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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 9

SSI MEDICAID – AUTOMATED PROCESS

(V.A.) 2. SSI Approval/Medicaid Denial (TPR Refusal) Report

a. For an SSI approval/Medicaid denial, EIS does not create a Medicaid case or generate a Medicaid card.

b. EIS sends an automated Medicaid denial notice. See DMA-5103D, SSI Denial Notice.

3. SSI Approval/Medicaid Terminated Report (except SAA, SAD, or HSF)

a. When the individual is in a single person case, the case is terminated.

b. When the individual is in a multiple person case, the individual is deleted from the case.

c. EIS sends an automated termination notice. See DMA-5103T, SSI Termination Notice.

4. Appeal Rights

a. The individual is advised in the denial or termination notice that:

(1) He may request an appeal to his county dss within 60 days from the date of the notice if he does not agree with the denial or termination, or

(2) He can become eligible for Medicaid by providing TPR information to the local county dss.

b. If the individual contacts the county dss and requests an appeal, follow procedures for local hearings in MA-2420, Notice and Hearings Process, for local hearings. Prepare a summary which states: “Social Security has advised the State that you refused to provide medical insurance information.”

c. The Medicaid denial or termination can be reversed only when the individual provides his insurance information. This can be done at the appeal or any time the information is provided.

d. When the recipient provides the necessary medical insurance information:

(1) Use the DMA-5049, Referral to Local Social Security Office, to inform the local SSA office that the recipient has provided the necessary medical insurance information. Request that SSA delete the “R” code from the recipient's record. When the SSA record is updated, this information will be transmitted to the State via the SDX.