Responding to the EAEDC Medical Provider Statement EAEDC

The EAEDC Medical Provider Statement is used to verify a disability or health condition:

  • to determine eligibility for Emergency Aid to the Elderly Disabled and Children (EAEDC),
  • for a disability exemption from the Department of Career Services (DCS) registration at MassHire or Transitional Employment for Massachusetts Parents (TEMP) participation rules in a Caretaker Family EAEDC case, or
  • to verify SNAP eligibility for disabled noncitizens who do not meet SNAP eligibility based on their noncitizen status.

For information on sending this form to clients see Disability Verifications-EAEDC.

When the EAEDC Medical Provider Statement form is returned to the Department, you must review the form for completion, as well as the relevant information indicated on the form, to determine if the client is to be considered a person with a disability or health condition for EAEDC purposes.

EAEDC Medical Provider Statement Returned Complete

An EAEDC Medical Provider Statement is considered complete when all sections of the form intended for the medical provider are complete. For example, if the client did not sign the Patient Authorization section of the form but the medical provider completed the form anyway, the form is considered complete and can be used to verify the client’s disability or health condition.

To verify the disability or health condition the form must contain the following:

  • the box next to the script that reads, “This patient has a health issue or combination of health issues that is expected to last 60 days or more and that substantially reduces or eliminates the patient’s ability to support their self”, must be checked,
  • the Diagnosis section must contain one or more diagnosis and a duration. For a diagnosis of a Substance Use Disorder there must be at least one other diagnosis indicated, and

    • Important: If the form indicates the condition will last more than 12 months or is expected to result in death, the client is considered federally certified for SNAP purposes.

  • the Signature section of the form must include the Medical provider signature, Medical provider name and title, Board of Registration number, Address and Telephone number.

    • Note: A stamp indicating the name and contact information for the provider is acceptable so long as the form contains their signature.

If all three sections are completed as indicated above, the client’s disability or health condition has been verified for EAEDC. Please see Entering the Disability-EAEDC for more details on entering the information contained on the EAEDC Medical Provider Statement into BEACON.

EAEDC Medical Provider Statement Form Returned Incomplete

If the returned EAEDC Medical Provider Statement form is missing information and the Patient Authorization section of the form has been signed by the client, you must attempt to make collateral contact with the medical provider to obtain the missing information.

If the client did not sign the Patient Authorization section of the form, you must attempt to reach the client to place a three-way collateral contact call to the provider to obtain the missing information.

  • If the call is successful, a detailed narrative must be completed indicating the information that was verified by the collateral contact. If the information verifies all of the components above, the client disability or health condition is considered verified.
  • If you are not successful in making contact with the provider, you must disposition the document as Incomplete or Incomplete & unsigned and notify the client. If the document is not resubmitted with the missing information within the application or reevaluation timeframe, the EAEDC must be denied or closed by selecting Noncooperation under the Reason category and Failure to submit the required verifications under Reason on the AU tab on the AU Composition Results page.

The EAEDC must be reinstated if the completed form is received within 30 days of the denial or closing and there are no other outstanding mandatory verifications.

When the Client Submits an EAEDC Medical Provider Statement that Appears Questionable

You must always apply fair and consistent criteria when determining if information is questionable. If the client submits an EAEDC Medical Provider Statement that appears to be questionable, a referral in the AR Referral Folder must be made to the Fraud and Overpayment Referral Screening (FORS) Unit. The FORS unit will review the referral for completeness and accuracy and make a determination. You would still process the case while the FORS unit reviews the questionable document.

ExampleExample

You sent a VC-1 to the client for an updated EAEDC Medical Provider Statement because the last one was submitted over a year ago. The client submits a new EAEDC Medical Provider Statement that is completed by the same doctor as the last form they submitted. When you look closely, you can see that the date next to the signature appears to have been altered and the rest of the form is identical to the previous form the client submitted. This would be questionable.

The case must be approved if there are no other outstanding verifications and a FORS referral must be made.

EAEDC Medical Provider Statement States Not Disabled

If the EAEDC Medical Provider Statement form is returned with the box checked that reads:

“I do not think this patient has or I do not have knowledge of this patient having a health issue of combination of health issues that is expected to last 60 days or more and that substantially reduces or eliminates the patient’s ability to support their self”,

the client’s disability or health condition is not verified.

The EAEDC must be closed or denied on the AU tab of the AU Composition Results page by selecting Disability from the Reason category and ‘Medical provider form states not disabled’ from the Reason drop down.

EAEDC Medical Provider Statement Not Returned at Application

On day 22 an INT-1 is sent to the client requesting the missing verifications and telling them how to request more time. If the EAEDC Medical Provider Statement is not returned within the application period, you must attempt to reach the client to inquire about the form and,

  • If the client has not already submitted a request for an INT-2 , ask the client if they need an additional 15 days to submit the form. If the client states yes, they must submit a written request or complete a telephonic self-declaration by using option six on the telephonic signature line by day 30 of the application. Once the request is received or a telephonic signature is completed, issue an INT-2 to the client.
  • If the client indicates they did not return the form within the application period due to a delay in getting an appointment, you must:
    • ask the client for the date of the appointment,
    • create an outlook calendar reminder to send a VC-1 for the EAEDC Medical Provider Statement seven days prior to the date of the appointment,
    • complete a telephonic signature for a self-declaration with the client, as a verification of last resort, and
    • approve the application if there are no other outstanding verifications.

