PM 03-19-01.

Provide applicants with the following information:

  • Medical Assistance and Third Party Liability (Form 2875), which explains the assignment of medical support rights and the agreement to cooperate.
  • Explain that adults who fail to cooperate without good cause are ineligible for medical benefits.

In addition, if an adult fails to cooperate without good cause in establishing paternity, or to cooperate with the Division of Child Support Enforcement (DCSE), the adult is ineligible for medical (see WAG 24-04-01 and WAG 24-04-02 ).

For applicants with a family member who has a high cost medical condition and available health insurance:

  • explain the Health Insurance Premium Payment (HIPP) Program; and
  • provide Health Insurance Premium Payment (HIPP) Program Information Sheet (Form 3459); and
  • help the applicant complete Health Insurance Premium Payment (HIPP) Referral (Form 3459B); and
  • explain that any adult who fails to cooperate without good cause is ineligible for medical benefits.

NOTE: For persons who lost the opportunity to enroll in a medical plan because there was a time limit to enroll (i.e. enrollment in a COBRA continuation plan) do not deny or cancel the person for noncooperation with the HIPP Program.