Family and Children's Medicaid MA-3215 Processing the Application

iii. procedures

A. Processing Timeframes

1. EIS calculates the 45th day based on the date of application entered into the system.

a. The 45-day time standard begins with the day after the date the application or base document is signed.

b. In determining the 45th day, EIS adjusts the 45th day to the next workday when the 45th day falls on a weekend or state and/or county holiday. For example, if the 45th day falls on a Sunday, EIS adjusts the Application Management Report to show that the 45th day falls on the next workday. If the 45th day falls on the Sunday prior to a state and/or county holiday, EIS adjusts the report to show that the 45th day is the first workday following the state and/or county holiday.

2. Process the application (approve, withdraw or deny) on or before the 45th day unless the application is pending for information in B.1.a., or two requests for the missing information have not been completed. If an application is missing more than one of these items, pend the application. Indicate on the date screen the item likely to take the most time to obtain.

a. If an application is pending proof of meeting a deductible and that is the only piece of information needed to process the application, hold the application open for up to six months if predicted medical expenses indicate that the deductible may be met.

b. If an application is pending for citizenship and/or identity documentation and that is the only piece of information needed to process the application, hold the application open for up to six months if the individual has received the one time 90 day reasonable opportunity period (existing C/I code 97) to provide documentation of citizenship/identity.

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(III.A.2.)

c. If the application is pending for citizenship/identity documentation as well as one of the items in III.B.1.a, and the individual has received the one time 90 day period (existing C/I code 97) to provide documentation of citizenship/identity, continue to pend the application until all items needed to process the application are received. Update the date screen in EIS. See EIS 2400, Application Processing.

3. The processing time ends the date the notice of decision is mailed or given to the individual. If the notice is automated, the processing time ends the day the system mails the notice. The automated notice is mailed the workday after the action has been keyed into and accepted by EIS.

4. If the application is pending for citizenship/identity documentation as well as one of the items in III.B.1.a, and the individual has not previously received the one time 90 day period (existing C/I code 97) to provide documentation of citizenship/identity:

a. During the 6 month pending period, if all eligibility requirements are met except for citizenship/identity before the 90 day reasonable opportunity period ends, complete the 8125 approving the application and authorize with the appropriate certification period using C/I code 97. The date entered is the date the first Request for Information (DMA-5097) is sent to the individual.

b. The 90 day reasonable opportunity period starts with the first notice (DMA-5097) even if the individual is not otherwise eligible at the time the first notice is sent. An individual pending 6 months for citizenship documentation and additional items in II.B.1.a, has received a Request for Information (DMA-5097) and a Your Application for Medicaid is Pending (DMA- 5098). It is not necessary to resend either request/form.

c. Although the individual is authorized, citizenship and identity have not been verified. The individual is allowed 90 days from the date the first Request for Information form (DMA-5097) is sent to provide acceptable documentation of citizenship and identity. The individual appears on the Case Management Report under special message “RESOLVE CITIZENSHIP ISSUE DUE” until the individual is terminated, or the C/I code 97 is changed to another code.

NOTE: It is important to key the date the first DMA-5097 is sent when entering C/I code 97 on the 8125. EIS automatically calculates the 90 days from the date entered for the Case Management report.

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(III.A.4.)

d. The caseworker must verify citizenship within 90 days. If unable to verify, send a timely notice, DSS-8110, on the 91st day or the next workday following the 90th day to terminate the individual or case.

e. During the 6 month pending period if all eligibility requirements are met except for citizenship/identity after the 90 day reasonable opportunity period, continue to pend the application for 6 months. Deny the application after pending 6 months when documentation is not received.

5. Examples

a. Application received 4/10/10 and Request for Information (DMA-5097) sent to individual 4/12/10 requesting documentation of citizenship and medical bills to meet a deductible. The 90 day reasonable opportunity period starts with the first notice (4/12/10) and the 90th day is 7/9/10. The individual does not respond. The individual is sent a Your Application for Medicaid is Pending (DMA- 5098). The Date Screen is completed in EIS and the application is put into 6 month pending.