      • Important: The self-declaration must attest to the fact that the client has a disability or health condition that is expected to last 60 days or more and prevents them from working.

  • If you are unable to reach the client or the client does not request additional time to submit the EAEDC Medical Provider Statement in the case of an application, and this is the only outstanding mandatory verification; you must deny the EAEDC on day 30 by selecting Disability from the Reason category and ‘Medical Provider Form not returned’ from the Reason in the AU tab on the AU Composition Results page.

    • Reminder: At this time this denial reason is not able to be reinstated in BEACON. This functionality will be revised in the next Phase of the disability determination project. If the client subsequently submits the EAEDC Medical Provider Statement within 30 days of the denial, and there are no other outstanding mandatory verifications; you must create a new Request For Assistance (RFA) and establish the EAEDC case back to the date of application.

When Can I process a Reevaluation Without an EAEDC Medical Provider Statement?

  • If a previously submitted EAEDC Medical Provider Statement has a duration of three months or more remaining since the form was signed by the provider, it must be used to complete the reevaluation.
    • These cases will be addressed when the next Disability Follow-up Report is sent to local office managers for completion.

When is the EAEDC Medical Provider Statement Needed to Process a Reevaluation?

  • If the EAEDC Medical Provider Statement has expired or will expire in less than three months and disability cannot be verified any other way, you must request a new EAEDC Medical Provider Statement.

What if the EAEDC Medical Provider Statement is Not Returned at Reevaluation?

  • If the EAEDC Medical Provider Statement is needed for a reevaluation because the time remaining on the disability duration is less than three months, the previous EAEDC Medical Provider Statement indicated a disability that would last more than 12 months or is expected to result in death, and the client states that they cannot get a new form by the due date because of a delay in getting an appointment with their provider to complete the new form, you must:
    • ask the client for the date of the appointment,
    • create an outlook calendar reminder to send a VC-1 for the EAEDC Medical Provider Statement seven days prior to the date of the appointment,
    • complete a telephonic signature for a self-declaration with the client, as a verification of last resort, and
    • submit the reevaluation if there are no other outstanding verifications.

      • Important: The self-declaration must attest to the fact that the client has a disability or health condition that is expected to last 60 days or more and prevents them from working.

      • ExampleExample

        Marishka (they/them) was approved for EAEDC on 5/2/2023 and submitted an EAEDC Medical Provider Statement at that time. The disability duration is More than 12 months or expected to result in death. Their certification period ends on 2/5/2024 because their EAEDC synced with their active SNAP when it was approved. During the reevaluation interview Marishka told their case manager that they have an appointment scheduled on 3/16/2024 with their provider. Because the EAEDC Medical Provider Statement has a duration with less than three months remaining the form was requested. However, because the duration on the previous form is More than 12 months or expected to result in death the case manager must:

        • create an outlook reminder to send a VC-1 with the form on 3/9/24 so that Marishka can have her provider complete the form while they are at their appointment. 
        • complete a telephonic signature for a self-declaration with the client, as a verification of last resort, and
        • submit the reevaluation if all other verifications have been submitted.
  • If the EAEDC Medical Provider Statement is needed at reevaluation because the duration remaining on the disability duration is less than 3 months, and the previous form indicated a disability that would last 60 days to 12 months, the reevaluation cannot be completed without a new form.
    • ExampleExample

      Anika (she/her) is receiving EAEDC and provided an EAEDC Medical Provider Statement when her reevaluation was completed on 1/25/23. It indicated a duration of 60 days to 12 months. There is no other disability verification available. If the verification is not returned, the EAEDC must be closed by selecting ‘Medical Provider form not returned’ under Disability on the AU Composition Results page.

  • If the form is needed at reevaluation, no other disability verification is found, and no EAEDC Medical Provider Statement has previously been submitted for the client, the reevaluation cannot be completed without the form.
    • ExampleExample

      Alex (they/them) applied for EAEDC on 7/23/23. At the time, they reported they did not have a medical provider to complete the EAEDC Medical Provider Statement. Alex’s case manager referred them to a Community Health Center in their area and approved the EAEDC with the client’s self-declaration that they have a disability or health condition that prevents them from working and is expected to last 60 days or more. When the EAEDC was approved it synced with their SNAP with a reevaluation end date of 3/3/24. Because the form has never been received, when the reevaluation is completed, if Alex does not return the form, the EAEDC must be closed by selecting ‘Medical Provider form not returned’ under Disability on the AU Composition Results page.

What if the EAEDC Medical Provider Statement is Not Returned at Reevaluation and the Client Does Not Have a Medical Provider?

If at reevaluation the client states they did not submit the form because they still do not have a medical provider to complete the EAEDC Medical Provider Statement, you must:

  • provide the client with information about a Community Health Center or Community Behavioral Health Center in their area,
  • advise the client they must contact a provider to schedule an appointment,
  • inform the client that the reevaluation cannot be completed without the form, and
  • close the EAEDC by selecting ‘Medical Provider form not returned’ under Disability on the AU Composition Results page.

To search for a local Community Health Center by address see Find a Health Center.

To search for a Community Behavioral Health Center by town or zip code, see Community Behavioral Health Centers Locations

Related Topics

Disability Policy and Procedures - EAEDC

Last Update: March 14, 2024