Family and Children's Medicaid MA-3215 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 Family and Children’s aid program/categories is 45 calendar days.

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 proof of medical bills to meet the deductible when anticipated expenses are within $300.00 of meeting the deductible may be held beyond the 45-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 given one (lifetime) 90 day reasonable opportunity 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.

F. Applicants with an existing C/I code 97 have received the one (lifetime) 90 day reasonable opportunity 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.

REISSUED 07/01/10 – CHANGE NO. 06-10

(II.)

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.