Form H1246, Medicaid Eligibility Interview Guide

Instructions for Opening a Form

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Effective Date: 9/2010


Updated: 9/2010


  • To serve as a reminder of items to be cleared during an interview with a client and/or his responsible party.
  • To record information provided by the client and/or his responsible party.


When to Prepare

The Medicaid Eligibility for the Elderly and People with Disabilities (MEPD) eligibility specialist completes Form H1246 for each application during the interview with the client and/or his responsible party.

Number of Copies

The MEPD eligibility specialist completes an original Form H1246.


File Form H1246 in the case record behind the corresponding Form H1201, MAO Worksheet.

Form Retention

Form H1246 is kept in the case record for three years after the case is denied.

Detailed Instructions


Note: When asking the client or his responsible party for information, the MEPD eligibility specialist should ask open-ended questions, if possible, and avoid using leading questions.