Administrative Rules of Montana
Department 37 - PUBLIC HEALTH AND HUMAN SERVICES
Chapter 37.86 - MEDICAID PRIMARY CARE SERVICES
Subchapter 37.86.1 - Physician Services
Rule 37.86.108 - MENTAL HEALTH SERVICES PLAN, APPLICATION FORMS, INCOME VERIFICATION

Universal Citation: MT Admin Rules 37.86.108

Current through Register Vol. 18, September 20, 2024

(1) Application forms and information regarding eligibility for the plan are available at all local county human services departments.

(2) The applicant must submit with the application form a completed and signed income statement and the necessary documentation to verify the income reported.

(3) For purposes of (2), necessary income verification may include one or more of the following or other appropriate and persuasive documentation:

(a) pay stubs or other pay statements;

(b) employee's W-2 forms;

(c) state or federal income tax returns and associated forms and schedules;

(d) union records;

(e) check copies;

(f) self-employment bookkeeping records;

(g) sales and expenditure records;

(h) employer's wage or payroll records;

(i) award notices or award letters;

(j) correspondence specifying a benefit;

(k) records of any government payer;

(l) court records or correspondence from attorneys;

(m) financial institution records;

(n) insurance company correspondence or records; or

(o) college or university financial aid correspondence or records.

41-3-1103, 53-2-201, 53-6-113, 53-6-131, 53-6-701, 53-6-706, MCA; IMP, 41-3-1103, 53-1-601, 53-1-602, 53-2-201, 53-6-101, 53-6-113, 53-6-116, 53-6-117, 53-6-131, 53-6-701, 53-6-705, 53-6-706, 53-21-139, 53-21-202, MCA;

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