For an alien who has been sponsored by an agency or an organization to be eligible for medical assistance, the following conditions shall be met:

1. (a) The alien shall provide a signed and dated affidavit, on which the sponsoring agency or organization has provided the following:

   1. (1) The name of the alien;
   2. (2) The alien’s date of entry into the United States;
   3. (3) The name and address of the sponsor;
   4. (4) The amount of money the sponsor contributed to the alien, if any;
   5. (5) The reason the sponsor cannot meet the alien’s total needs; and
   6. (6) A statement that the sponsor agrees to a financial audit when needed to substantiate conflicting information;

2. (b) The sponsor shall be considered to be not meeting the alien’s total needs, if:

   1. (1) The sponsor is contributing no money to the alien; or
   2. (2) The amount contributed is not enough to render the case ineligible for medical assistance due to excess income; and

3. (c) If the alien claims that the sponsoring agency or organization no longer exists, the alien shall provide:

   1. (1) A written, signed, and dated statement indicating the name and former address of the sponsor;
   2. (2) A statement that the sponsor no longer exists; and
   3. (3) The reason the sponsor no longer exists, if known.

Source. #13857, eff 1-23-24