227.23 Family Planning MA Required Verification (MAM)

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The individual who signs DFA Form 800FP, Application for Family Planning Medical Assistance, must provide verification of all eligibility criteria:

. NH residency;

. identity;

. enumeration status;

. alien or citizenship status;

. all income, including the most recent 4 weeks of earned income;

. health insurance, if already covered. This can be a copy of the front and back of the insurance card as long as it contains the following information, or the following information: Name of insurance company, Policy and Group Number, Name of Policy Holder, date the insurance began and the date it ends, if known; and

. if the family claims deductions, the deductions must be verified, otherwise no amount is deducted from income.

References: He-W 509, He-W 626, RSA 126-A:4-c, 42 CFR 435.914, 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)