ICAMA Forms Overview

The day-to-day administration of the ICAMA is done by state professionals using the ICAMA forms.

 

ICAMA 7.02 and 7.02b

The ICAMA 7.02 is the NOTICE TO FAMILIES and is sent to the adoptive parents or guardians. Included with the ICAMA 7.02 are a copy of the ICAMA 700 (Notice of Medicaid Eligibility/Case Activation) that was sent to the new Residence State and the 702b Important Information for Families.
The ICAMA 7.02b IMPORTANT INFORMATION FOR FAMILIES helps parents or guardians better understand the interstate process.

To download the ICAMA 702 click here.
To download the ICAMA 702b click here.

The ICAMA 702 is now available in Spanish.
The ICAMA 702b is now available in Spanish.

ICAMA forms 702/702b in English and Spanish were effective July 30, 2012.

The ICAMA 702 and 702b were revised in January 2015 to reflect that fact that effective January 2014 New Hampshire provides Medicaid services for children living in New Hampshire with state-funded adoption assistance agreements (AAA) signed by other states.

ICAMA 7.5 series

ICAMA 7.5
The purpose of the 7.5 form is to facilitate communication between the Agreement State and the Residence State about changes to the information in a case opened with ICAMA 6.01.
To download the ICAMA 7.5 click here.

ICAMA 7.5 Additional
The purpose of the ICAMA 7.5 Additional is to allow more than one child to be included in the information exchange indicated on the ICAMA 7.5.
The ICAMA 7.5 Additional is not a stand-alone form and is used only in conjunction with the ICAMA 7.5.
To download the ICAMA 7.5 Additional click here.

ICAMA 7.5 Explanatory Information
The purpose of the ICAMA 7.5 Explanatory Information is to provide information for ICAMA Professionals that may help in completing the ICAMA 7.5
To download the ICAMA 7.5 Explanatory Information click here.

 

ICAMA 6.01

The ICAMA 6.01 was withdrawn on February 26, 2015 and was replaced by the ICAMA 700 Form.

ICAMA 6.02

The ICAMA 6.02 was withdrawn on July 27, 2012 and was replaced by the ICAMA 7.02.

ICAMA 6.03

The ICAMA 6.03 was withdrawn as of December 1, 2014 and wass replaced by the ICAMA 7.5 series

 

 

 

 

Updated: March 7, 2015