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DEPARTMENT FOR AGING AND REHABILITATIVE SERVICES AUXILIARY GRANT PROGRAM NON-FINANCIAL REQUIREMENTS 07/19 CHAPTER C, PAGE 53 To be eligible for Medicaid, an individual must: • Assign his rights to medical support and payment for medical care from any third party to the Department of Medical Assistance Services (DMAS), • Cooperate with the agency in identifying (to the extent he/she is able) potentially liable insurers and other third parties, and • Provide information to assist DMAS in pursuing payments from any third party who may be liable to pay for the individual's care and medical services.

The assignment of rights agreement is included in the “Application for Benefits”. • By signing the application form the applicant is agreeing to assign his rights and meets the initial requirements. Note: Assignment of rights is not an eligibility factor for AG. 11.1. Good Cause A waiver of the requirement to cooperate in identifying and providing liable third party information is allowed if the individual claims good cause for not cooperating and the agency finds that good cause does exist. Good cause will exist when cooperation will result in reprisal against or cause physical or emotional harm to the individual. The case record must be documented to reflect the reason the individual believes harm will occur and information to support the agency findings. 11.2. Unable To Assign Rights If the individual is unable to assign his/her rights, a spouse, legally appointed guardian or conservator, attorney-in-fact (person who has the individual’s power- of-attorney), or the representative can make the assignment. The failure of this person to assign the individual’s rights will not affect the individual’s eligibility for Medicaid. 11.3. Refusal To Assign Rights Or Cooperate If an individual does not comply with the assignment of rights and cooperation requirements, he/she will remain AG eligible but will not be Medicaid eligible. 11.3.1. Initial Application If otherwise eligible, approve AG and deny Medicaid. Send a Notice of Action that reflects the AG and Medicaid actions.