The deductible is met on the 60^th day (6/9/10). All eligibility requirements are now met except for citizenship/identity. Authorize the individual because he became otherwise eligible prior to the 90^th day (7/9/10), and the individual has not previously received the 90 day reasonable opportunity period to secure citizenship documentation. Authorize effective the date the deductible is met (6/9/10) for certification period 4/1/10 – 10/31/10. Key the 8125 entering C/I code 97 and the date the first notice was sent (4/12/10). EIS automatically calculates the 90 days from the date entered and the individual appears on the Case Management Report under special message “RESOLVE CITIZENSHIP ISSUE DUE” until the individual is terminated, or the C/I code is changed to another code. If the documentation is not provided by or on the 90^th day (7/9/10), send a timely notice on the 91^st day or next workday following the 90^th day to terminate.

b. Application received 4/10/10 and Request for Information (DMA-5097) sent to individual 4/12/10 requesting documentation of citizenship and medical bills to meet a deductible. The 90 day reasonable opportunity period starts with the first notice (4/12/10) and the 90th day is 7/9/10. The individual does not respond. The individual is sent a Your Application for Medicaid is Pending (DMA- 5098). The Date Screen is completed in EIS and the application is put into 6 month pending.

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(III.A.5.b.)

The deductible is met on the 100^th day (7/19/10). Do not authorize the individual because he became otherwise eligible beyond the 90 day reasonable opportunity period (7/9/10). The individual would remain pending until the end of the 6 month pending period or until all information is received. Deny the application after pending 6 months when documentation is not received.

B. Excluding Days from the Processing Time

1. Under certain circumstances, days may be excluded from the application processing time.

a. As a general rule, days may be excluded only when the county is waiting for one item in the following list and the missing item is the only information needed to process the application. However, days may also be excluded when the county is waiting for item (9) and one of the items in (1) through (8).

(1) Medical bills to meet a deductible, or

(2) Disability determination, or

(3) Medical records needed to determine emergency dates for non-qualified aliens, or

(4) A request for additional time to supply verification extends processing time beyond the 45/90 day limit, or

(5) Receipt of the FL-2/MR-2, or

(6) Receipt of the CAP Plan of Care, or

(7) Receipt of undue hardship documentation, or

(8) Receipt of North Carolina Health Choice enrollment fee, or

(9) Receipt of U.S. citizenship and/or identity documentation, if unable to verify.

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(III.B.1.b.)

b. The exclusion of days cannot begin any earlier than the date the individual is notified of the last pieces of information needed to process the application using the DMA-5098/DMA-5098S, Your Application for Medicaid is Pending, or the DMA-5099/DMA-5099S, Your Application for Medicaid is Pending for a Deductible, or the DMA-5113, Notice of Right To Request A Hardship Waiver or notice of date hardship waiver was mailed. See MA-2245, Undue Hardship Waiver For Transfer Of Assets.

(1) The DMA-5098/DMA-5098S can be mailed or given to the applicant on the day all points of eligibility are met except for receipt of the following:

(a) Disability determination. Before days can be excluded, transmittal to Disability Determination Services (DDS), using the DMA-4037, Disability Determination Transmittal, is required, or

(b) Medical records to determine emergency days for non-qualified aliens. Before days can be excluded, verification must be requested from the medical provider, and/or

(c) Citizenship and/or identity documentation when documentation requests are sent to a third party source such as Vital Records. The DMA-5098/DMA-5098S can be mailed or given to the applicant on the same day the third party documentation is requested or it can be sent later. When requesting documentation from the a/r, see (2) below.

(d) NCHC enrollment fee. Before days can be excluded, the enrollment fee must be requested from the a/r.

