As of September 1, 2019, applicants for Medical Assistance whose basis of eligibility is age 65 or older, blind or disability are required to have a signed and completed Authorization to Obtain Financial Information from the Account Validation Service (AVS) form (DHS-7823). Bulletin #19-21-02, DHS Announces Implementation of the Account Validation Service (AVS) for Medical Assistance (MA), was released in June 2019 and provides information about the AVS and what population it impacts. The form (DHS-7823) is a condition of eligibility for applicants that meet the criteria listed in the bulletin. If it is not completed and on file at the applicant’s county or tribal agency, the application may be denied or coverage closed with 10-day advance notice.

Applicants applying for coverage are required to complete the form as part of their application process if they meet the criteria listed in the bulletin. For those already enrolled in MA that meet the criteria listed in the bulletin, DHS will mail the form and a /assets/AVS%20Cover%20Letter_tcm34-402522.pdfcover letter to them to complete and return to their county or tribal agency. The cover letter contains the due date for the form and information about why the form is required.

Applicants and enrollees may ask you about the form. If they have additional questions other than what’s covered in this communication and the bulletin, direct them to their local county or tribal agency or the Disability Hub MN™. If they are not able to return the form by the due date, they should contact their county or tribal agency immediately.