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North Carolina Department of Health and Human Services AGED, BLIND AND DISABLED MEDICAID MANUAL

MA-1100 AGED, BLIND AND DISABLED

SSI MEDICAID – COUNTY DSS RESPONSIBILITY

6 REISSUED 10/01/05 – CHANGE NO. 28-05

II. COUNTY DSS RESPONSIBILITY FOR RETROACTIVE SSI MEDICAID

This section applies ONLY to individuals requesting retroactive Medicaid based on an SSI date of application. Individuals can also apply for retroactive Medicaid based on the Medicaid date of application at the dss. Refer to MA-2301, Conducting A Face To Face Intake Interview, for procedures when accepting and processing non-SSI retroactive Medicaid applications.

A. Policy Rules

1. The retroactive period for SSI Medicaid is the 1, 2, or 3 month period prior to the SSI month of application. This date is protected for any Medicaid coverage group.

2. An individual cannot apply for retroactive SSI Medicaid until his SSI application is disposed.

3. The a/r must apply for retroactive SSI Medicaid within 60 days (90 days with good cause) from the date of the SSI Medicaid approval or denial notice in order to protect the SSI retroactive period.

B. Establish Timely Application

1. Verify that the request for retroactive Medicaid is within 60 days of the date of the SSI Medicaid disposition notice generated by EIS:

a. View applicant's Medicaid approval or denial notice. The 60 day period begins with the Date Mailed on the Notice, or

b. Verify the case create date on the case data (cd) screen in EIS. This is the date the Medicaid notice is mailed. The 60 day period begins with the date the Medicaid notice was mailed,

c. Verify via the on-line SDX the date of SSI denial. The 60 day period begins with the date of the first Saturday after the SSI denial. This is the date the Medicaid notice is mailed. (Use this method to establish the date of the notice only when the applicant cannot provide his SSI Medicaid denial notice).

2. When more than 60 days but less than 90 days have elapsed, determine if good cause exists for failure to apply timely. Good cause is limited to:

a. The applicant states he did not receive the SSI Medicaid notice; or

b. The applicant dies; or

c. The applicant is incapacitated, incompetent, or unconscious and there is no representative acting on his behalf; or

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Official source

North Carolina Department of Health and Human Services AGED, BLIND AND DISABLED MEDICAID MANUAL

MA-1100 AGED, BLIND AND DISABLED

SSI MEDICAID – COUNTY DSS RESPONSIBILITY

6 REISSUED 10/01/05 – CHANGE NO. 28-05

II. COUNTY DSS RESPONSIBILITY FOR RETROACTIVE SSI MEDICAID

A. Policy Rules

1. The retroactive period for SSI Medicaid is the 1, 2, or 3 month period prior to the SSI month of application. This date is protected for any Medicaid coverage group.

2. An individual cannot apply for retroactive SSI Medicaid until his SSI application is disposed.

3. The a/r must apply for retroactive SSI Medicaid within 60 days (90 days with good cause) from the date of the SSI Medicaid approval or denial notice in order to protect the SSI retroactive period.

B. Establish Timely Application

1. Verify that the request for retroactive Medicaid is within 60 days of the date of the SSI Medicaid disposition notice generated by EIS:

a. View applicant's Medicaid approval or denial notice. The 60 day period begins with the Date Mailed on the Notice, or

b. Verify the case create date on the case data (cd) screen in EIS. This is the date the Medicaid notice is mailed. The 60 day period begins with the date the Medicaid notice was mailed,

2. When more than 60 days but less than 90 days have elapsed, determine if good cause exists for failure to apply timely. Good cause is limited to:

a. The applicant states he did not receive the SSI Medicaid notice; or

b. The applicant dies; or

c. The applicant is incapacitated, incompetent, or unconscious and there is no representative acting on his behalf; or