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fill out the Combined Application (CA). The D.C. Healthy Families application is shorter, and families applying for Medicaid using this form are required to verify less information provided on the application. Many children and parents applying for Medicaid using the D.C. Healthy Families Application are found eligible for Medicaid under the AR program type.

In cases where the policies differ for families with children based on the type of application filed rather than on the program type under which their eligibility will be determined, the Manual uses the following groupings to distinguish between families filing a D.C. Healthy Families Application and families filing a CA: AR/AX D.C. Healthy Families Application Users, AR/AX Combined Application Users, and the other groups will remain as described above (SR and QM).

EPSDT/Health Check 2.2.8

Federal Medicaid rules require that the District's Medicaid program provide Early Periodic Screening Diagnosis and Treatment (EPSDT) services to children receiving Medicaid. EPSDT services – called Health Check in the District – include medical, dental, vision, and hearing screening and all medical services deemed necessary to treat to prevent health problems in these areas. Immunizations are also considered an EPSDT service.

MAA is responsible for ensuring that Medicaid providers offer these services to children under age 21, or under age 22 in the case of a child receiving SSI due to a disabling medical condition.

ESA is responsible for informing Medicaid applicants and recipients, including those who are deaf, blind, non-English speaking, and/or functionally illiterate of the Health Check services and of the assistance MAA can provide in scheduling EPSDT appointments and assisting with transportation to and from EPSDT appointments. ESA must inform all Medicaid applicants and recipients of these services in writing and orally, at application, recertification, and when adding a child to the group.

TEMPORARY ASSISTANCE TO NEEDY FAMILIES (TANF) 2.3

The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 ended the federal entitlement of individuals to cash assistance under the Aid to Families with Department Children Program (AFDC), formerly authorized under Title IV-A of the Social Security Act. This law replaced AFDC with the Temporary Assistance Needy Families (TANF) block grant. The District uses this block grant to operate a cash assistance program for poor families with children. The District calls this program 'TANF.' The District's TANF program includes requirements for recipients to participate in work or other activities that will lead to paid employment. The program is intended to reduce dependence on public assistance and enhance individual and family economic self-sufficiency.

PRWORA and District law impose a lifetime limit of 60 months on receipt of cash benefits funded with federal TANF funds. Subject to some exceptions, federal TANF funds cannot be used to provide cash assistance to a family that has received assistance for 60 months. In addition, in order to receive TANF cash benefits, an adult recipient, unless exempt, must be engaged in work-related activities, including work experience, job training, and subsidized and unsubsidized employment for a defined number of hours each week (see Chapter 1: Work Requirements in Part V). Failure to participate in work activities can lead to a reduction in the family's TANF grant. Individuals are exempt from work requirements only in special circumstances, such as disability, incapacity or illness, lack of appropriate child care, caring for a disabled child, or advanced age. Additional exemptions, exclusions, and restrictions apply (see Section 1.6: Exemptions from Work Requirements in Part V).

Effective April 1, 2011, a Reduced Payment Level will be used to determine eligibility for assistance groups that have received TANF for more than 60 months, if the group includes as one of its mandatory or