zz – Obsolete

0105.025.15.25 Medical Assistance Program Explanation – OBSOLETE

Obsolete per IM-126 September 15, 2022

IM-44 September 4, 2014, IM-105 August 23, 2002

Give copies of the following leaflets:

  1. Medicaid and You; IM-4 Medicaid
  2. Non-Emergency Medical Transportation;
  3. Medical Assistance Benefits; IM-4 MA
  4. Medical Assistance Spenddown, if needed; IM-4 SPDN
  5. Hearing Rights; IM-4 Hearings
  6. HCY, if applicant under 21
  7. Personal Care; IM-4 PC
  8. Health Insurance Premium Payment (HIPP) Program

Complete the following forms, at a minimum:

  1. Application and Eligibility Statement; IM-1MA
  2. Request for Direct Deposit; (if dual eligibility for GR) IM-4DD
  3. Insurance form, IM-9, if needed;
  4. Referral for Social Security Number, SSN-1 if needed;
  5. If applying based on disability and a Medical Review Team (MRT) decision will be required, complete and submit all documents necessary in the MRT-Processing Center Packet:
    • MRT Checklist
    • Authorization for Disclosure of Consumer Medical/Health Information (MO-650-2616) (requires applicant’s signature)
    • Social Information Summary (IM61)
    • Disability Questionnaire (IM61B)
    • Work History (IM61C)
    • Facility/Doctors List (IM61D)
    • Visual Disability Examination Report (if application includes a determination based upon blindness) (IM68)
  6. Home and Community Based Referral (if applying for HCBS); IM-54A
  7. Request for Information, if needed; IM-31A
  8. Third Party Liability, if needed; TPL-1
  9. HIPP-1, if applicable

Explain the following:

  1. How spenddown works (if spenddown)
  2. December 1973 eligibility requirements (see 0105.020.15.60)
  3. Lack of a cash grant
  4. Need
  5. Division of assets (if institutionalized or HCB and there is a community spouse)
  6. Special Eligibility Groups (MACC, QMB, SLMB, QDWI, MADC, MOCDD, 1619)
  7. Prior quarter coverage
  8. Medicare Buy-in
  9. SSN
  10. Available services and how to access them