Program Participation and Eligibility Standards

(a)General Eligibility Criteria. To be eligible for Program coverage, an applicant for the Medically Indigent Program must be a resident of Guam as defined by § 2903(e) of this Article and as further defined by this Section. In addition, an applicant shall also meet the additional standards for eligibility according to the following three

(3)criteria:

(1)General Eligibility Standards,

(2)Income Limitations, and

(3)Resource Limitations as established in this Section, § 2905.4, and § 2905.5.

(b)Effective Date of Coverage. Except as specifically required by Federal law, § 2905.3 or by § 2914 of this Article, the Program is only responsible for providing medical coverage effective the first day of the month of application provided that that person has been determined eligible for the program.

(c)Applications. Applications for the Medically Indigent Program shall be completed by the applicant, or by someone authorized to act on the applicant’s behalf. Upon receipt of an application, the program shall investigate and prepare a complete record of the circumstances of the applicant and provide the applicant with a written response as to the person’s eligibility under the Program.

(d)Application Requirements. Each applicant shall be required to file an affirmation setting forth such facts about their qualifications for eligibility, annual income and other resources as may be required by the Program. Such statements shall be on forms prescribed by the Program, and may be accepted as evidence of the facts stated, but shall not be interpreted to preclude a full and complete investigation by the Program.

(e)System for Quality Reviews (QR). The Administrator shall establish a system for QR of a sufficient sample size of applications to assure the validity of all applications. CH. 2 DIVISION OF PUBLIC WELFARE

(f)False Declarations as to Eligibility; Liability for Repayment; Penalty. Any individual receiving assistance under this Article for which they were not eligible on the basis of false declarations as to their eligibility, or on behalf of any other person receiving assistance under this Article for which such other person or persons were not eligible, shall be liable for repayment of all benefits received and shall be guilty of a misdemeanor or felony depending on the amount paid in that person’s behalf for which the person was not eligible, as specified in the Criminal and Correctional Code, Title 9 of the Guam Code Annotated.