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F-215 Division of Welfare and Supportive Services HOME AND COMMUNITY BASED SERVICES Medical Assistance Manual ELIGIBILITY DETERMINATION PROCESS 24 Jan 25 MTL 02/24 Note: Medicaid cannot be approved/continued under this category unless the customer is found eligible in both areas.

To make the Medicaid eligibility determination, the following steps must then be taken:

a. If the applicant is not eligible for Medicaid, the case manager will deny the case. A copy of the Notice of Decision with Form NMO-3010 will be sent to the administering division and notifying them of the denial.

b. If the HCBW services are denied, the administering division will send the denial information via Form NMO-3010. The Medicaid application will then be denied if the applicant does not qualify under another category of eligibility.

c. If the waiver team denies waiver admission, the Medicaid application will be denied for the reason given on Form NMO-3010, unless the applicant qualifies for another category of eligibility.

d. If the administering division determines the individual meets the criteria for home based services, they will send Form NMO-3010 to DWSS and the administering division’s case managers with the decision.

e. The DWSS case manager will approve Medicaid eligibility and apply the appropriate aid code, using the effective date provided on Form NMO-3010, if all other eligibility criteria are met.

The DWSS case worker will send Form NMO-3010 verifying approval back to the administering division and notify the DHCFP waiver unit in Central Office via email within two (2) days of approval.

If the application was previously denied for non-cooperation and the customer reapplies and/or cooperates with verifications, contact the administering agency prior to approval to determine if the waiver slot is still available.

f. If Form NMO-3010 indicates the individual is eligible but is on a waiting list, and the individual meets financial eligibility, the case will remain pending up to the 45 day processing timeframe. Contact the administering division case manager at 45 days to determine if the waiver slot has become available. If no slot is available, deny eligibility.