121 INITIATION OF MEDICAL ASSISTANCE SR 13-06, 10/13 (MAM-A)

Medical assistance begins on the date of application if all eligibility requirements are met. Applications are made using DFA Form 800, Application for Assistance, DFA Form 800MA, Application for Health Coverage & Help Paying Costs, DFA Form 800P, Application for Children’s Medicaid (CM) and Medical Coverage for Pregnant Women (MCPW), or DFA Form 779, Application for Retroactive Medical Assistance.

Exceptions:

• Children’s Medicaid (CM) for newborns begins on their birth date, if all eligibility factors are met on that date.

• Medical assistance for recipients of Refugee Medical Assistance and 1619 certified individuals begins on the first of the month in which all eligibility requirements are met.

• Medical assistance for an individual being added to an existing group begins on the date on which the individual meets all eligibility factors.

• In and Out medical assistance begins on the day of the month on which the spenddown is met.

• Medical assistance for individuals being released from a public institution begins on the date of their release.

• Medical assistance for individuals eligible using the life insurance offset begins on the specific day of the month that life insurance, minus incurred unpaid medical bills, plus other resources, are equal to or less than the resource limits, providing all other eligibility requirements are met.

• Medical assistance can be retroactive up to 3 months preceding the application date when permitted by policy.

• Individuals found presumptively eligible for CM or Medical Coverage for Pregnant Women (MCPW) must be opened for benefits within 5 days of receipt of DFA Form 800P by the District Office, unless, upon review, the District Office determines that:

- the presumptive eligibility decision was in error; or

- the individual has had consecutive presumptive eligibility determinations without an intervening period of receipt of medical assistance for which the District Office has conducted a full eligibility determination and verified all pertinent eligibility criteria.