Medicaid Policy                                                                 

703-4 What to Do With an Application

Effective Date: December 1, 2024

Previous Policy

 A. Process Application

1. Each application must be processed to a decision for each applicant unless:

1. 1. The individual and other household members are already on the most beneficial medical program. If better coverage is not available, document that no action was taken on the application.

1. 2. The individual has already applied and that application is still pending

1. 3. The individual withdraws the application

1. 4. The individual cannot be located, in which case deny the application. If the individual contacts the agency before the end of the application-processing period, resume the application process.

2. Process an application received from the FFM within 30 days of receiving the electronic account.

• • • • • An individual enrolled in a FFM plan may be eligible for CHIP or UPP if determined ineligible for Medicaid. If there are any applicants who do not qualify for Medicaid, the application must be screened for CHIP or UPP even if there is a health plan listed (220-9 in the CHIP manual and 1003-11 for UPP).

3. Deny applications that do not meet the signature requirements within the application-processing time as an incomplete application. Do not make a determination of eligibility (703-1 and 703-3).

4. Process data transmitted from SSA Low Income Subsidy (LIS) applications as an application for Medicare Cost-Sharing programs.

1. 1. LIS data is not an application for Medicaid.

1. 2. LIS data transmitted from SSA meets the signature requirements for Medicare Cost-Sharing programs (See 703-1 on applications).

B. Provide Information

1. All applicants have the right to register to vote at application (109).

2. Tell individuals who are age 19-64 about the Disability Medicaid program.  Give or mail a copy of the brochure called Medicaid for People with Disabilities to all individuals who are 19-64 years old. (See 303-3 if the individual claims to be disabled or blind.)

3. The Dept. of Health will mail the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) information to households with pregnant women and children ages birth through 20 who qualify for Traditional Medicaid.

C. Determine Eligibility

1. Consider Eligibility for the Retroactive Period (705). Always determine retroactive eligibility for SLMB and QI programs for all applicants who are Medicare eligible, including LIS applicants received from SSA.
2. Screen the application and address all factors of eligibility. 731 details the various methods of verification.
3. Request any needed verifications.
   1. An interview may be helpful in gathering information, but is not required.

1. 2. Send a written request for verifications to the applicant (731).

• • • • • If the application has health insurance listed, the agency must determine the type of insurance before making an eligibility decision (220-9 in the CHIP manual or 1003-11 for UPP).

• • • • • If the applicant reports expenses and not enough income to cover those expenses, or the applicant reports zero income, the applicant must verify how they are meeting their expenses.

1. 3. LIS application data from SSA will be incomplete. Request additional information and required verifications needed to process the application. If the stated assets on the LIS application are well over asset limit, follow #A.4.

1. 4. Give applicants at least 10 days from the mailing date of the request to return verifications. Applicants may request more time by the due date, in which case, give applicants at least 10 more days.

1. 5. Applicants have until the end of the application-processing period to provide verifications. Do not deny an application for lack of verifications until the end of the processing period. The processing period is 30 or 90 days, as applicable.

1. 6. Request only those verifications that the agency cannot obtain through other means like electronic matches.

4. Determine eligibility after receiving verifications (703-5).

5. Mail a notice of the eligibility decision to the applicant, and the representative if applicable (811).

6. The electronic individual information will be transferred to the FFM when an application is denied as being ineligible.

7. Document decisions made on each application in the case record (703-5).