(2) The DMA-5098/DMA-5098S or if applicable, the DMA-5099/DMA-5099S can be mailed or given to the applicant at the end of the first 12-day request for information period when all points of eligibility are met except for receipt of the following information:

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(III.B.1.b.(2))

(a) FL-2/MR2, or

(b) CAP Plan of Care, or

(c) Medical bills to meet a deductible, or

(d) Undue hardship documentation, and/or

(e) U.S. citizenship and/or identity documentation, when requesting documentation from the individual.

Before days can be excluded, the applicant or third party must be given at least 12 full days to provide the missing information. Request the missing information from the applicant using the DMA-5097/DMA-5097S or from the third party using the appropriate verification form.

(3) The DMA-5098/DMA-5098S, Your Application for Medicaid is Pending, or DMA-5099/DMA-5099S, Your Application For Medicaid is Pending A Deductible, can be mailed or given to the applicant on the same date that the applicant or third party requests additional time to provide information and the county has met all requirements for requesting the information in MA-3210, Verification Requirements For Applications, section III.D.

When the IMC has only made one request for the information and the applicant or third party asks for additional time late in the processing period the exclusion of time does not apply.

When the second 12 days has not yet run, but the applicant or third party asks for additional time, wait until the second 12 day period has run before sending the DMA-5098/DMA-5098S or DMA-5099/DMA-5099S.

When the IMC learns of additional information needed after the initial request (s) for information have been made, the 12/12 requirement must be met. In such a case, the applicant may request additional time even if the request comes after the 45/90 day period has run.

(4) The DMA-5098/DMA-5098S or DMA-5099/DMA-5099S can be mailed or given to the applicant on the same day of the second or subsequent request for the missing information, provided the 12-day requirement has been met, or it can be sent later.

The exclusion of days cannot begin any earlier than the 13^th day after the missing information was first requested.

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(III.B.1.)

c. If an application is filed for both retroactive and ongoing coverage, exclusion is permitted for each part of the application.

d. When the DMA-5098/DMA-5098S or DMA-5099/DMA-5099S is mailed or given to the individual notifying him of the last piece of information needed to process the application, the days can be excluded from the application processing time. The exclusion of days begins on the date the DMA-5098/DMA-5098S or DMA-5099/DMA-5099S is given or mailed to the client following the procedures above.

e. Key the date screen in EIS. See EIS-2400.

(1) The begin date on the date screen is the date the DMA-5098/DMA-5098S or DMA-5099/DMA-5099S is mailed or given to the client.

(2) The end date for excluding days is the date that the Disability Determination Section (DDS) releases the case on the Disability Determination (DD) screen.

For non-qualified alien emergency dates, the exclusion of days ends on the date the medical records are received. Days cannot be excluded while waiting for DMA to determine emergency dates.

The end date for excluding days in NCHC cases is the day the fee is received or the 13th calendar day, whichever occurs first.

(3) The begin and end dates count in the application processing time.

2. Change in Situation

a. If a change in situation, which affects eligibility, becomes known after the exclusion of days begins, request the new or additional information following procedures in MA-3210, Verification Requirements For Applications.

(1) If the change results in an increased or decreased deductible amount, notify the applicant of the new deductible amount using the DMA-5099/DMA-5099S, Your Application For Medicaid Is Pending A Deductible.

(2) If the change results in eligibility, approve the application.

(3) If the change results in eligibility for the time prior to the change and ineligibility after the change, approve the application as open/shut. Refer to D.3.

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(III.B.2.a.)

(4) If the information results in ineligibility, deny the application.

b. On the date that eligibility or ineligibility is established, the days can no longer be excluded. Enter this date in the end date field on the date screen.

C. Calculating the Six-month Pending Period

Calculate the six-month pending period by counting forward to the sixth calendar month following the month of application. The six-month pending period ends on the same calendar day as the date of application. If the six-month pending period ends on a weekend or holiday, dispose of the application the next workday.

