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DocuSign Envelope ID: 3289A281-EC13-40C5-A56D-BE1F23756321 North Carolina Department of Health and Human Services AGED, BLIND AND DISABLED MEDICAID MANUAL MA-1000 12

SSI MEDICAID – AUTOMATED PROCESS

(VII.B.) If the recipient lives in another county, the county dss in which the SSI TERMINATION REPORT appears must contact the dss in the county of residence immediately and tell them of the SSI termination. Within 5 workdays the first county must send a copy of the SSI TERMINATION REPORT to the county of residence who must complete the evaluation. Once completed, the first county must be notified so they can key in the results of the evaluation and, if eligibility continues, transfer the case to the county of residence. Cooperation between the two counties is essential to ensure that the evaluation for ongoing coverage is completed timely and there is no break in coverage for the recipient.

C. Medicaid Evaluation for Ongoing Eligibility - Ex Parte Review Procedures The term “ex parte review” means to review information available to the agency to make a determination of eligibility, without requiring the recipient to come into the agency or make a separate application. The county must explore and exhaust all possible avenues of eligibility in all Medicaid coverage groups. If information is not available to make a determination of eligibility, the county must provide the recipient reasonable opportunity to provide the necessary information. Do not require citizenship/identity documentation during an ex parte review. See MA-2506, US Citizenship Requirements. 1. What Information Must be Reviewed Review only those eligibility factors that are subject to change, such as income or resources. Do not reverify factors that are not subject to change, such as date of birth or citizenship. 2. Where to Look For Possible Sources of Information Review all possible sources of information available to the agency, including information verified by other programs. Medicaid eligibility is determined according to the rules of the appropriate Medicaid coverage group. However, the county must accept as accurate verifications from other programs, including: a. Information available through automated queries, such as SDX, BENDEX, TPQY, SOLQ, ESC, ACTS and FSIS. (Refer to MA-2430, Automated Inquiry and Match Procedures, and EIS 1103 for instructions on using the SDX, BENDEX, SOLQ and other online inquiries.) b. Information collected in the determination of eligibility for other programs, such as Food Stamps, Work First, child care assistance, IV-D child support services and adult or children's services, if the information can be released by the other programs within its rules for confidentiality. For example, child protective services records may not be available. c. Information that is current. "Current" means that the information was obtained and verified by the other program within the time frames for redeterminations of eligibility for the Medicaid coverage group being considered, unless there is reason to believe it is inaccurate.