Medical Frailty Verification

Please review and respond to the following verification request.

Dear [DOCTOR NAME],

Your patient, [PATIENT NAME], has applied for a work requirement waiver through Pennsylvania Medicaid based on a medical frailty condition.

Under Pennsylvania's Medicaid work requirements, beneficiaries must complete 80 hours of qualifying activities per month. Individuals with verified medical frailty conditions are exempt from this requirement.

We are requesting your professional verification to process this waiver. Please respond within 10 business days.

Can you verify that [PATIENT NAME] has a medical condition that prevents them from working at least 80 hours per month?

Yes, I can verify This patient has a condition that limits their ability to work 80 hours/month No, I cannot verify I am unable to verify this condition at this time

✓

Thank You

Your verification has been submitted to the Pennsylvania DHS Medicaid Office.

No further action is needed. The patient will be notified that their waiver has been approved.

✗

Response Recorded

Your response has been submitted to the Pennsylvania DHS Medicaid Office.

Because the condition could not be verified, the patient will be notified and given the option to:

1 Submit their own medical documentation to support the waiver request
2 Designate a different medical provider for verification
3 Comply with the standard work requirement (80 hours/month)

Questions? Contact PA DHS Provider Support