EXAMPLES
Application Date	Six-month pending period ends
April 10	October 10
May 1	November 1
March 31	September 30

D. Application Outcomes

1. Withdrawal

The individual may decide after signing the application (either the DSS-8124 or the DMA-5063) that he does not want to continue the process. In this case, the application is withdrawn. The IMC must follow the procedures below:

a. Discuss with the individual the reason for the withdrawal and the facts supporting that decision.

b. Discuss with the individual the alternatives to withdrawal. Some alternatives include but are not limited to:

(1) Completing an open-shut application for a period of time when eligibility was established, or

(2) Transferring or reopening the application to an allowable Medicaid program protecting the original date of application, or

(3) Reapplying for retroactive coverage to reduce the deductible and allow for eligibility.

c. Carefully document the reason for the withdrawal including the facts that support the decision, the alternatives to the withdrawal that were offered and the individual’s response. It is suggested that a worksheet be used for documentation.

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(III.D.)

d. Use the DSS-8109, Your Application For Benefits Is Being Denied or Withdrawn, to notify the individual of the action and provide hearing rights. Refer to MA-3430, Notice and Hearings Process, for instructions on completing the manual DSS-8109. The DSS-8109 is also automated.

e. If the individual requests the withdrawal by mail or by leaving a message:

(1) Make one attempt to contact the individual by phone to discuss the request and the alternatives.

(2) Document the attempt to contact the individual and, if successful, document the discussion and results.

(3) If the IMC cannot make contact with the individual, withdraw the application.

2. Denial

Prior to denying an application, evaluate eligibility under other aid program/categories for each assistance unit member. If an assistance unit member is eligible under another aid program/category, open an application for that program with the original date of application and process under that aid program/category.

a. Deny the application anytime:

(1) Ineligibility for Medicaid under all aid program/categories is established.

(2) It is determined that the individual cannot meet his Medicaid deductible. Refer to MA-3315, Medicaid Deductible.

(a) If, based on the individual’s statement of old, current and anticipated expenses, it appears that he is not or will not be within $300.00 of meeting the ongoing deductible, deny the application.

(b) If, based on the individual’s statement and/or third party verification of old and actual expenses during the retroactive certification period, it is determined that he has not met the retroactive deductible, deny the application. Ensure that all of the budget unit’s old and retroactive medical expenses have been evaluated.

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(III.D.2.a.)

(3) It is determined that the individual has excess resources and the individual states verbally or in writing that he does not intend to reduce his resources within the 45-day application processing time, accept his statement. Document the record and deny the application.

Do not deny the application prior to the 45^th day if the individual states he does intend to reduce his resources or says nothing. Request verification of reduced resources following procedures in MA-3210 and hold the application until the 45^th day for proof that resources have been reduced. See 2.c. below.

(4) The individual cannot be located.

(a) Use this reason for denial only when it is impossible to contact the individual by letter or telephone or mail has been returned by the post office.

(b) If the whereabouts of any of the children included on the application are known, continue to process the application for the children only.

(c) Since it is possible to record incorrect information during the interview, check possible sources of information such as the telephone directory, city-county directory or postal service.

(d) If there is a forwarding address, do not deny the application because the applicant has moved.

(e) Do not deny the application because the applicant does not have a permanent address.

(f) Clearly document all attempts to locate the individual prior to denial.

(5) The applicant refuses to assign his own rights or those of any other individual for whom he can legally make an assignment or he refuses to cooperate in identifying and providing TPR information. Refer to MA-3510, Third Party Recovery.

b. Deny the application the next workday following the second scheduled appointment for an intake interview when the individual failed to complete the interview and two appointments were scheduled with at least 12 calendar days between the appointments.

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(III.D.2.b.)

The IMC may schedule appointments more frequently than 12 days apart, but if the applicant fails to keep all of them, the application cannot be denied unless there are at least 12 days between the first appointment and one of the subsequent appointments.

c. Deny the application on the 45th day when:

(1) The individual or third party fails to provide information needed to determine eligibility. This information includes medical records needed to determine emergency dates for non-qualified aliens, DMA determination of emergency dates, FL-2/MR-2 or CAP Plan of Care, even if days are being excluded from the processing time,

and

(2) The information was requested following procedures in MA-3210, Verification Requirements For Applications. There must be at least two requests for the information with at least 12 calendar days between the requests and 12 calendar days must have passed since the second request.

