M E M O R A N D U M

IM-149  10/17/00  IM-1MA & INST; IM-3MA & INST; FORMS MAN REV 33


SUBJECT:
IM-1MA, MEDICAID APPLICATION/ELIGIBILITY STATEMENT, AND INSTRUCTIONS; IM-3MA AND INSTRUCTIONS; INSTRUCTIONS FOR COMPLETING YOUR MEDICAID APPLICATION
  FORMS MANUAL REVISION #33
 
DISCUSSION:
The IM-1MA has been created to simplify the Medicaid and cash assistance application process for the aged, blind and disabled.  This new form is concise and restricted to aged, blind and disabled eligibility factors.  It should be used for all aged blind and disabled Medicaid and cash assistance applications, except those taken in conjunction with Food Stamps, Temporary Assistance, or MC+. 

As we strive to continually improve delivery of services to our clients, we are processing an increasing number of aged, blind and disabled Medicaid and cash assistance applications by mail, never seeing the applicant. In most cases, the mail-in procedure is a more efficient way to receive and process these applications.  The IM-1MA is designed to better support the process than previous use of the IM-1 and IM-2D, and should be used for all mail-in applications.  Do not use the IM-2 for mail-in applications. 

In addition, the IM-3MA Instructions (the cover letter used in conjunction with mail-out medicaid applications) have been revised.
 
NECESSARY ACTION:
  • Share this memorandum with staff.

    •  
  • An initial supply of IM-1MA and revised IM-3MA will be sent to local offices

    •  
  • Begin using the IM-1MA and revised IM-3MA for all aged, blind and disabled Medicaid applications

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  • File the IM-1MA and the revised IM-3MA and their instructions in the Forms Manual.  Remove the previous IM-3MA and instructions
CM
DISTRIBUTION 2
Form not available on-line, hard copy only
[ Memorandum Table of Contents ]