101.09 COMBINATION MAGI AND ABD APPLICATIONS

Although MAGI and ABD are separate programs, there are common elements that allow an individual to apply in one program but be determined eligible in the other using available information. The MAGI application asks specific questions at the individual level regarding possible ABD eligibility. These questions ask if the applying household member: • is disabled, or • has a physical, mental or emotional condition that limits common activities, or • lives in a medical facility or nursing home. An affirmative response to any of these questions requires further development as quickly as possible during the MAGI application process to follow up on possible ABD eligibility if it is unlikely that the individual will qualify for MAGI based on application information. For example, an applying household member is over the age of 18 and is not a parent or caretaker of a minor child in the home, or the parent/caretaker has income over the limit for adult coverage, or a disabled child’s family income is over the Medicaid and CHIP limit. In all these situations, if a disability is alleged for an applying MAGI household member, that individual must be allowed the opportunity to apply for ABD in an expeditious manner. MAGI Application Filed with DOM Indicates Possible ABD Eligibility To fulfill the requirement for a MAGI applicant to apply for ABD when a MAGI application indicates possible ABD eligibility, do the following: • Issue the ABD application form (DOM-300) via DOM-307 requesting only the information that is not available as part of the MAGI application process. The types of verification needed to establish ABD eligibility may be: o Requesting disability information for a DDS decision if disability cannot be established using electronic verification from SSA on the SVES. o Verification of any income not counted for MAGI purposes, such as VA benefits, that will not be verified during the MAGI application process. o Verification of resources for the individual, couple, or parent(s) of a disabled child, which are not considered for MAGI eligibility. • A signed ABD application form is required to formalize receipt of an ABD application. If a signed (complete or incomplete) ABD application form is not received, document the MAGI case that there is no further action required regarding ABD follow-up. • If a signed ABD application form is received but missing required information, obtain the information by using telephone contact when possible or the issuance of DOM-307/309 to obtain missing information. • Telephone contact with the ABD applicant or representative may be used in this situation to describe the ABD application process and to inform the ABD applicant of any other requirements unique to ABD. These include ownership of resources, requirements to consent to the AVS (Asset Verification System) requirement described on the application form. For any application for long term care or institutional ABD categories of eligibility, a telephone interview is required to explain any applicable long term care provisions such as estate recovery, spousal impoverishment, transfer of assets, Medicaid Income and the Income Trust provision that are not applicable to MAGI eligibility. If the ABD applicant(s) follow through with the remaining ABD application requirements, such as providing requested information or taking required actions, the ABD application can be processed and approved regardless of the action taken on the MAGI application. If the MAGI and ABD applications are approved, the case becomes a combination ABD/MAGI case in MEDS and is handled accordingly. MAGI Application Filed with the FFM Indicates Possible ABD Eligibility For MAGI applications filed with the FFM and referred to DOM as an Account Transfer, the system recognizes any affirmative responses to the questions that indicate a request to apply for ABD Medicaid and issues DOM-304, Non-MAGI Application Letter (located in the Appendix page by the same name). This letter informs the applying household member that additional information will be needed if the applying household member wants to pursue applying for Medicaid based on disability, i.e., resource information and disability information unless the individual has already been determined disabled by SSA. The letter instructs the individual to sign, date and return the letter to DOM by mail, in person, by fax or email if he/she wants to continue with an application for ABD Medicaid or, if needed, the individual can contact the agency by phone to continue the process. If an individual signs and returns the “non-MAGI letter” to the agency via any means acceptable for filing an application, an ABD application must be issued to the individual and the steps described above in “MAGI Application Filed with DOM Indicates Possible ABD Eligibility” must be followed for processing the ABD application. If a signed non-MAGI letter is not returned to the agency, no further action is required.