(1) Public assistance staff determine eligibility for Family-related Medicaid at application, when a change in conditions of eligibility is reported, or, on not greater than a 12 month cycle. The individual or the designated representative is required to assist the Department in completing the determination or redetermination of Medicaid eligibility. Qualified designated Medicaid providers determine presumptive eligibility for pregnant women. Requests for Medicaid coverage on behalf of children in care of the Department of Juvenile Justice are made on form CF-ES 2293, Child in Care Medicaid, May 2010
April 2007 (incorporated by reference).
(2) Simplified Eligibility for Pregnant Women
(a) The application form for a pregnant woman applying only for Medicaid and only for herself based on pregnancy is CF-ES Form 2700, Health Insurance Application for Pregnant Women
Woman, 05/2010 10/2008 (incorporated by reference). This form and attached information/rights and responsibilities (pages 2 & 3) may be used as a mail-in application form or it may be provided directly to a local Children and Family Services office, health department or other Qualified Designated Provider (QDP). Copies of the mail-in application forms may be offered to pregnant women by mail or picked up by them in health departments and other QDP sites as well as selected doctors’ offices designated by each circuit/regional ACCESS Program Office.
4. A declaration of citizenship is required. The applicant’s statement on the Health Insurance Application for Pregnant Women
Woman, CF-ES 2700, is acceptable as a declaration of citizenship. U.S. citizens must provide proof of their U.S. citizenship and identity, if they are not subject to an exemption as specified in 42 C.F.R. 435.406 (2009) (2007) (incorporated by reference).
Specific Authority 409.919 FS. Law Implemented 409.902, 409.903, 409.904, 409.919 FS. History–New 10-8-97, Amended 2-7-01, 10-21-01, 4-1-03, 2-4-04, 6-26-08,_________.