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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 16

SSI MEDICAID – AUTOMATED PROCESS

(VII.E.) c. Medicaid Family Planning Waiver (FPW) – If the recipient is a female age 19 through 55 or a male age 19 through 60, with an income at or below 185% of the federal poverty level, and is not eligible for any other coverage group, evaluate for FPW.

7. North Carolina Health Choice for Children - If the recipient is up to age 19 and is not eligible for Medicaid in any other coverage group, evaluate for North Carolina Health Choice for Children.

F. When and How To Request Information From The Recipient

Information must be requested from the recipient only when it is necessary to determine ongoing eligibility AND the information is not already available to the agency or is not current as described in C.2.

1. Necessary information may be requested by telephone or in writing. If a telephone request is made, advise the recipient what information is needed and that he may request additional time or assistance in obtaining necessary information. Document the record to show the date of the telephone contact, the specific information requested and that the recipient was offered assistance. If the request is in writing, use the DMA-5097, Request for Information.

2. Allow the recipient at least 12 calendar days from the date of the request to provide the information. For example, if a DMA-5097, Request for Information is mailed on January 7 to request current wage information, the deadline for providing the information is January 19.

3. If the recipient does not provide the requested information by the deadline, send timely notice proposing termination for failure to provide the necessary information.

4. Letter to Recipient Prior to Termination

There may be situations in which there is little or no information in the agency regarding an SSI recipient. If you complete the evaluation above and the only potential coverage groups available are in Family & Children's Medicaid, eligibility cannot be established without determining if the recipient is pregnant or has minor children living in the home.

For example, a 34 year old SSI recipient is terminated because she is no longer disabled. She does not receive any other services and is not known to the agency. She could potentially be eligible for MPW if she is pregnant or as an MAF caretaker if she has minor children living with her. If she appeals the SSI termination timely, she can continue to receive MAD.