101.05 MEDICAID APPLICATIONS FILED THROUGH ANOTHER

AGENCY OR ENTITY Certain applications for Medicaid are filed through other agencies or entities. Currently, these include the following types of applications that are discussed in further detail below. • SSI applications. SSI applicants approved for SSI are automatically eligible for Medicaid with no separate application for Medicaid required unless retroactive Medicaid is needed or there are missing months of SSI eligibility that need to be evaluated for Medicaid-only eligibility to fill in gaps of ineligibility for SSI. In addition, SSI recipients entering long term care in a nursing facility, ICF/IID or PRTF require DOM authorization of a Medicaid per diem payment to the facility. • Children under age 21 who are in the custody of the Department of Child Protection Services (DCPS) and who are certified as Medicaid eligible by the DCPS. Foster children and adoption assistance children determined eligible for Medicaid by DCPS require no separate application. If the individual enters a nursing facility, ICF/IID or PRTF, DOM must authorize the Medicaid per diem payment to the facility. • Applications filed with the FFM and transferred to the Division of Medicaid as Account Transfers (AT’s). Referrals from the FFM require a decision to approve or deny eligibility for Medicaid or CHIP from DOM. • Applications submitted by individuals through the Common Web Portal (CWP) are loaded directly into MEDS to be processed by the Division of Medicaid. Applications from the CWP require a decision to approve or deny eligibility for Medicaid or CHIP from DOM. • LIS (Low-Income Subsidy) applications filed as part of an application for Medicare coverage through the Social Security Administration (SSA). LIS applications are applications whose eligibility is limited to one of the Medicare cost-sharing coverage groups (QMB, SLMB or QI) and require a DOM decision to approve or deny eligibility. • Hospital Presumptive Eligibility (HPE) applications processed by qualified hospitals to certify and place time-limited Medicaid eligibility on file for individuals qualifying for HPE. HPE eligibility is determined by qualified hospital staff. • Presumptive Eligibility for Pregnant Women (PEP) applications processed by qualified providers/entities to certify and place time-limited Medicaid eligibility on file for individuals qualifying for PEP. PEP eligibility is determined by qualified provider/entity staff.