910              APPLYING FOR CAMAChronic and Acute Medical Assistance

910-1           APPLICATION

An application for CAMAChronic and Acute Medical Assistance must be made on the GEN 50c form.  Any person acting on the applicant’s behalf (authorized representative ) may apply for assistance under the CAMAChronic and Acute Medical Assistance program by submitting a complete “identifiable application ”.  An applicantAny individual who completes an application for assistance should be instructed to enter “N/A” in sections of the application that do not pertain to the applicant’s particular situation.

An application is considered filed when received in a DPADivision of Public Assistance office. A faxed application will be accepted.

A separate application is not required to make a Medicaid eligibility determination.  A CAMAChronic and Acute Medical Assistance applicant will most likely be eligible for a category of Medicaid.

910-2           INTERVIEW

The caseworker must interview the applicantAny individual who completes an application for assistance before determining eligibility unless the caseworker determines that an interview is impossible or inadvisable because of illness, distance, or other cause.  The purpose of the interview is to establish to the satisfaction of the caseworker that the facts of the case are consistent with the statements made on the application and remind the applicantAny individual who completes an application for assistance that coverage does not begin until the month after the month of application.  When an interview is not possible, the application along with collateral statements from responsible individuals who have knowledge of the applicant’s need or circumstances will suffice.  

The caseworker must explain the responsibilities of a CAMAChronic and Acute Medical Assistance recipientAn individual who is receiving a public assistance program. and instruct the applicantAny individual who completes an application for assistance to report any changes that might affect his or her eligibility.  This includes changes in the nature of the medical need, living arrangement, income, or resources.   The recipientAn individual who is receiving a public assistance program. or the recipient’s authorized representative must report changes to the nearest DPADivision of Public Assistance district office within 10 days of the change.

910-3           VERIFICATION AND DOCUMENTATION

An applicantAny individual who completes an application for assistance must provide adequate evidence to demonstrate his or her eligibility and financial need.  The caseworker must verify the factors of eligibility and document this in the EISEligibility Information System online case notes.

The caseworker may verify factors of eligibility through the best means available to the applicantAny individual who completes an application for assistance.  For example, verification of income and expenses (i.e. business costs for self-employed applicants) may be accomplished through copies of pay stubs, the applicant’s1040 federal income tax forms, fish tickets, or a letter from the IRS verifying the applicantAny individual who completes an application for assistance did not pay taxes.

In villages serviced by a fee agent , verification requirements (with the exception of medical verification) may be satisfied by a statement signed by the fee agent attesting to the validity of information given on the application.  

Before initial eligibility can be determined, the caseworker must have a completed MED 11 (see Appendix-A) as verification of the applicant’s covered medical need.  The MED 11 must be completed by a physician, physician assistant, or advanced nurse practitioner verifying that the applicantAny individual who completes an application for assistance is terminally ill , is a cancer patient in need of chemotherapy, or has one of the four chronic conditions listed in Section 920-6.  

A MED 11 form is valid for 90 days from the date it is signed by the health care providerAny doctor or health facility which has agreed to provide medical services to recipients under the medical assistance program..  If an applicantAny individual who completes an application for assistance has a completed MED 11 form, but is denied eligibility for another reason, the applicantAny individual who completes an application for assistance may reapply for CAMAChronic and Acute Medical Assistance using the same MED 11 if the time between the date the providerAny doctor or health facility which has agreed to provide medical services to recipients under the medical assistance program. signed the MED 11 and the date of the new application does not exceed 90 days.  Once eligibility is established, the recipient’s medical status is presumed to continue until the next review.

A new MED 11 form is required when a former recipientAn individual who is receiving a public assistance program. reapplies for CAMAChronic and Acute Medical Assistance after any month of ineligibility.

910-4           MED 11 PROCESSING INSTRUCTIONS

The caseworker completes the PATIENT IDENTIFICATION and the RETURN TO CASEWORKER sections of the MED 11 form.  The form should be given to each applicantAny individual who completes an application for assistance to take to his or her health care providerAny doctor or health facility which has agreed to provide medical services to recipients under the medical assistance program..  If the applicantAny individual who completes an application for assistance has already seen a health care providerAny doctor or health facility which has agreed to provide medical services to recipients under the medical assistance program., the caseworker may fax the MED 11 directly to that providerAny doctor or health facility which has agreed to provide medical services to recipients under the medical assistance program..  If an applicantAny individual who completes an application for assistance has also applied for Interim Assistance and has been issued a DE-25 coupon, the providerAny doctor or health facility which has agreed to provide medical services to recipients under the medical assistance program. may use the DE-25 coupon to complete the MED 11 as part of the IAInterim Assistance disability assessment.

The Medical providerAny doctor or health facility which has agreed to provide medical services to recipients under the medical assistance program. completes the MED 11 form and returns it directly to the DPADivision of Public Assistance caseworker identified at the bottom of the form.  The applicantAny individual who completes an application for assistance is responsible for ensuring the providerAny doctor or health facility which has agreed to provide medical services to recipients under the medical assistance program. completes and returns the MED 11 to the DPADivision of Public Assistance caseworker in a timely manner.  If a MED 11 form is received directly from the applicantAny individual who completes an application for assistance, it must be sealed in a provider’s envelope to be valid.

The caseworker completes the eligibility determination upon receipt of the MED 11 and verification of all other factors of eligibility.  If the medical providerAny doctor or health facility which has agreed to provide medical services to recipients under the medical assistance program. does not find medical evidence to support the application, the caseworker must deny the application with adequate notice.  An applicantAny individual who completes an application for assistance may choose to get a second opinion, in which case the caseworker may provide another MED 11 to the applicantAny individual who completes an application for assistance, but may not issue another DE-25 coupon.

Example 1:

Application received 10/15/02. The MED 11 returned 10/25/02. Eligibility issued for November.


Example 2:

Application received 10/24/02. The MED11 returned 11/4/02. Eligibility issued for November.