Andreas Malone

Use Andreas’ completed portion of his DHS-5590 (MA-LTC Case Checklist) to answer the following questions.

1. What is Andreas’ MA basis of eligibility?

Age 65 or over. His age (79) is listed on the completed checklist.

2. Has Andreas provided a Social Security number (SSN)?

Yes, Andreas has provided an SSN, which can be found on the checklist. The SSN was verified through a data exchange with SSA at the time he applied for basic MA.

3. Has Andreas provided proof of his citizenship and identity?

Andreas is exempt from this requirement due to his receipt of Medicare. Andreas’ basic MA worker should have added a required case note regarding this exemption.

4. Does Andreas meet Minnesota residency requirements?

Yes, Andreas is a Minnesota resident based on his receipt of basic MA and QMB.

To Do: Update Andreas' MA-LTC Case Checklist (DHS-5590) as needed with this information in the appropriate fields of section two found on page one of the form.