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UPDATED: JANUARY 2011

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OTHER ELIGIBILITY REQUIREMENTS APPLICATION, CERTIFICATION AND RENEWAL

NEW APPLICATION

NOTE: If an applicant seeking Medicaid coverage of nursing facility services does not meet a request for documentation deadline and the applicant is eligible for Medicaid coverage, QMB, SLIMB, or QI the case must be opened for the coverage for which the applicant is eligible.

If an application is submitted and all necessary information is included, an application must not be denied due to the failure to provide information that is inconsequential. For example: An application must not be denied if supporting documentation of a water expense or childcare expense is not submitted if the applicant can be determined eligible without this deduction.

The determination of eligibility is made promptly, generally within 45 days of the date of application. Determinations for persons eligible under the poverty-based programs (pregnant women and children under age 19) are completed within 30 days. Determinations of eligibility based on a disability are completed within 90 days. Under certain circumstances additional time may be required, such as when there is a delay on the part of the applicant, an examining physician or because of an administrative or other emergency that could not be controlled by the district.

NOTE: If the district is waiting for essential information, the reason for the delay is noted in the record. The applicant is notified by letter of the reason for the delay in his/her eligibility determination. Although the DOH-4220 asks the applicant to list a Client Identification Number (CIN) or an identification number from a plan card, if this information is not provided, the LDSS must not deny the application or request the information from the applicant.

Disposition: The eligibility worker reviews the application for completeness and accuracy. The LDSS must contact the applicant to obtain additional information that is needed to make an eligibility determination. If the application is being made through a facilitated enroller, the facilitated enroller does not forward the application to the district until the application is complete. (See OTHER ELIGIBLITY REQUIREMENTS APPLICATION, CERTIFICATION AND RENEWAL FACILITATED ENROLLERS) When the applicant fails or refuses to provide information essential to the eligibility determination, s/he is informed in writing that his/her application is denied, the reasons for the denial and his/her right to a fair hearing.

NOTE: If a community applicant who is age 65 or older, certified blind (MRG)