R-2700, Notification of Pre-Screening Result for Medicaid

Revision 12-2; Effective June 1, 2012

Occasionally, for purposes of receiving assistance from drug companies or other private entities, a person will request a pre-screening for Medicaid in conjunction with a request for a letter to substantiate the results of the pre-screening.

Form H1035, Pre-Screening Result for Medicaid, is used to notify an interested person of the pre-screening results for Medicaid if:

  • the notice is requested by the person;
  • the pre-screening is based on a verbal conversation;
  • an official determination of eligibility is not conducted; and
  • the person does not appear eligible for Medicaid.