Medicaid Policy
Medicaid Policy
Non-institutional cases
Reopen a case without a new application when:
The case closed because of an administrative error and the closure occurred during the previous 12 months.
Reopen the case back to the date of closure. Notify the member that the case was closed in error and request any information you need to determine eligibility for the months the case was closed.
If a closure due to an agency error occurred more than 12 months ago, do not reopen the case.
The case closed for failure to complete the review.
If the member submits the review or the requested verification within 3 months of case closure, redetermine eligibility without requiring a new application form. This date is a new application date and allows for application time frames to provide verification (721-1 and 703-1).
The case closed for failure to provide requested information or verification after a change report.
The agency receives the information or verification by the last day of the month of closure. There is no change to the review period; or
The member provides all requested verification in the month immediately following closure. Treat the response as a new application date. An application form or signature is not required. Do not change the review date unless all factors of eligibility are updated. For denied applications see 703-1.
Nursing Home Cases
Reopen a Nursing Home case that has been closed for no more than one calendar month without a new application when:
The case was closed for only one calendar month for a reason other than a review,
AND
The member resided continuously in the nursing home,
AND
All factors of eligibility are met for the month immediately following the one month of ineligibility,
AND
The case record contains verification of eligibility.
Non-institutional and nursing home cases
Use either the latest application form or review form, whichever is most current, to reverify eligibility items. Record the new application date and eligibility decision in the case record.