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MEDICAL SERVICES POLICY MANUAL,SECTION C C-100 Application Process

C 135 Time Limit for Disposition of Application

Applications submitted online will automatically be registered by the system. Applications submitted to DHS via mail, phone, fax, email or in person must be entered into the system and registered by agency staff no later than the close of business of the first workday following receipt of the application. Applications submitted through the Federally Facilitated Health Insurance Marketplace (FFM), that appear to be eligible for Medicaid, will be sent to DHS for processing. If found eligible, the applicant will be approved in the appropriate category based on the eligibility determination. The applicant will not be required to submit a separate Medicaid application to DHS.

C-135 Time Limit for Disposition of Application MS Manual 01/13/15 Medicaid applications must be disposed of within 45 days from the date of application unless a disability determination is required. Applications requiring a disability determination must be disposed of within 90 days from the date of application.

C-140 Eligibility Determination MS Manual 01/01/14 Eligibility for all Medicaid categories will be determined in accordance with MS Section D, General Eligibility Requirements, and MS Section E, Financial Eligibility. Non-financial criteria (Re. MS Section F) will be determined depending on the category of coverage. Eligibility factors will be verified in accordance with MS Section G. Generally speaking, the system will determine Medicaid eligibility according to a rules based engine utilizing the data entered into the system by the individual, agency staff or a combination of both. Specific eligibility determination process steps are as follows: 1. Once enough information has been entered, the system will screen the applicant’s eligibility for Medicaid and if the individual appears eligible, will verify the applicant’s data through various data matches. 2. If the applicant’s data and data sources are “reasonably compatible” (MS G-151 and MS G-152) and eligibility exists, the system will approve the application, update all information regarding the case, and send a notification of approval to the individual. 3. If eligibility does not exist based on the information entered on the application, the system will deny the application and send a notice to the individual.