151 ADDITION OF AN INDIVIDUAL (MAM)

SR 13-35 Dated 10/13

Previous Policy

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Determine eligibility when a new individual must be added to the case.

Process a request to add a new individual as if it were a new application for that person. A new DFA Form 800, Application for Assistance, or DFA Form 800MA, Application for Health Coverage and Help Paying Costs, is not required.

Process the application within time frames, using the date of the request as the file date.

If the new individual is ineligible or does not provide enough information, take the steps in the following chart:

Reason for Ineligibility

Action

Refuses or fails to provide required verification for an individual who must be included in the assistance group

Terminate entire case

Refuses or fails to provide required verification for an individual who may be included in the assistance group

Deny the new member only

Required verification is not available for the new member

Deny the new member only

New member does not meet the program criteria for inclusion in the assistance group

Deny the new member only

If the addition of a new individual is not reported within time frames, process a claim for overpayment if:

• the new individual must be included in the assistance group, and

• including the new individual would have decreased or terminated medical assistance benefits.