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Division of Welfare and Supportive Services F-215 Medical Assistance Manual HOME AND COMMUNITY BASED SERVICES 24 Jan 25 MTL 02/24 ELIGIBILITY DETERMINATION PROCESS

Note: 45 days for aged and 90 days for disabled unless extenuating circumstances exist.

g. The DHCFP waiver unit will enter the individual’s benefit plan into the MMIS database when notification of approval is received. The plan will start on the date listed on Form NMO-3010 or the date Medicaid eligibility is established, whichever date is later.

h. The waiver benefit will remain in MMIS until/unless the DHCFP waiver team in DHCFP central office is notified by the case manager to terminate the benefit, or until the individual loses Medicaid eligibility. DWSS case manager should notify DHCFP waiver unit of all waiver approval, termination and reinstatements via email within two (2) business days.

i. If a case terminates and is subsequently reinstated prior to the end of the month (effective date of closure), the customer’s approved waiver admission will continue in MMIS.

j. If a case is reinstated after the end of the month, email the DHCFP waiver team, who will determine the status of the prior approved waiver. If the waiver team finds the waiver admission open, Form NMO-3010 will be sent and Medicaid eligibility will be reinstated, and the prior approved waiver continues. If the waiver team finds the prior approved waiver admission ended, the individual must complete and submit another application packet with Form NMO-3010 through the administering division case manager to the waiver team for waiver admission.

k. Copies of all notices, such as approvals, denials, and P/L, which are usually sent to the institution, will be sent to the administering division by entering them as the secondary representative in the Authorized Representative screen.

Note: If the applicant falls into another eligible category, such as SSI, QMB or SLMB, approve the case under that category and do not wait for the HCBW services decision. Notify the administering division the case has been approved under another category of Medicaid. Eligibility can be updated once it is determined the customer is eligible for HCBW services. If it appears the person may be eligible for SSI, refer them to apply, but do not hold the case if they can be approved sooner under this category.