Page 4

MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL MEDICAL

d. due to exceptional circumstances resulting in significant financial duress, a higher minimum monthly maintenance needs allowance is needed to provide additional income to the community spouse; or

e. the community spouse resource allowance is inadequate to raise the community spouse's income level to the minimum monthly maintenance needs allowance without adding more resources which are income producing.

Continued benefits will be provided if a hearing request is RECEIVED in writing no later than the 10th day after the effective date of the proposed action. Assistance will continue unchanged until the hearing decision is made unless the client provides a written request asking benefits not be continued or the hearing officer makes a preliminary finding the sole issue is one of state or federal law requiring automatic benefit adjustments. See Welfare Administrative Manual Section 3100 for more detailed information regarding the hearing process.

G-300 MEDICAID PROGRAM CLAIMS

G-300.1 Definition of a Claim A Medicaid claim is the calculated value of any service, good or other item of value paid by the Medicaid Program which exceeds the amount of benefits the individual(s) was eligible for. G-300.2 Medicaid Claims When information exists that a Medicaid claim exits the case manager will:

• Ensure the household’s current budget reflects correct, up-to-date information to avoid further incorrect payment of benefits.

• Obtain written verification of the questionable issue.

• Refer the claim to I&R via the Investigations and Recovery Information System (IRIS) for review, calculation and claim establishment. G-300.3 Claim Packet Immediately at claim referral, case manager shall compile a “claim packet.” The claim packet must include: • a copy or original of all pertinent documents (applications, picture ID, etc.) contained within the case file; • a copy or original of substantiating documentation relative to the claim;

G-200 Division of Welfare and Supportive Services NON DISCRIMINATION/HEARINGS/CLAIMS Medical Assistance Manual HEARINGS MTL 01/13 01 Oct 13