731-8 Verification for Targeted Adult Medicaid (TAM)

Effective Date: October 1, 2023

Verifying eligibility for the TAM coverage group (346) is based upon the different coverage groups and subgroups. Use the table below to determine the verification process and which verification is needed at application and review. See Table XVII for the list of approved agencies that can complete TAM referral forms.

Group	Subgroup	At Application	At Review	Verification
Chronically Homeless	12 Month Homeless	Must meet the homeless or supportive housing criteria.	Must still meet the homeless criteria. A collateral contact may be completed, or a new referral form is required.	Form 42A (question 1)
	6 month homeless	Must meet the homeless or supportive housing criteria.		From 42A (question 2)
	Domestic violence (DV)	Had to be a victim of DV	Must still meet the DV criteria. A collateral contact may be completed, or a new referral form is required.	Form 42A (question 3)
	Supportive Housing	Must meet the homeless or supportive housing criteria.	Must still meet the supportive housing criteria. A collateral contact may be completed, or a new referral form is required.	Form 42A (question 4)
Justice Involved	Released from jail or prison and has complied with SUD treatment while incarcerated.	Must meet the treatment criteria and the application must be submitted within 60 days from date of release.	No new referral form needed unless there is a break in coverage, at which time the ‘At Application’ criteria would apply.	Form 43A (question 1)
	On parole or probation	Must be on parole or probation	Must still be on parole or probation. A collateral contact may be completed, or a new referral form is required.	Form 43A (question 4)
	Involved with a Drug or Mental Health Court	Must be currently involved with the court.	Must still be currently involved with a court. A collateral contact may be completed, or a new referral form is required.	Form 43A (question 2)
	Court ordered substance use or mental health treatment	Must be currently court ordered for treatment.	Must still be currently court ordered for treatment. A collateral contact may be completed, or a new referral form is required.	Form 43A (question 3)
	Discharged from State Hospital - Criminal Charge	Must meet the State Hospital criteria and the application must be submitted within 60 days of being discharged.	No new referral form needed unless there is a break in coverage, at which time the ‘At Application’ criteria would apply.	Form 44A (question 1)
Needing Treatment	Discharged from State Hospital - Civil Commitment	Must meet the State Hospital criteria for Needing Treatment and the application must be submitted within 60 days of being discharged.	No new referral form needed unless there is a break in coverage, at which time the ‘At Application’ criteria would apply.	Form 44A (question 2)
Needing Treatment	Receiving General Assistance (GA)	Must meet the GA criteria.	Must still meet the GA criteria. AND New referral form or collateral contact is required unless a substance use or mental health disorder has been verified in the last 12 months.	Form 45A (Substance use or mental health disorder) Form 20 (Substance use disorder only) Form 1GA or 20M (Mental health disorder only) Other medical evidence by a licensed practitioner Note: Form 1, 20 and 20M are only valid to verify a substance use or mental health disorder for 12 months from date of completion.