IM-4MA Instructions

IM-4 IMPORTANT INFORMATION ABOUT YOUR MEDICAL ASSISTANCE BENEFITS

PURPOSE:   To provide each Medical Assistance applicant/recipient information regarding:

• His/her Medicaid card
• Getting medical care
• About eligibility
• About reinvestigations
• About hearings

NUMBER OF COPIES AND DISTRIBUTION: Provide one copy of the brochure to any applicant/recipient upon notice of approval or when a reinvestigation is completed and continued eligibility exists.

MANUAL REFERENCE:

0840.005.00 Annual Reinvestigation
0105.025.15.25 Medical Assistance Program Explanation

INSTRUCTIONS FOR COMPLETION: Enter the name of the eligibility specialist and his/her phone number on the back of the brochure.