Adult Medicaid Manual MA-2304 - PROCESSING THE APPLICATION

II. POLICY PRINCIPLES

A. There are three possible outcomes for an application: withdrawal, denial or approval. Regardless of the outcome, the applicant must be provided a written notice explaining the decision made on the application and the right to a hearing if he disagrees with the decision.

B. The application processing time standard for all MAA and MQB aid program/categories is 45 calendar days. The application processing time standard for the MAD aid program/category is 90 calendar days.

The MAD aid program/category includes individuals whose disability has already been established by the Social Security Administration, Office of Disability Determination Services, or Office of Hearings and Appeals and individuals whose disability must be determined.

C. Applications that include a request for both retroactive and ongoing Medicaid count as two separate applications and are tracked as two separate applications. Each part must be dispositioned.

D. In some cases, applications may be held pending for up to six months. Applications in which eligibility has been established, except for receipt of a disability determination decision, and/or proof of medical bills to meet the deductible when the anticipated medical expenses are within $300.00 of meeting the deductible, may pend beyond the 45/90 day time standard.

E. Applicants for whom a SSA data match is submitted and returned with an inconsistent match or for whom an SSA data match cannot be completed must be approved if all other eligibility factors are met, and are given one (lifetime) 90 day period to provide acceptable documentation of citizenship/identity. Send a timely notice to terminate the case or individual after the 90th day if verification is not provided. Do not hold (pend) the application for 6 months during or following the 90 day period.

REVISED 07/01/10– CHANGE NO. 10-10

(II.)

F. Applicants with an existing C/I code 97 have received the one (lifetime) 90 day period to provide acceptable documentation of citizenship/identity. Applicants with an existing C/I code 97 in which all other eligibility factors are met except for receipt of U.S. citizenship/identity documentation may be held pending for up to six months.

G. Process applications opened or reopened due to a local/state appeal reversal or remanded appeal within five workdays of receipt of the last piece of needed information.