Family and Children's Medicaid MA-3425 CERTIFICATION AND AUTHORIZATION

VII. AUTHORIZATION

A. Policy Rule

The period authorized is the portion of the c.p. when all factors of eligibility are met and the individual receives Medicaid benefits.

B. Procedures

1. Deductible Cases:

Authorize the day the deductible is met and through the last day of the c.p., provided all other eligibility factors are also met.

2. Cases With No Deductibles/No Excess Reserve/MPW/MIC:

Authorize the first day of the c.p. through the last day of the c.p.

3. Long-Term Care Cases:

LTC budgeting begins the month following the month of entry into LTC (See MA-3325, Long-Term Care Budgeting).

a. There is no deductible for months of LTC budgeting. A patient monthly liability (PML) is assigned.

b. If all eligibility factors are met, authorization begins the first day of the first month of LTC budgeting.

4. For cases with excess reserve, authorize the day reserve is within allowable limits and all other eligibility factors are also met.

5. When there is both a deductible and excess reserve, and these are met on different dates, authorize on the later of the two days.

(VII.)

C. Authorization in EIS

1. When all conditions of eligibility are met, notify a/r on the appropriate notice and refer to instructions in the EIS Manual for authorization procedures.

2. Follow instructions in EIS Manual regarding when authorization must be updated because of changes in situation.

3. Refer to MA-3420, Re-Enrollment, for instructions in situations where the redetermination has not been completed timely or timely notice has not expired, to authorize benefits month by month.