Medicaid Policy
Medicaid Policy
Creating a Case Record
Create a case record for each application received.
The case record must include:
Date of application and signed application form
Action taken on the application
Reason for decision
Benefit effective date
Information and verifications required to determine initial and on-going eligibility,
Information received through exchanges from other sources required under law as described in 751-1.
Reason for denial or closure
Case Maintenance
Re-certification records must include:
Review forms if returned by the recipient (may not always be needed).
Electronic data match information or other verifications required for re-certification.
Actions taken to complete reviews.
Decision made on review and reason.
Record of changes must include:
Change reports including date report was made.
Electronic data match information or other verifications of changes
Actions taken on changes.
Case narration must:
Describe all factors and activities that lead to the eligibility determination and case maintenance.
Contain client contacts and discussions.
Contain actions taken by the agency, including corrections, agency conferences, hearings, overpayments, investigations, etc.
Be written in a professional manner.
Label all statements of fact, hearsay evidence, employee's professional opinion or situational judgement.
Retention of Records
Records relevant to current eligibility must be maintained as long as it related to the individual's eligibility, plus the retention time frame for that record. See Table VIII-A for retention time frames of records.