PM 15-07-02

  1. When Medical has been approved and the beginning month's Medical eligibility must be changed, send Request for Correction/Addition to MMIS Medical Eligibility File (Form 2958) to the Exception Processing Unit.
  2. Complete and send Form 2434 as notice of change in enrollment period.

For spenddown cases indicate the new beginning medical eligibility date for each month and whether or not a split bill form is required.