Page 17

DocuSign Envelope ID: 3289A281-EC13-40C5-A56D-BE1F23756321 North Carolina Department of Health and Human Services AGED, BLIND AND DISABLED MEDICAID MANUAL MA-1000 17

SSI MEDICAID – AUTOMATED PROCESS

(VII.F.4.) a. Send a DMA-5180, SSI Check Terminated: Information Needed to Determine Medicaid Eligibility, to the recipient advising that Medicaid eligibility is being evaluated and additional information is needed. This letter asks if the recipient is pregnant or has minor children living in the home. The letter also explains the Medicaid Family Planning Waiver and asks the recipient if he wishes to apply.

b. Allow the recipient at least 12 calendar days to return the letter or contact the agency. If the recipient contacts the agency by the deadline, the recipient may request additional time to obtain necessary information such as pregnancy verification.

If the recipient answers yes to either question but provides no other information, contact the recipient to determine if he needs assistance obtaining documentation. Document all efforts to assist the recipient.

c. If there is no response to the letter by the deadline date, either by phone or in writing or in person, and the recipient is not eligible in any other category, send a timely notice to propose termination.

G. Results of Evaluation for Ongoing Eligibility

1. When all necessary information has been obtained and/or requested, determine whether the recipient is eligible for Medicaid under any aid program/category. One of several eligibility outcomes is possible:

a. Recipient is eligible for full Medicaid (MAABD or Family & Children's Medicaid) without a deductible; or

b. Recipient will be eligible for full Medicaid (MAABD or Family & Children's Medicaid) if he meets a deductible (Medically Needy), or recipient is eligible as MQB, Q, B, or E, Family Planning Waiver or Breast and Cervical Cancer Medicaid; or

c. Recipient is eligible for North Carolina Health Choice for Children; or

d. Recipient is ineligible for Work First; or

e. Recipient is ineligible for any Medicaid coverage; or

f. Recipient did not provide necessary information and coverage must be terminated after timely notice.

2. It is also possible that an additional application may be necessary if the recipient requests assistance for other family members, such as a spouse or children, during the review. Treat the request for additional coverage as a separate application.