IM-6 01/11/00 FAILURE TO COOPERATE - MEDICAL SUPPORT
|FAILURE TO COOPERATE WITH REGARD TO MEDICAL
MANUAL REVISION #3 FAMILY HEALTHCARE
IMNL Sections 0905.010.40, 0905.010.45.10, 0910.040.00, 0920.010.35.05
|Eligibility for MC+ healthcare coverage
cannot be denied or terminated for a child due to the refusal of another
person to cooperate in establishing paternity or obtaining medical support
for the child. Therefore, sanction of a parent or caretaker for failure
to cooperate should not affect the eligibility of the child. Health
Care Financing Administration (HCFA) issued policy clarification that allows
states to leave the sanctioned parent in the assistance group.
Effective immediately for Medical Assistance for Families (MAF) and MC+ cases, do not reduce the size of the child's assistance group on the basis that a parent refused to cooperate in establishing paternity and pursuing medical support. The family size and need remain the same for MC+ healthcare coverage purposes, whether or not the parent cooperates. Failure to cooperate will make the caretaker ineligible for MC+ healthcare coverage, except MC+ for Pregnant Women.
As an included member of a MAF assistance group, the sanctioned person is considered a caretaker relative. When applicable, eligibility for Transitional Medical Assistance exists for the children but not the caretaker.
NOTE: There is no change in policy and procedures with regard to sanctioning for Temporary Assistance.
MAF cases without cash will not accept a "S" (sanctioned) level of care. As an included member of a MAF assistance group, the sanctioned persons must be shown as a "C" level of care. Sanctioned individuals are shown as included individuals on the IMU5 on C7 cases. It must be noted in the case file the individual is sanctioned, reason for sanctioning, etc., to insure the individual is not inappropriately added to MAF or as a Custodial Parent.
IMNL sections 0905.010.40, 0905.010.45.10, 0910.040.00, 0920.010.35.05 have been revised to reflect this change.
Distribution # 2