167.07 Determining Good Cause (MAM)

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If an individual fails to meet a requirement for 12-month extended medical assistance and claims to have a good reason for failing to do so, determine whether the reason meets the criteria for good cause. If good cause appears to exist, do the following:

• obtain approval of the good cause claim from the DFA supervisor, and

• document the good cause claim and any verification provided in the case record.

Good cause for not returning a timely, completed DFA Form 890 exists only for the following reasons:

• mail delay,

• illness of the parent/caretaker relative or other family member, or

• emergency situations such as flood, fire, loss of shelter, or similar events which prevent the individual from returning the form.

Good cause for failure to be employed exists only for the following reasons:

• involuntary loss of employment,

• illness of the parent/caretaker relative or other family member, or

• emergency situations such as flood, fire, loss of shelter, or similar events which prevent the individual from continuing employment.

References: He-W 882.05; RSA 167:82, VI; 42 USC 1396r-6(b); 42 USC 1396u-1(c)(2)