229.01 Required Verification: CSD SR 14-04 Dated 01/14

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The individual who signs DFA Form 800, DFA Form 800MA, or New HEIGHTS-generated Form 800HR on behalf of the child who is applying for Children with Severe Disabilities (CSD) medical assistance, must provide verification of *MAGI medical assistance eligibility criteria except for living with a specified relative and deprivation of parental care and support.

If a preliminary determination of eligibility, including a manual computation of financial eligibility, indicates the child would be eligible for CSD medical assistance, the Disability Determination Unit (DDU) requires all of the following for the medical eligibility determination:

. a separate DDU Form 900, Authorization for Release of Protected Health Information, for each provider listed on the Form 968;

. DDU Form 940, Cover Memo for Medical Eligibility Information;

. DDU Form 968, Family Information Report; and

. a copy of the child's Individual Education Plan (IEP) or "504" Plan, if available.

DDU is responsible for requesting additional information or verification, if required, to complete the CSD medical eligibility determination.

References: He-W 641.04, 42 CFR 435.845(c), 42 USC 1396a, Section 1902(a), (f), & (r) of the Social Security Act [42 USC 1396a]