Sponsored Aliens Who Apply for Medical Assistance. For an alien who has been sponsored by an agency or an organization to be eligible for medical assistance, the following conditions shall be met:

(a) The alien shall provide a signed and dated affidavit, on which the sponsoring agency or organization has provided the following:

(1) The name of the alien;

(2) The alien’s date of entry into the United States;

(3) The name and address of the sponsor;

(4) The amount of money the sponsor contributed to the alien, if any;

(5) The reason the sponsor cannot meet the alien’s total needs; and

(6) A statement that the sponsor agrees to a financial audit when needed to substantiate conflicting information;

(b) The sponsor shall be considered to be not meeting the alien’s total needs, if:

(1) The sponsor is contributing no money to the alien ; or

(2) The amount contributed is not enough to render the case ineligible for medical assistance due to excess income; and