163.03 Changes During the Four-Month Coverage Period (MAM)

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If an individual reports changes in eligibility factors during the four-month extended medical assistance (EMA) coverage period, take action as indicated below:

• Add eligible individuals to the assistance group (AG) if they join the household during the coverage period and inclusion of them will not cause the case to terminate.

• Add eligible children born during the coverage period as of their date of birth.

• If the individual reports a decrease in income which would make the AG eligible for financial assistance and the individual wishes to receive financial assistance, take the following action:

• obtain a completed DFA Form 800, Application for Assistance,

• ensure all FANF program criteria and resource requirements are met, and

• reopen financial assistance.

• Process other changes in income without changing the individual’s eligibility for four-month EMA.

• If an individual reports a change in program criteria or nonfinancial criteria which makes the individual or group ineligible, terminate medical assistance.

References: He-W 882.04; 42 CFR 435.115(f)-(h); 45 CFR 233.20(a)(15); 42 USC 1396u-1(c)(1)