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MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL Exception: When a child(ren) moves from one household to another household, there may be overlapping months of eligibility. When moving an individual to another household, do not post downgrades to eligibility after cut-off for the next month, MMIS cannot recognize this action and the eligibility will not be terminated. D-240 "PRUDENT PERSON" PRINCIPLE

The policies included in the manual are rules for determining eligibility. It is impossible to foresee and give examples for all situations; therefore, case managers are encouraged to use reason and apply good judgment in making eligibility decisions when rare and unusual situations are encountered. Reasonable decisions made by staff based on the best information available using good judgment, program knowledge, experience, and expertise in a particular situation is referred to as the prudent person principle Document the rationale used to make a decision and any applicable manual references and policy interpretations. Follow local office procedures for obtaining an interpretation from Eligibility and Payments (E&P) Program Specialists in Central Office, or submit Form 6018, Policy and Procedure Inquiry requesting clarification or directives, to the Chief of E&P, when it is impossible or inadvisable to follow the prudent person principle because of a lack of information or program knowledge. Note: Suspicious circumstances should be referred to I&R using Investigative Referral Form (2683-EE). D-245 PRIOR MEDICAL COVERAGE Prior medical coverage is available for up to 3 months prior to the application month if the individual requesting the coverage meets all eligibility requirements, in that month, for the specialized group. Eligibility is determined on a month-by-month basis for each individual requesting coverage. D-245.1 How to Apply for Prior Coverage A request for prior medical coverage may be made on any medical assistance application and is considered a separate application because it is for months predating the initial application. Prior medical requests may be added during the pending period and during the 12 month period after approval provided the case remains open. Therefore, approval, denial or pending of a prior medical request must always be addressed in a notice to the household. Do not delay an ongoing eligibility decision while obtaining information to determine prior medical eligibility. In addition, if the household is only requesting prior coverage, provide an ongoing eligibility decision at the time of application. D-235 Division of Welfare and Supportive Services SPECIALIZED GROUPS-APPLICATION PROCESSING Medical Assistance Manual DUPLICATE ASSISTANCE SCREENING 16 Jul 01 MTL 03/16