315.05 Cooperation Requirements for Developing Potential Sources of Income (MAM)

__________________________________________________________________

Individuals who are potentially eligible to receive other income or a benefit are required to cooperate in applying for, and pursuing receipt of, the other income or benefit. This means that the individual must:

• provide all required information and verification required by the eligibility-determining agencies or individual(s) responsible for the other income or benefit(s);

• complete all forms as required in the application process for the other income or benefit in the timeframes and manner required by the Department and the eligibility-determining agencies or individual(s) responsible for the other income or benefit(s); and

• pursue all appeal options within the timeframes set by the eligibility determining agencies or individual(s) responsible for the other income or benefit(s), up to, but not including, court action, if found ineligible for the other income or benefit due to medical reasons.

Terminate medical assistance for all adults in the assistance group if any individual in the assistance group who is potentially eligible for other income or benefits:

• fails or refuses to complete the application process for the other income or benefit;

• fails or refuses to provide information or verification to obtain the other income or benefit;

• fails or refuses to cooperate with the eligibility-determining agencies or individual(s) responsible for the other income or benefit;

• fails or refuses to accept the benefit if found eligible; or

• fails or refuses to pursue all appeal options up to, but not including, court action, if found ineligible for the income or benefit due to medical reasons.

Exceptions:

• 12 Month EMA cannot be terminated for refusal or failure to apply for potential benefits. See Section 167.05, Ineligibility Reasons, for valid termination reasons.

• Women who are pregnant or are within the 60-day post-partum medical coverage period cannot be terminated from medical assistance for failure or refusal to obtain third party medical coverage or cooperate with DCSS.

References: He-W 652.07, 42 CFR 435.608, 45 CFR 233.20(a)(3)(ix)