(a) Excess Resources

1) If the individual with excess resources states verbally or in writing that he does intend to reduce his resources, explain to him that the resources must be reduced by the 45th day and he must provide verification that the resources have been reduced within the application processing time.

2) If the individual has not provided verification of the reduced resources on the 45th day and the 12-12 rule has been met, deny the application.

3) If the individual has not provided verification of the reduced resources on the 45th day and the 12-12 rule has not been met, hold the application pending until the end of the second 12-day period or until ineligibility is verified.

For example, an applicant is notified of excess resources on the 40^th day. The individual is notified of the reserve reduction options and allowed 12 calendar days to reduce, rebut or designate assets for burial. At the end of the 12-day period, a second notice is sent to the individual.

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(III.D.2.c.(2)(a)3))

If excess resources can be reduced by rebuttal or burial designation, hold the application pending until the end of the second 12-day period for verification of rebuttal evidence or burial designation.

If the excess resources cannot be reduced by rebuttal or burial designation and resources are not reduced by the 45^th day, the case is ineligible. Deny the application once ineligibility is verified.

(b) Emergency Medical Dates

1) If the case is pending a decision from DMA regarding emergency dates, contact DMA on the 45th day to see if the decision has been made.

2) If DMA has not made a decision and the 12-12 rule has been met, deny the application.

3) If a favorable decision of emergency dates is received from DMA after the application is denied, reopen the application as an administrative application using the original date of application.

(c) Never deny on the 45th day if the 12-12 rule has not been met and ineligibility has not been established.

1) If 12 days have not passed since the second request for information and ineligibility has not been established, hold the application pending for the full 12 days, even if it pends beyond the 45th day.

2) If the verification is provided by the end of the second 12-day period and all other points of eligibility are met, authorize assistance.

3) If the application is pending for a reason cited in III.B.1. and for other information that the individual or third party must provide, deny the application on the 45th day, provided the 12-12 rule has been met.

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(III.D.2.d.(2)(c)3))

For example, an individual in an MAF application has a deductible that based on his statement might be met during the certification period. However, the individual has not returned required verification of resources. Deny the application on the 45^th day.

d. Deny the application at the end of six months when the:

(1) Application pended for proof of meeting a deductible and the individual has failed to provide proof that the deductible was met, or

(2) Application pended for a disability determination and the decision has not been rendered, or

(3) Application pended for proof of citizenship and/or identity, the individual had previously received the 90 day reasonable opportunity period to provide the documentation, and the information has not been received, or

(4) Application pended for proof of citizenship and/or identity, as well as one of the items in III.B.1.a, and the individual became otherwise eligible after the 90 day reasonable opportunity period to provide the documentation, and the information has not been received.

3. Approval

a. Approve assistance anytime all factors of eligibility have been verified and eligibility is established.

b. If all other eligibility factors are met except for documentation of citizenship/identity and the individual states they are a US citizen:

(1) Send the individual the Request for Information (DMA-5097) advising what items can be used to verify citizenship and identity.

(2) If the individual has received the one time 90 day reasonable opportunity period (existing C/I code 97) to provide documentation of citizenship/identity hold the application open for up to six months. See III.A. above.

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(III. D.3.b.)

(3) If the individual has not received the 90 day reasonable opportunity period to provide citizenship/identity documentation, complete the 8125 approving the application and authorize with the appropriate certification period using C/I code 97. The date entered is the date the first Request for Information (DMA-5097) is sent to the individual. Allow the individual 12 days and, if the requested information is not received, a second DMA-5097 is required.

(4) Complete the DMA-5177, Documentation of Identity and Citizenship for US Citizens, in the CID subfolder with a C/I code 97. The date is the date the first Request for Information (DMA-5097) is sent.

