169.03 Individuals Who Request Assistance Due to Section 1619 Status (MAM)

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Individuals who are certified by SSA under Section 1619 and are not receiving medical assistance at the time of certification must complete DFA Form 800, Application for Assistance, or DFA Form 800MA, Application for Health Coverage & Help Paying Costs, to request medical assistance.

1. Verify if SSA certified the individual under Section 1619.

2. Determine if the individual was receiving medical assistance in the month prior to Section 1619 certification.

3. If the individual was receiving medical assistance in the month prior to Section 1619 certification, a new eligibility determination is not needed. Begin medical assistance as of the first of the month the individual was certified under Section 1619.

4. If the individual was not receiving medical assistance in the month prior to Section 1619 certification, determine eligibility for three-month retroactive medical assistance.

- If the individual was eligible for retroactive medical assistance in the month prior to Section 1619 certification, begin extended medical assistance as of the first of the month the individual was certified under Section 1619.

- If the individual was not eligible for medical assistance in the month prior to Section 1619 certification, determine if the individual is currently eligible for medical assistance under any of DFA’s programs. Do not begin extended medical assistance due to Section 1619 status in this situation.

Exception: Automatic continued Medicaid coverage due to Section 1619 Status does not apply to individuals who were open for TANF cash and/or medical assistance in the month prior to being certified by SSA as Section 1619 Status.