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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M01 April 2022 Subchapter Subject Page ending with Page M0120 MEDICAL ASSISTANCE APPLICATION M0120.300 9

• the deceased received a Medicaid-covered service on or before the date of death, and • the date of service was within a month covered by the MA application. If the above conditions were met, an application may be made by any of the following:

• his guardian or conservator,

• attorney-in-fact, • executor or administrator of his estate • his surviving spouse, or • his surviving family member, in this order of preference: adult child, parent, adult brother or sister, adult niece or nephew, or aunt or uncle. Under no circumstances can an employee of, or an entity hired by, the medical service provider who stands to obtain MA payment file an MA application on behalf of a deceased individual. Medicaid coverage can begin no earlier than three months prior to the application month. The entitlement rules for retroactive coverage apply to the application's retroactive period. Retroactive FAMIS coverage is available ONLY to an eligible child who was born within the 3 months prior to the FAMIS application month. E. Enrollee Turns 18 When a child who is enrolled in MA Medicaid turns 18, it is not necessary to obtain a new application signed by the enrollee. As long as the enrollee is under age 21, he does not need to authorize a parent with whom he lives for the parent to continue to conduct the enrollee’s MA business.

M0120.300 Medical Assistance Application Forms

A. General Principle – Application Required A signed application for MA is required for all initial requests for medical assistance, except for: • IV-E Foster Care/Adoption Assistance children • Auxiliary Grant (AG) applicants • Newborn children under age 1 born to women eligible for Medicaid, FAMIS, FAMIS MOMS, or FAMIS Prenatal Coverage.