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MEDICAL SERVICES POLICY MANUAL,SECTION F

F 100 Non Financial Eligibility Requirements

2. Good Cause An applicant or recipient may have good cause not to cooperate in the state’s efforts to collect child or Medical support. The applicant or recipient may be excused from cooperating if they believe that cooperation would not be in the best interest of the child, and if the applicant or recipient can provide evidence to support this claim. The following are circumstances under which DCO may determine that the applicant or recipient has good cause for refusing to cooperate: • Cooperation is anticipated to result in serious physical or emotional harm to the child. • Cooperation is anticipated to result in physical or emotional harm to the individual that is so serious it reduces the ability to care for the child adequately. • The child was born as a result of rape or incest. • Court proceedings are in progress for the adoption of the child. • The individual is working with an agency helping to decide whether or not to place the child for adoption. 3. Refusal to Cooperate-Sanction A child’s Health Care benefits cannot be denied or terminated due to the refusal of a parent or another legally responsible person to assign rights or cooperate with OCSE in establishing paternity or obtaining medical support. Health Care for the parent or caretaker relative will end after the appropriate notice has expired. If a parent or another legally responsible person states that they refuse to cooperate with the OCSE referral process during any case action (such as during the initial application or case change), the sanction can be applied by the DHS Eligibility Worker.

Note: If the parent, guardian, or caretaker relative is currently pregnant, they may still be referred to OCSE but will not be sanctioned if they refuse or fail to comply. Sanction will not be applied to the pregnant member’s coverage until the month after the end of their 60-day post-partum period. If the parent, guardian, or caretaker relative has already been sanctioned then reports a pregnancy, sanction will be lifted until the month after the 60-day post-partum period ends. If cooperation occurs, no sanction will be applied.

F-140 Medical Care Requirements MS Manual 07/01/20 For facility care, the individual mustmeet the categorical eligibility andmedical necessity requirements. Refer to MS F-150 and F-151.