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State of Maryland Medical Assistance Manual Revised April 2014

DOCUMENTATION RETURNED TO THE LDSS CASE MANAGER FOR ASSIGNMENT OF SUPPORT RIGHTS, RIGHT OF ELECTIVE SHARE

□ Meets a situation described indicated in Policy Alert 10-4, Supplement in which there should not be referred to Eligibility Services.

FAILED TO PROVIDE: □ Cover letter with all items completed. □ Assignment of Support Rights letter. □ Notary Certificate □ Documentation (printouts) for the absent spouse or verify searches failed to produce any data about the absent spouse.

Comments:_______________________________________________________________________ ________________________________________________________________________________ ____________________________________________________________________

Respectfully,

Program Specialist Office of Eligibility Services

Attachment D