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MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL The Division of Child and Family Services (DCFS) is a qualifying public agency only if: ● the agency is assuming partial or full financial responsibility for the child; and ● the child is placed at Desert Willow; and ● DCFS DOES NOT have custody of the child. D-215.1 Application To apply for Medicaid, the responsible agency must: • Complete and return Form 2447-EM, Medicaid Application for Children in the Custody of a Public Agency; and • Provide the information required for an eligibility determination. The DWSS case manager must make an eligibility determination within 3 working days from receiving the completed application AND the information required to process the case, unless unusual circumstances exist. The public agency must be mailed notification of the eligibility decision on the date the determination is made. If unusual circumstances prevent the application from being processed within this time frame, the reason for the delay must be documented in the case record. Medical benefits are approved when eligibility criteria are met. Notify the applying agency of the approval with the Notice of Decision, Form 2447-EM (page 3). D-215.2 Verifications By signing the application, public agencies (except DCFS) are attesting to having full or partial financial responsibility of the child for whom they are making application. If the agency is requesting prior medical assistance under this category, the agency must have had supervision of the child for a portion of the month for which assistance is being requested.  Children in the custody of DCFS ARE NOT eligible for this category of assistance. Children for whom DCFS is NOT taking custody, but for whom DCFS is assuming partial or full financial responsibility, may be eligible if the child meets all other eligibility criteria.  The public agency is required to provide legal documentation showing physical or legal supervision or wardship, copies of Agreements for Substitute Care Placement, reports to the court, or other pertinent documents showing changes in legal or physical supervision status as the documents become available. Division of Welfare and Supportive Services D-215 Medical Assistance Manual SPECIALIZED GROUPS-APPLICATION PROCESSING 17 Jul 01 MTL 04/17 CHILDREN FOR WHOM A PUBLIC AGENCY HAS ASSUMED FINANCIAL RESPONSIBILITY