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

C 145 Application Disposal

C-145 Application Disposal MS Manual 01/01/14 Applications must be disposed of by one of the following actions: approval or denial. Approval When all eligibility requirements are determined to be met, the application will be approved and the individual enrolled in the appropriate Medicaid coverage group. An approval notice will be sent to the applicant advising that he or she has been approved for coverage with the effective beginning date of coverage. Denial An application will be denied in the following situations: 1. The applicant is determined to be ineligible due to an eligibility requirement not being met; 2. Eligibility cannot be established due to failure of the applicant to provide information necessary to determine eligibility; or 3. The applicant withdraws the application. When an application is denied, a denial notice will be sent advising the applicant of the denial, reason for denial and the applicant’s right to appeal the denial.

C-150 Enrollment MS Manual 02/01/18 Each individual approved for Medicaid by DHS will be enrolled in the appropriate eligibility coverage group. The system will make this determination based on the information entered to the system. Upon enrollment, a Medicaid or ARKids ID card will be issued to each eligible individual if the person does not already have an existing card. The enrollment process for the Adult Expansion Group requires that once eligibility is determined, the applicant will receive a letter explaining which coverage is suitable for their need. The Division of Medical Services will issue an eligibility approvalnotice for the Adult Expansion Group which will provide instructions regarding the next steps needed to complete the enrollment process.