812-1        INFORMING APPLICANTS AND RECIPIENTS ABOUT MEDICAL SUPPORT ORDERS AND REQUIREMENTS

When an initial application is received and when a recipient requests that a child be added to the case, DPADivision of Public Assistance must give medical support cooperation and enforcement requirements to the parent or guardians who are required to cooperate and provide them with:

• A Child Support Information form to complete for each noncustodial parent not living in the home of the dependent child. This form is not sent to CSSDChild Support Services Division. It is used to collect whether a client agrees to cooperate, is requesting good cause, and information about the non-custodial parent. The individual will work directly with CSSDChild Support Services Division for choosing to opt out of cash enforcement support, keeping information confidential, etc.

• Written notice of the specified relative's right to claim good cause for not cooperating with CSSDChild Support Services Division;

• A Child Support Cooperation Statement (GEN 80Child Support Cooperation Statement) for specified relatives to complete if they choose not to provide the information requested on the Child Support Information form and who want to claim good cause.

If a signed Child Support Information form is required as explained in section 812, the parent or guardian must be notified of the requirement to submit a completed Child Support Information form and be given at least 10 days to provide this documentation or request good cause.

If all other eligibility requirements are met and the parent or guardian states they will cooperate with CSSDChild Support Services Division, authorize Medicaid based on the client’s declaration and send a written notification of the requirement to submit a completed Child Support Information form. If the parent or guardian does not provide the necessary documentation by the due date, the adult household member is ineligible for MAGIModified Adjusted Gross Income Medicaid and must be removed from the case with adverse action. See section 812-4 for penalty information.

If all other eligibility requirements are met and DPADivision of Public Assistance does not receive a statement of cooperation, non-cooperation, or request for good cause from the specified relative, authorize the benefits for the eligible child(ren) in the household and send a written notification of cooperation to the parent or guardian.