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(b) 401 Waiver of Face to Face Interview with the Representative

The LDSS/LHD may waive the requirement for a face-to-face interview with a representative of a public or private agency who files on application for Medical Assistance (DHMH 115B (7/83)) on behalf of a child under 21 committed to the agency.

Public and private agencies including the department of Juvenile services (DJS), Social Service Administration (SSA), Mental Retardation/Developmental Disabilities Administration, Associated Catholic Charities, and Family and Children’s Society.

It may waive the requirement if, in gathering information required for the child’s placement, the representative has had recent face-to-face contact with his parent or guardian or, in the absence of one of these, some other responsible person who is knowledgeable about the child’s circumstances. Face-to-face contact between a representative and a parent or a guardian may be deemed to satisfy the face-to-face interview requirement. Provided the LDSS meets the additional requirements which follow.

The LDSS/LHD must contact the person who completed the application and determine:

1. If the information contained in the MA application was gathered from recent contact with the parents or other responsible persons; and 2. The dates and type(s) of contact (e.g., face-to-face, letter, or telephone).

In the context of this requirement, “recent” means the month of the application or the month prior to the month of application.

The LDSS/LHD must also discuss with the representative the responsibility to report all changes, proper use of the card, etc.

If, based on this contact, the LDSS/LHD is not satisfied that the information necessary to determine eligibility has been recently gathered and is complete and accurate, waiver of the face- to-face interview may not be allowed. (For persons residing in or entering a long-term care facility, see section entitled “Application Procedures Specific to Institutionalized Persons”).

(c) Exploring Alternative Avenues of Eligibility

The MA program has numerous eligibility coverage groups. For eligibility determinations, local departments must have systems and processes in place that explore all reasonable avenues of eligibility. At application, these systems must ensure that eligibility is tested beyond the first designated coverage group. At redetermination, these systems and processes must first consider whether the individual continues to be eligible under the current coverage group and, in the case of a negative finding, explore eligibility under other possible coverage groups. The extent to which, and the manner in which, other possible coverage groups must be explored will depend on the circumstances of the case and the information available to the local department.