227.03 Family Planning MA Application Process (MAM)

_____________________________________________________________

Application for Family Planning medical assistance (MA) may only be made on DFA Form 800FP, Application for Family Planning Medical Assistance. The individual who signs DFA Form 800FP must provide verification of all eligibility criteria.

A valid Family Planning application is one that contains the Family Planning applicant’s name, address, and the signature of the applicant or their authorized representative. *Family Services Specialists (FSS) *review the application and other submitted information, request missing verification (if applicable) from the *client, and process the application in accordance with policy. The official filing date of the application is *the date the valid DFA Form 800FP was received by the District Office or CMU.

*

The 10-day verification and 45-day eligibility decision timeframes apply to Family Planning MA determinations. Upon receipt of the Family Planning MA application, the *FSS must make a determination of eligibility for Family Planning MA within that 45-day timeframe.

*

Because no Medicaid cards will be issued for this program, *the New-HEIGHTS-generated AE0124, Proof of Family Planning Medical Assistance (FPMA), which will be automatically generated to the client once determined eligible for FPMA, must be used by the FPMA recipient in lieu of a card. Eligible individuals must use the AE0124 with healthcare providers for subsequent access to Family Planning Services. If New HEIGHTS is unavailable, the FSS must complete and send DFA Form 809, Proof of Family Planning Medical Assistance (FPMA), the paper back-up to the New HEIGHTS-generated AE0124, to the client.

*

References: He-W 509, He-W 841.01, He-W 841.07, RSA 126-A:4-c, Section 1902(a)(10)(A)(ii) of the Social Security Act [42 U.S.C. 1396a(a)(10)(A)(ii)]; 42 USC 1396r-1c; 42 U.S.C. 1396a(ii)(3)