222.03 Family Planning MA Application Process SR 13-30, 07/13 (FAM-A)

Application for Family Planning medical assistance (MA) may only be made on DFA Form 800FP, Application for Family Planning Medical Assistance. The individual who signs DFA Form 800FP must provide verification of all eligibility criteria. See Section 222.23, Family Planning MA Required Verification.

A valid Family Planning application is one that contains the Family Planning applicant’s name, address, and the signature of the applicant or their authorized representative. The Family Planning Family Services Specialist (FSS) stationed at the Children’s Medicaid Unit (CMU) reviews the application and other submitted information, requests missing verification (if applicable) from the qualified entity (QE) or client, and processes the application in accordance with policy. The official filing date of the application is either:

• the date that the QE worker interviewed the client and signed the DFA Form 800FP; or

• the date the valid DFA Form 800FP was received by the CMU, if completed and submitted directly by the applicant.

If the application is valid but is missing information needed to make a determination of eligibility, the QE worker must request the necessary information if involved in the case. If any verification is still needed after receiving a PE determination from a QE, or after receiving a DFA Form 800FP if the individual applies for Family Planning MA directly, the Family Planning FSS must use DFA Form 808, Proof Needed to Determine Your Assistance, to collect the outstanding verifications.

The 10-day verification and 45-day eligibility decision timeframes apply to Family Planning MA determinations. Upon receipt of the Family Planning MA application, the Family Planning FSS must make a determination of eligibility for Family Planning MA within that 45-day timeframe.

Once determined eligible or ineligible by the Family Planning FSS, “open” or “deny” notices of decision (NODs) must be manually issued to the individual. If a DFA Form 11 has been completed, these notices must also be sent to the QE identified on DFA Form 11:

• Because no Medicaid cards will be issued for this program, an “open” NOD must also include a completed DFA Form 809, Certification of Medicaid Eligibility for Family Planning Medical Assistance. In lieu of a card, the eligible individuals must use DFA Form 809 with healthcare providers for subsequent access to Family Planning services.

• Although DFA Form 810, Notice of Rights and Responsibilities, is generally provided with every NOD, Family Planning FSS do not have to include DFA Form 810 with the NODs associated with Family Planning MA because pertinent information was culled from DFA Form 810 and inserted directly into the manual NODs for this program.

Reasonable Opportunity Period

Family Planning MA applicants are eligible for the 95-day “reasonable opportunity” period to provide proof of citizenship and identity (see Sections 301.07, Verification of Identity, and Section 305.05, Verification of Citizenship, for more information). For those individuals who are eligible for Family Planning MA except that the applicant has not provided original documents verifying proof of citizenship and identity, the ID-citizenship NOD must be manually issued to the applicant. This NOD must also include the:

• DFA Form 800CITZ, Citizenship & Identity Acceptable Proof; and

• DFA Form 809, in which the eligibility period begins with the date the ID-Citizenship NOD is generated, which is considered day one, and ends 95-calendar days later.