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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M01 October 2022 Subchapter Subject Page ending with Page M0120 MEDICAL ASSISTANCE APPLICATION M0120.200 7

If the child was emancipated by the court, request the child’s signature on the application. If the application is mailed to the child, allow 10 calendar days for the signed application form to be returned. If the application form is not signed by the applicant, the guardian, the custodial adult, or the emancipated child and returned to the agency by the specified date, deny the application because it is invalid. 2. Non-custodial Parent Applying for Child Eligibility for a child is based on the income of the parent with whom the child lives. If a non-custodial parent applies for his child, he must give written permission for the eligibility worker to contact the custodial parent. The eligibility worker must obtain the custodial parent’s income information, written permission to verify income using available online data sources, and other information necessary to verify and calculate countable income, including Social Security Number and residence address. If either the non- custodial parent or the custodial parent fail to give the necessary permission, the child’s eligibility cannot be determined using the application filed by the non-custodial parent. 3. Minor Parent Applying for Child Parent(s) under age 18 years may apply for MA for their own child because they are the parent of the child. An undocumented minor can apply for FAMIS Prenatal Coverage since the coverage is considered to be for the unborn child. If the individual is eligible, the parent can then be enrolled for the duration of the pregnancy and the 60 day postpartum period. Any future applications filed for the minor prior to turning age 18 would need to be signed by someone who is legally authorized to sign on the individual’s behalf. 4. Foster Care Child a. IV-E The Title IV-E Foster Care & Medicaid Application form, available at https://fusion.dss.virginia.gov/Portals/%5Bdfs%5D/Files/Copy%20of%20032- 03-0636-06-eng.xlsx, is used for the IV-E Foster Care eligibility determination. A separate MA application is not required for a child who has been determined eligible for Title IV-E Foster Care. However, if there is a non-custodial agreement for the IV-E eligible child, the parent or legal guardian must sign an MA application for the child. b. Non-IV-E The Cover Virginia Application for Health Coverage & Help Paying Costs is used for the MA eligibility determination of a non-IV-E Foster Care child. Applications for non-IV-E Foster Care children may also be filed online. The MA application for a non-IV-E child who is in foster care must be signed by an authorized employee of the public or private agency that has custody of the child. Exception: If the child has been placed with and is living with a parent or care-taker relative, the parent or care-taker relative can sign the application. If there is a non-custodial agreement, an MA application form must be filed and the parent or legal guardian must sign the application.