COMBINED Medicaid 300 Nonfinancial Requirements
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Governs the nonfinancial criteria and related cooperation obligations for determining Medicaid eligibility for assistance unit members in Montana's Medicaid program.
No material clinical or coverage changes in this revision.
Non‑Financial Eligibility & Cooperation Requirements
Non‑financial eligibility criteria
Each assistance unit member must meet the following non-financial criteria to be eligible for Medicaid:
ALL of the following
- Age: must meet minor child or aged‑only criteria.
- Minor child living with a specified relative: applies to ACA PCR and Family medically needy only.
- Social Security Number: SSN required; Social Security card is NOT required.
- Montana residence: must reside in Montana.
- Citizenship and/or immigration status: must meet applicable citizenship or immigration criteria.
- Identity: identity must be documented for all applicants and recipients.
- Blind/Disabled criteria: may need to meet blind/disabled criteria (ABD only).
- Level of care: level of care requirement applies (ABD only).
- Community engagement: community engagement requirements as applicable to ACA Adult Medicaid and ACA Adult; see CMA 310-1 Community Engagement and Exclusion Policy.
Cooperation and Third Party Liability (TPL)
Cooperation requirements affecting eligibility:
ALL of the following
- Primary Care Case Management: cooperate with PASSPORT provider (Primary Care Case Management).
- Program compliance reviews: cooperate with Medicaid program compliance reviews.
Third Party Liability (TPL)
- HIPPS questionnaires.
- Trauma questionnaires.
- Providing information on available insurance.
- Insurance questionnaires.
Coding & Counts
| No codes listed |
Required Cooperation and Provider/Recipient Obligations
Cooperation obligations (PCCM, program compliance, TPL)
Applicants, recipients, and providers must cooperate with Primary Care Case Management (PASSPORT provider), Medicaid program compliance reviews, and Third Party Liability (TPL) processes. TPL cooperation specifically includes completing HIPPS, trauma questionnaires, providing information on available insurance, and completing insurance questionnaires. If an adult fails to cooperate with program compliance or TPL, only the adult's eligibility is affected; children's eligibility is not impacted.
- Cooperate with Primary Care Case Management (PASSPORT provider).
- Cooperate with Medicaid program compliance reviews.
- Cooperate with Third Party Liability (TPL) activities: HIPPS, trauma questionnaires, providing information on available insurance, and insurance questionnaires.
- Note: Adult noncooperation with program compliance or TPL affects only the adult’s eligibility; children remain unaffected.
Key Terms
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