223.03 Required Verification SR 97-09, 03/97 (FAM-A)

The individual who signs Form 800 or Form 800P on behalf of the child must provide verification of TANF medical assistance eligibility criteria, except for living with a specified relative and parental deprivation.

If a preliminary determination of eligibility, including a manual computation of financial eligibility, indicates the child would be eligible for medical assistance, require the individual to provide the information needed by the Joint Medical Review Team to determine medical eligibility by requiring all of the following:

- Form 11, Applicant’s Authorization to Release Information,

- Form 940, Cover Memo for Medical Eligibility Information,

- Form 967, Children with Severe Disabilities Report of Medical Findings,

- Form 968, Children with Severe Disabilities Report of Parent of Guardian,

- Form 969, Children with Severe Disabilities Report of Medical Care, and

- Form 970, Children with Severe Disabilities Authorization to Release Information.

• If the child is mentally disabled, also require the following:

- Forms 966a and 966b, Children with Severe Disabilities Report of Mental Status.

MAB is responsible for requesting additional information or verification if required to complete the medical eligibility determination.