Administrative Provisions

(a)The Administrator may:

(1)prescribe uniform forms to be used by all Providers and shall prescribe and furnish uniform forms and procedures, including methods of identification of members, to be used for determining and reporting eligibility of members; and CH. 2 DIVISION OF PUBLIC WELFARE

(2)enter into an interagency agreement with the Department to determine the eligibility of all persons defined pursuant to this Article, and ensure that the eligibility process is coordinated with other assistance Programs.

(b)No less than sixty

(60)days prior to the implementation of a policy or a change to an existing policy relating to reimbursement, the Administrator shall provide notice to interested parties.

(c)The Administrator is authorized to apply for any Federal funds available for the support of Programs to investigate and prosecute violations arising from the administration and operation of the Program. Available local funds appropriated for the administration and operation of the Program may be used as matching funds to secure Federal funds pursuant to this Subsection.

(d)Determination of Head of Household.

(1)In a single-member household the person shall be the head of household.

(2)In a household where there is only one

(1)parent, that parent shall be the head of household.

(3)In a household where both the male and female parents have earned income, the parent with the higher income shall be the head of household.

(e)Document Verification; Birth Certificates and Social Security Card.

(1)A birth certificate and social security card are required for each member of the household applying for assistance.

(2)Birth certificates may be substituted by a passport, baptismal certificate, an Alien Registration Receipt Card (green card) or a government of Guam Identification Card, if birth certificates are not available.

(3)In the absence of a Social Security Card, a receipt of the application for Social Security Card should be sufficient; however, the member shall provide the Program with a photocopy of the Social Security Card after its receipt. For verification, a written statement or other documents from the Social Security Administration, or a Guam driver’s license or Guam ID if the social security number is indicated on it shall be accepted.

(f)Alien Registration Receipt Card. The Alien Registration Receipt Card will be required for all resident alien applicants.

(g)Income.

(1)Last two

(2)month’s check stubs and current month’s check stub shall be provided as part of income verification.

(2)An employment verification from the employer must be obtained showing the average hours worked and hourly rate the employee has earned for the last three

(3)months.

(3)Self-employed individuals, other than those farming and fishing, with income over One Hundred Dollars ($100.00) a month must provide the latest business privilege, tax receipts and the latest 1040 Forms. If no 1040 Forms can be provided, an affidavit indicating expenses for the same month shall be furnished. For fishermen or farmers, a notarized statement of income will be required and proof of being exempted from filing the business privilege tax must be obtained from the Department of Revenue and Taxation and submitted to the Medically Indigent Program. Those others with income less than One Hundred Dollars ($100.00) a month will be required also to submit a notarized statement of earnings. CH. 2 DIVISION OF PUBLIC WELFARE

(h)Vehicle and Property. An affidavit shall be provided indicating that the applicant meets the eligibility restrictions on ownership of vehicles and real property as provided in § 2905.5

(f)and (g).

(i)Cash Resources. Photocopies of passbooks and bank statements are required if an applicant indicates amounts of cash resources in the application form.

(j)Permanent Resident Alien. Aliens who are applying for assistance shall provide information and required documentation concerning the sponsor’s income and resources as a condition for eligibility.

(1)In determining the eligibility for all qualified aliens, the income and resources of any person who executed an affidavit of support pursuant to the Immigration and Nationality Act on behalf of the qualified alien and the income and resources of the spouse, if any, of the sponsoring individual shall be counted at the time of application and for the re-determination of eligibility for the duration of the attribution period, as specified in Federal law.

(2)If a resident alien’s sponsor did not execute an affidavit of support pursuant to the Immigration and Nationality Act on behalf of the qualified alien, then the income and resources of a sponsor(s) and the sponsor’s spouse, if living together, shall be treated as unearned income and resources.

(k)Issuance of Program Card. An identification card will be issued identifying all eligible family members. Each household will be assigned a unique number. Cards will indicate the period of Medically Indigent Program coverage, other medical insurance coverage, applicable liability rates, and selected primary physicians and specialist(s).

(l)Denials. Applicants will be denied when:

(1)ineligibility is established;

(2)an applicant fails to provide necessary information to determine eligibility; or

(3)the Program loses contact with the applicant before eligibility is determined.

(m)Reporting Requirements. All MIP Program Participants shall report within ten

(10)days to the Medically Indigent Program any changes in their households, such as the following:

(1)moved to another house;

(2)someone moved into the household;

(3)someone moved out of the household;

(4)someone in the household has given birth;

(5)someone in the household terminated from employment;

(6)someone in the household received a raise in wage or salary;

(7)someone in the household obtained a job;

(8)someone in the household reached the age of nineteen

(19)or sixty-five

(65)years old;

(9)someone in the household becomes permanently disabled; or

(10)someone in the household has expired.

(n)Penalty for Failure to Report Changes. The above list is not inclusive. Therefore, all changes shall be reported.

(1)Failure to report changes within ten

(10)calendar days, a change or changes in household circumstances which should have resulted in ineligibility, making false or misleading statements or CH. 2 DIVISION OF PUBLIC WELFARE withholding information at the time of application which should have resulted in ineligibility, the head of household and spouse (if any) shall be suspended from the Program participation for:

(A)Three

(3)months, for the first occasion;

(B)Six

(6)months, for the second and subsequent occasions.

(2)The individual(s) must be notified in writing once it is determined that he/she is to be penalized. The period of suspension shall be no later than the second month which follows the date the individual(s) receive the written notice of the suspension. The period of suspension must continue uninterrupted until completed regardless of the eligibility of the suspended individual’s household. This penalty is in addition to the recoupment of improper payments made to the service provider.

(o)Termination of Assistance. In addition to any other penalties imposed elsewhere in this Article for fraud or false declarations with an intention to obtain improper access to Program services, the following shall constitute grounds for the termination of assistance:

(1)false declarations in seeking Program eligibility; or

(2)failure to report changes in household status as required by this Article.