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TITLE 16 HEALTH AND SAFETY DELAWARE ADMINISTRATIVE CODE 5 20103.1 Agency Responsibilities 20103.1.1 Time Standard 20103.1.2 Timely Documentation 20103.1.3 Time Standard Extension 20103.1.1 Time Standard The Federal regulation at 42 CFR 435.911 requires that Medicaid determine eligibility within 90 days for applicants who apply for Medicaid on the basis of disability. This time standard covers the period from the date of application to the date Medicaid mails notice of its decision to the applicant. 20103.1.2 Timely Documentation The DMMA Medicaid worker must explain this 90-day time standard to the applicant or representative. It must be emphasized to the applicant or their representative, that all documentation needed for the worker to determine Medicaid eligibility must be received by the date indicated on the "Request for Verification" letter (Form 415) or the application will be denied. In cases where verification is incomplete, the worker will give the applicant 15 days to return the information on the initial "Request for Verification" letter (Form 415). The date by which all documentation must be received must be clearly noted on this form. 22 DE Reg. 66 (07/01/18) 20103.1.3 Time Standard Extension The Medicaid worker will automatically give all applicants an extension of 15 days, if needed, using a second "We Need" letter (Form 415) to note the required documentation and the deadline date. At the request of the applicant, a second extension of 15 days may be granted using a third Form 415. With supervisory approval, a further extension may be granted in cases with unusual circumstances. Unusual circumstances include, but are not limited to, awaiting placement in a Medicaid nursing facility bed or difficulty obtaining an out-of-state deed. Medicaid is held to the 90 day timeliness standard except in unusual circumstances. If the information is not received by the given deadline date, the application will be denied. 20103.2 Applicant's Responsibilities It is the applicant or representative's responsibility to obtain the documentation needed to determine the applicant’s eligibility for Medicaid. The applicant should provide the required documentation by the deadline date. The applicant will be given an extension of 15 days via a second Form 415. An additional 15 day extension will be granted upon the applicant/representative’s verbal or written request. A further extension is not granted except in cases of unusual circumstances. 20110 Managed Care Enrollment Requirements Individuals who are found eligible must enroll with a managed care organization. The Health Benefits Manager (enrollment broker) will be responsible for the enrollment process. 15 DE Reg. 1716 (06/01/12) 20200 Income 20200.1 Available Income Available income Is the total amount of money authorized (designated by the payor) for the recipient's benefit, whether received by the recipient directly or received by a representative payee. Income includes anything received by the individual, in cash or in kind, that can be used to meet needs for food, clothing or shelter. 20200.2 Excluded Income Excluded income is money which is income by definition but does not count in determining eligibility. Some income is excluded when determining eligibility, but may be included when calculating patient pay amount. The following items are excluded income: (a) Victims compensation payments from a State established fund. (b) German reparations payments. These payments are not counted in the eligibility nor post eligibility process. (c) Effective 9/1/91 Austrian social insurance payments specifically based on wage credits granted under Paragraphs 500-506 of the Austrian General Social Insurance Act. (d) Japanese-American, Japanese-Canadian and Aleutian restitution payments. (e) Agent orange settlement payments. (f) Impairment-related work expenses. (g) Radiation Exposure Compensation Trust Fund payments.