Adult Medicaid Manual MA-2309 LIS APPLICATION FOR MEDICAID
IV. County Procedures
A. The LIS Exception List must be worked daily. These are applications where LIS data and EIS data did not have an exact match. They will remain on the LIS Exception List until they are resolved. If an application is required, it is created the night the exception is resolved.
B. The county must pull the Adjusted Application Management Report daily to find the LIS Medicaid applications and assign them to the appropriate worker. Once assigned, the worker should key her worker/district number on the DSS-8124.
NOTE: The LIS application information goes on the DHRWDB LIS DAILY TRANS RPT in NCXPTR the day it is received by DIRM on the LIS file. This happens even if there is an exception posted to the LIS Exception screen. For this reason, it is important to note the post date on the exception screen when you work the exception. That will be the date of the LIS DAILY TRANS RPT in NCXPTR where you will need to print the information for that individual.
ISSUED 01/01/10 - CHANGE NO. 02-10
(IV.)
C. Application/Processing Time Standards.
1. The 45/90 day processing time standard begins when the LIS Medicaid application is created by EIS plus 2 calendar days.
2. The application date for Medicaid is the date the LIS application was received by SSA.
3. The applicant may be evaluated for retroactive coverage for the three months prior to the month of application.
4. EIS creates a Date Screen for each LIS Medicaid application. EIS uses the Date Screen to disregard the processing time between the LIS application date and the date EIS creates the application on the night of receipt from SSA. EIS adds 2 calendar days to this date. The exclusion reason is “LIS”. The Begin Date of the excluded time is the date of the LIS application. The End Date of the excluded time is the date EIS creates the application plus 2 calendar days.
D. Use DMA-5000 or DMA-5008 as the base document to ensure all required information is documented. Put “LIS App” on the signature line. An a/r signature is not required.
E. Take the following actions upon assignment of the application.
1. Conduct a telephone call to the applicant or representative within two workdays of the receipt of the application by the county. Do not deny after 2 unsuccessful phone attempts. Continue to process following application processing regulations.
2. Review the application and document the answers given by the applicant on the DMA-5000 or DMA-5008 base document. If a telephone contact cannot be made, proceed to IV. E. 3. below.
3. Review records the county may have from previous applications or ongoing cases in any program.
a. Evaluate the application and determine what additional information is needed, especially concerning life insurance, contributions, and the living situation. (For LIS, SSA does not count life insurance as a resource or in-kind payments as income.)
b. The information from NCXPTR report DHRWDB DAILY TRANS RPT is verified by SSA. Screen print this information and put it in the case record.
ISSUED 01/01/10 - CHANGE NO. 02-10
(IV.E.)
c. Specific items, such as resources, need verification. SSA does not break out separate resources, but includes them as a total figure. Consider this as lead data.
d. Resource verification may also be required for the three months prior to the application date.
4. When additional information is needed:
b. Include the Food and Nutrition Services insert with the DMA-1049.
c. The DMA-1049 must also include the local telephone number for the Seniors’ Health Insurance Information Program (SHIIP). If the worker does not have the local contact number, use the state SHIIP office at 1-800-443-9354.
d. Following verification procedures, if a second DMA-5097 is necessary, a second DMA-1049 is not required. Follow policy in MA-2303, Verification Requirements for Applications.
F. Process the application according to the procedures in MA-2303, Verification Requirements for Applications and MA-2304, Processing the Application. Retroactive Medicaid may also be authorized if there is a medical need and the individual meets all eligibility requirements in the retroactive period.
G. If the case is assigned to the incorrect county of residence, the assigned county must process the application. Transfer the case to the correct county of residence, if approved.
