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Attached Document:
92_lcm-020.pdf
OMM/OCFS/OTDA Materials: LCM from DSS
92 LCM-20: Revised Medicaid Presumptive Eligibility for Pregnant Women Screening Checklist (DSS-4150) and updated list of qualified providers
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This form is used by Prenatal Care Assistance Programs (PCAP) and other qualified providers to determine presumptive eligibility for Medicaid for pregnant women. This form has been revised to reflect new monthly income levels effective January 1, 1992.
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Created: 7/10/2007
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