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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M01 September 2012 Subchapter Subject

Page M01 APPLICATION FOR MEDICAL ASSISTANCE TOC i

TABLE OF CONTENTS

M01 APPLICATION FOR MEDICAL ASSISTANCE

SUBCHAPTER Page

General Information M0110

Legal Base and Agency Responsibilities ......................... M0110.100.................................... 1

Definitions ......................................................................... M0110.200.................................... 5

Availability of Information .............................................. M0110.300.................................... 7

Retention of Case Information ........................................ M0110.400.................................. 10

Virginia DSS Strengthening Families Initiative Practice Model.......................................... M0110.500 ................................. 13

Virginia DSS Strengthening Families Initiative Practice Model (Full) ............................................... Appendix 1 .................................. 1

Medical Assistance Application M0120

Right to Apply ................................................................... M0120.100.................................... 1

Who Can Sign the Application ........................................ M0120.200.................................... 1

Medical Assistance Application Forms .......................... M0120.300.................................... 8

Place of Application ......................................................... M0120.400.................................. 11

Receipt of Application ...................................................... M0120.500.................................. 15

When An Application Is Required ................................. M0120.500.................................. 15

Sample Letter Requesting Signature .............................. Appendix 1 ................................. 1

The Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA) Medicaid Application, form #032-03-384……………………Appendix 2 ................................. 1

Interstate Compact on Adoption and Medical Assistance (ICAMA) Member States and Reciprocity……..…Appendix 3 ................................ 1

Application Processing M0130

Processing Time Standards ............................................. M0130.100 ................................... 1

Required Information and Verifications ....................... M0130.200 ................................... 3

Eligibility Determination Process ................................... M0130.300 ................................... 8

Applications Denied Under

Special Circumstances .......................................... M0130.400 ................................. 11