101.04.02 REQUEST FOR AN INFORMAL MEDICAID ELIGIBILITY OPINION

An individual seeking assistance from other social service agencies may be required to obtain a statement from DOM advising that he is not eligible for Medicaid to obtain that agency’s services. If the individual indicates through questioning that none of the categorical requirements would be met, i.e., the person is not aged, blind, disabled, pregnant, under age 19 or part of a family with dependent children, the regional office may provide the individual with a statement that he is not eligible based on the self-declared information. The statement must also explain to the individual that the decision is not an official denial and cannot be appealed. If an official denial notice is required, an application must be filed, and a decision rendered after all eligibility factors have been examined according to policy. The “Request for Unofficial Denial” form is in the Appendix page by the same name and must be used to issue an unofficial denial of eligibility.