225.03 Required Verification SR 05-25, 08/05 (FAM-A)

The individual who signs Form 800 or Form 800HR to apply on behalf of the child must provide verification of TANF medical assistance eligibility criteria except for deprivation of parental care and support.

• Require written verification of the child’s age.

If a preliminary determination of eligibility, including a manual computation of financial eligibility, indicates the child would be eligible for medical assistance, the *Office of Medicaid, Business, and Policy (OMBP) requires all of the following for the medical eligibility determination:

• * a separate Form 900, Authorization for Release of Protected Health Information, for each provider listed on the Form 968;

• Form 940, Cover Memo for Medical Eligibility Information;

• Form 968, Children with Severe Disabilities Report of Parent or Guardian; and

• * a copy of the child’s Individual Education Plan (IEP) or "504" Plan, if available.

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