Interview Requirements

A face-to-face (FTF) interview is not a requirement for any Medicaid COA. At the caseworker’s discretion or the request of the A/R or AREP, a FTF interview may be scheduled; however, an application may not be denied for failure to appear for an interview.

A telephone interview is required for ABD LA-D COAs and Adult Medically Needy (AMN) COAs.

Caseworker will attempt to reach the A/R or AREP by conducting two unscheduled telephone attempts prior to scheduling an interview.

The A/R considered to be is the primary source of information for him or herself. The A/R may authorize an Authorized Representative (AREP) to apply, interview, and provide information on his or her behalf. An elected AREP may have verbal or written designation. If the designation is written, the applicant’s signature is required. If the designation is verbal, it must be documented. If the information is provided by an AREP is questionable or unclear, attempt to contact the A/R for clarification. This may be accomplished by telephone, mail, fax or in-person,

The A/R may withdraw, at any time, authorization of an AREP to act on his or her behalf. This request can be given verbally or in writing. If the request is given verbally, it must be documented. If the request is written, the applicant’s signature is required.

Information necessary to complete an eligibility determination may be obtained by any of the following methods:

FTF interview

A FTF interview may not be required of the applicant or AREP and an application may not be denied solely for failure to complete a FTF interview.

telephone call

mail

home visit

secure e-mail

Fax

Gateway

Orally or in writing, inform the A/R about the Medicaid program(s) for which he or she may be entitled. Provide relevant information pamphlets or other printed material.

Explain the following information to the A/R and/or AREP:

services provided by DFCS and how to obtain those services

requirements of eligibility and the A/R’s responsibility to provide correct information to establish eligibility and benefit level.

HIPAA and confidentiality

basic and financial eligibility requirements

Clearinghouse requirements for any AU/BG member

potential Medical Assistance COAs

potential coverage for three months prior to the month of application

periodic renewals

timely reporting of changes and how and where changes are to be reported

assignment of Third Party Liability (TPL)

Medically Needy requirements, if applicable

patient liability or cost share, if applicable

The applicant’s right to the following: a fair hearing. Refer to Appendix B - TOC for details a decision within the standard of promptness (SOP) confidentiality non-discrimination in the processing of the application their rights and responsibilities in the Medical Assistance program, included in the single streamlined application or Form 297A - Rights and Responsibilities.