines that:

- the presumptive eligibility decision was in error; or

- the individual has had consecutive presumptive eligibility determinations without an intervening period of receipt of medical assistance for which the District Office has conducted a full eligibility determination and verified all pertinent eligibility criteria.