(5) Although the individual is authorized, citizenship and identity have not been verified, and the information must be requested from the individual. The individual is allowed 90 days from the date the first Request for Information form (DMA-5097) is sent to provide acceptable documentation of citizenship and identity. The individual appears on the Case Management Report under special message “RESOLVE CITIZENSHIP ISSUE DUE” until the individual is terminated, or the C/I code is changed to another code.

NOTE: It is important to key the date the first DMA-5097 is sent when entering C/I code 97 on the 8125. EIS automatically calculates the 90 days from the date entered for the Case Management report.

(6) The caseworker must verify citizenship within 90 days. If unable to verify, send a timely notice, DSS-8110, on the 91st day or the next workday following the 90th day to terminate the individual or case.

The individual is allowed only one (lifetime) 90 day reasonable opportunity period to provide documentation of citizenship/identity. If he reapplies, citizenship documentation must be provided before approval of benefits.

(7) If documentation from any level is provided within the 90 days, key an 8125 and update the C/I field with the appropriate C/I code. Complete the DMA-5177, Documentation of Identity and Citizenship for US Citizens, in the CID subfolder with appropriate C/I code and the date the documentation is received.

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(III.D.3.b.)

(8) If the individual cannot obtain the necessary documents, requests help, or has special needs demonstrating a need for assistance and lacks someone who can act on his behalf, the county must assist the individual in acquiring the documents, including bearing the cost involved. See MA-3210, Verification Requirements for Applications.

c. If an application includes a request for retroactive and ongoing Medicaid, it is counted as two separate applications and each part must be dispositioned. If all other eligibility factors are met for either or both the retroactive or ongoing application(s), except for documentation of citizenship/identity, and the individual states they are a US citizen:

(1) Send the individual the Request for Information (DMA-5097) advising what items can be used to verify citizenship and identity.

(2) If the individual has not received the 90 day reasonable opportunity period to provide documentation of citizenship/identity, complete the 8125 approving the application(s) and authorize with the appropriate certification period using C/I code 97. The date entered is the date the first Request for Information (DMA-5097) is sent to the individual. Allow the individual 12 days and, if the requested information is not received, a second DMA-5097 is required. Follow procedures outlined above in III.D.3.b.

Example: Application received 4/10/10 requesting both retroactive (January, February, March) and ongoing coverage. All eligibility requirements are met for both the retroactive and ongoing applications, except citizenship documentation and the individual has not received the 90 day reasonable opportunity period.

The Request for Information (DMA-5097) is sent to the individual 4/12/10. The 90^th day to provide citizenship/identity documentation is 7/10/10. Complete the 8125’s for both applications approving and authorizing for the appropriate certification periods using C/I code 97 and the date the first DMA 5097 is sent to the individual, in this example 4/12/10.

The retroactive application is authorized for certification period 1/1/10 – 3/31/10 using C/I code 97 and the 4/12/10 date. The individual will not appear on the case management report for this application approval because the certification period has ended at the time the approval is keyed.

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(III.D.3.c.)

The ongoing application is authorized for certification period 4/1/10 – 9/30/10 using C/I code 97 and the 4/12/10 date. The individual will appear on the case management report for this application approval under RESOLVE CITIZENSHIP ISSUE DUE with a due date of 7/10/10 (90th day).The caseworker must verify citizenship within 90 days. If unable to verify, send a timely notice, DSS-8110, on the 91^st day or the next workday following the 90^th day to terminate the individual or case.

Example: Application received 4/10/10 requesting retroactive coverage (January, February, March). All eligibility requirements are met except citizenship documentation and the individual has not received the 90 day reasonable opportunity period. The Request for Information (DMA-5097) is sent to the individual 4/12/10. Complete the 8125 approving and authorizing for the appropriate certification period, 1/1/10 – 3/31/10, using C/I code 97 and the date the first DMA- 5097 is sent to the individual, in this example 4/12/10.

