All Medicaid Programs |
Obsolete Policy |
Process application
Each application must be processed to a decision for each applicant unless:
The client 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.
The client has already applied and that application is still pending
The client withdraws the application
The client cannot be located, in which case deny the application. If the client contacts the agency before the end of the application-processing period, resume the application process.
Process an application received from the FFM within 30 days of receiving the electronic account.
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. (See Sec. 703-1 and 703-3 on applications and signature.)
Process data transmitted from SSA Low Income Subsidy (LIS) applications as an application for Medicare Cost-Sharing programs.
LIS data is not an application for Medicaid.
LIS data transmitted from SSA meets the signature requirements for Medicare Cost-Sharing programs. (See Sec. 703-1 on applications.)
Deny a LIS application for being over the assets limit without requesting additional verification from the client if:
The stated assets on the LIS application are well over the asset limit for Medicare Cost-Sharing programs and additional verification is unlikely to result in eligibility, and
There is no information in an existing case that conflicts with the client’s statement of assets.
If assets are close to the limit, request additional verification from the client.
Provide Information
All applicants have the right to register to vote at application. (See Sec. 109 Voter Registration Requirements.)
Tell clients 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 clients who are 19-64 years old. (See section 303-3 if the client claims to be disabled or blind.)
The Dept. of Health will mail the Child Health Evaluation and Care (CHEC) information to households with pregnant women and children when medical benefits are approved.
Determine Eligibility
Consider Eligibility for the Retroactive Period. (See Sec. 705 on retroactive assistance. Always determine retroactive eligibility for SLMB and QI programs for all applicants who are Medicare eligible, including LIS applicants received from SSA.
Request any needed verifications.
An interview may be helpful in gathering information, but is not required.
Screen the application and request the needed verification. Send a written request for verifications to the applicant. (See Sec. 731 for information about the verification process.)
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.
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.
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.
Request only those verifications that the agency cannot obtain through other means like electronic matches.
Determine eligibility after receiving verifications. See Sec. 703-5.
Mail a notice of the eligibility decision to the applicant, and the representative if applicable. See Sec. 811.
The electronic client information will be transferred to the FFM when an application is denied as being ineligible.
Document decisions made on each application in the case record. See Sec. 703-5.