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• Health insurance policies, including health insurance policies from the Federal Marketplace, carried by the applicant, or carried for the applicant by an employer or relative. • Government financed health programs, such as: o Medicare - Parts A and/or B o CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) o CHAMPVA (Civilian Health and Medical Program of the Veterans Administration) and Veterans' benefits. o Tricare o Workman's compensation (for employment related accidents) o Automobile insurance (for automobile accidents). It is crucial that all medical resources be identified so that, if the applicant is determined to be eligible for MA, the Medicaid Fiscal Contractor, when processing provider claims, can seek payment from these resources before payment is made by Medicaid.

2434.20.00 THE RIGHT TO CLAIM GOOD CAUSE - MEDICAL SUPPORT Upon receipt of a medical sanction request from IV-D, a Medical Assignment Good Cause Notice (FI 2009) must be sent to the client prior to any enforcement of a sanction. The Good Cause notice gives the client 20 days to come into compliance with the medical support obligations by:

Claiming good cause by returning the form, along with evidence supporting their claim, to the DFR. If the form is not returned within the 20 days, the sanction is enforceable. If the form is returned within 20 days, the sanction is not enforceable, pending the good cause decision. A copy of the notice must be retained in the case record. Please note that a good cause notice must also be given to an applicant/recipient who is deciding whether to claim good cause. Good cause is defined as any circumstances in which cooperation would result in serious physical or emotional harm to the individual for whom medical support is sought. The evidence needed to substantiate a good cause claim is specified on the good cause notice.

If the client returns the Good Cause Notice to the local office, the form and any other related documentation should be sent to Central Office for review. While Central Office is deciding, benefits cannot be delayed, denied, or discontinued, if all other financial and non-financial eligibility requirements have been met.

If Central Office determines that Good Cause has been established, the sanction is not enforceable.