The individual will not appear on the case management report for this application approval because the certification period has ended at the time the approval is keyed. If the individual reapplies at a later date, the C/I code 97 will flag that he has received the 90 day reasonable opportunity to provide citizenship/identity documentation.

Example: Application received 4/10/10 requesting both retroactive (January, February, March) and ongoing coverage. All eligibility requirements are met for the retroactive application except citizenship documentation and the individual has not received the 90 day reasonable opportunity period. All eligibility requirements are not met for the ongoing application. The individual must provide medical expenses to meet a deductible for the ongoing application and citizenship documentation.

The Request for Information (DMA-5097) is sent to the individual 4/12/10 requesting documentation of citizenship and medical bills to meet a deductible. The 90 day reasonable opportunity period starts with the first notice (4/12/10) and the 90^th day is 7/9/10.

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(III.D.3.c.)

The retroactive application is authorized for certification period 1/1/10 – 3/31/10 using C/I code 97 and the 4/12/10 date. The individual will not appear on the case management report for this application approval because the authorization period has ended at the time the approval is keyed.

The individual does not respond. The individual is sent a Your Application for Medicaid is Pending (DMA- 5098). The Date Screen is completed in EIS for the ongoing application and is put into 6 month pending.

The deductible is met on the 60^th day (6/9/10). All eligibility requirements are now met except for citizenship/identity. Authorize the individual because he became otherwise eligible prior to the 90^th day (7/9/10). The 90 day reasonable opportunity period starts with the first notice (DMA-5097) even if the individual is not otherwise eligible at the time the first notice is sent.

Authorize effective the date the deductible is met (6/9/10) for certification period 4/1/10 – 10/31/10. Key the 8125 entering C/I code 97 and the date the first notice was sent (4/12/10). EIS automatically calculates the 90 days from the date entered and the individual appears on the Case Management Report under special message “RESOLVE CITIZENSHIP ISSUE DUE” until the individual is terminated, or the C/I code is changed to another code. The individual has until the 90^th day (7/9/10) to provide documentation of citizenship. If the documentation is not provided by or on the 90^th day (7/9/10), send a timely notice on the 91^st day or next workday following the 90^th day to terminate.

d. Open/shut approvals

(1) If at any time during the application process, the individual is determined ineligible for Medicaid under the program for which he applied, evaluate whether the individual is eligible under any program for any portion of the time covered by the application.

(2) If at any time the individual is authorized for SSI Medicaid, continue to determine eligibility for any period of time, retroactive and ongoing, that is covered by the application. Refer to MA-3120, SSI Medicaid.

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(III.D.3.d.)

(3) If at any time the individual requests to withdraw his application, explore with him the possibility of his eligibility for any period of time during his certification period. If he wishes to be evaluated for eligibility for any period of time covered by his date of application, do not withdraw the application.

(4) When an individual is found eligible for a portion of a certification period, authorize assistance open/shut for the period of time the individual was eligible.

When a medically needy applicant requests ongoing Medicaid, the six-month deductible must be met prior to authorization regardless of the number of months in the ongoing certification period unless there is a change in income or the individual dies.

(a) Example #1 A medically needy non-qualified alien has a medical emergency during the month of application. Emergency medical dates are approved by DMA. The individual must meet the ongoing six-month deductible before the emergency medical dates can be authorized.

In this situation, the IMC should fully explain to the individual the option of applying for retroactive assistance including the reserve and residence requirements.

(b) Example #2 A medically needy individual requests withdrawal of his application because he has moved to another state to live with his son. The individual reports that he moved to the other state upon discharge from the hospital.

The individual also reports that he has enough medical bills to meet the original six-month deductible. The certification period is January through June. Medical bills indicate that the six-month deductible was met on March 9^th. The individual moved to the other state on March 16^th.

Approve the application open/shut for March 9^th through March 31^st. Do not re-compute the deductible. The ongoing six-month deductible must be met even if the certification period is three months.

REISSUED 07/01/10 – CHANGE NO. 06-10