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Title 8: Medicaid Page 10 Iowa Department of Health and Human Services Employees’ Manual Chapter B: Application Processing Procedures for SSI Applicants or Potential… Revised October 17, 2025 Medicare Savings Program Applications 3. Make ELIAS system entries to approve or deny the application. If no decision has been entered by the 30th day, the system will automatically send a Notice of Decision denying the MSP application for failure to return form 470-4846. The Medicare Savings Programs (MSPS) screen displays data from the SSA that was used to deny the application. Use this information to support a denial of eligibility for MSP in the event the applicant appeals the denial decision. See 14-B(4), MSPS = LIS-Application History.

1. SSA receives Ms. Z’s application for Extra Help on January 15. SSA determines that Ms. Z is eligible for Extra Help on March 1. Ms. Z indicated that she wanted to also apply for the Medicare Savings Program. On March 1, SSA sends Ms. Z’s data from the Extra Help application to the Department. The Department receives the data on March 1. Ms. Z’s application date for MSP is January 15. The Department has 30 days beginning March 1 to determine Ms. Z’s eligibility for MSP. On March 1, the Department sends her form 470-4846, Medicaid Savings Programs Additional Information Request. The cover letter tells Ms. Z to return the form by March 11. Ms. Z reviews the forms and does not make any changes to the data printed in the form. She returns the form on March 8. The worker determines that Ms. Z is eligible for QMB effective April 1. 2. Same situation as above except that Ms. Z is determined to be eligible for SLMB. Ms. Z’s eligibility is effective January 1. If Ms. Z indicates that she has medical expenses for the three months before January 1 and she meets the SLMB eligibility requirements before January 1, Ms. Z would need to meet a category of eligibility for the retroactive period as defined in 8-A, Definitions. If she does, Ms. Z could be eligible for SLMB benefits effective October 1.