Adult Medicaid Manual MA-2302: RECEIVING MAIL-IN APPLICATIONS
III. Procedures
A. Mail-in Application Log
If a county chooses not to use the DMA-5105, Log for Adult Medicaid Mail-In Applications, the county must establish a mail-in application log to register and track applications. Refer to, DMA-5105, Log for Adult Medicaid Mail-In Applications. The log must include, at a minimum, the following information:
1. Applicant’s name
2. Address
3. Contact number (if available)
4. Date received in the agency
5. Source of the application (Aging Office or Mail-in)
REVISED 11/01/11 – CHANGE NO. 17-11
(III.A.)
REVISED 11/01/11 – CHANGE NO. 17-11
(III.B.)
C. Evaluating the Application for the Appropriate Medicaid Categories
1. The MA-5000, Adult Mail-In Application, can be used as an application for any Medicaid category and for all individuals listed on the application. The individuals listed on the application must be evaluated for all Medicaid categories (including Family and Children categories).
2. If the information included on the application or your follow-up telephone interview indicates that the individual(s) should apply for Family and Children’s Medicaid program:
a. Within one workday of receipt of the application, send the DMA-5000, Adult Mail-In Application, to the appropriate Medicaid unit within the agency.
b. Document the log that the application was sent to another unit.
c. The date of the Family and Children’s Medicaid application is the date the complete DMA-5000, Adult Mail-In Application, was received in the agency.
d. Do not require the individual to sign another application.
REISSUED 11/01/11 – CHANGE NO. 17-11
(III.C.)
e. Use the DMA-5000 or DMA-5063 to process the application for the adult or child or both in the most appropriate Medicaid category.
D. Date of Application
1. The date of a mail-in application is the date that a complete application is received in the agency or the information is finally received from the applicant or representative. Always date stamp the date the application and other information for processing the application is received in the agency.
2. If the county receives the DMA-5000 and it is incomplete and the missing information can be gained through a phone call, the county will gather the missing information during the mandatory follow-up call. In this situation, the date of application is the date the DMA-5000 is first received in the agency.
E. Missing Information
If the complete application is received, has missing information and:
1. The individual does not have a contact number or representative listed on the application:
a. Send a DMA-5097, Request for Information, with an appointment date and time for the a/r to call you.
b. Indicate on the DMA-5097 what information is missing.
2. The a/r does not contact you by the appointment date on the DMA-5097:
a. Send another DMA-5097 with a second appointment date and time.
b. Indicate on the DMA-5097, that if he does not contact you by this date you will deny the application.
c. After two DMA-5097s, Request for Information, have been sent, deny the application. Follow procedures in MA-2304, Processing the Application.
F. Entering the Application into the Eligibility Information System
REVISED 05/01/09 – CHANGE NO. 07-09
(III.)
G. MAD Applications Where Disability Determination is Required
1. During the mandatory follow-up call, complete the DMA-4037, Disability Determination Transmittal, DMA-5009, Social History Summary for the Disabled and DMA-5028, Authorization to Disclose Information.
2. Send the DMA-5028, Authorization to Disclose Information, to the applicant for his signature along with a DMA-5097, Request for Information.
4. If you do not receive the DMA-5028, Authorization to Disclose Information, from the applicant, send a DMA-5097, Request for Information, with an appointment date and time for the a/r to call you. Indicate on the DMA-5097 what information is missing.
