Page 286

MRG

UPDATED: JUNE 2010

712

OTHER ELIGIBILITY REQUIREMENTS PRESUMPTIVE ELIGIBILITY

CHILDREN UNDER THE AGE OF 19

documentation requirement and collection process. However, the QE continues to be responsible for the PE screening process and issuance of the PE screening determination form.

• forwards the completed application package (the PE for Children Screening form; PE for Children Determination letter; DOH 4220 application form; and, all documentation needed to determine eligibility) within 21 days from the date of initial screening (or within a reasonable extended timeframe if the applicant is making a good-faith effort to secure necessary documentation). • QEs are not to forward completed PE screening forms to the LDSS for children who do not screen as PE eligible. The QE should provide the ineligible household with the DOH-4220 application form to complete and submit to a Facilitated Enroller or to the LDSS. Children are to be referred to FEs and/or Child Health Plus health plans.

The local social services district:

• designates one or more staff as a liaison to the designated QEs;

• accepts completed PE/MA application packets from the QE and processes them in a timely manner, but in no event later than 30 days from the date of the QE screening/assessment for pregnant women and children, and within 45 days for all other applications not requiring a disability determination;

• allows for a reasonable extension of time and extends PE coverage so that the applying household and/or the QE/FE can obtain required documentation;

• determines eligibility for the 3-month retroactive period as appropriate NOTE: Retroactive eligibility cannot be provided to children who are eligible for presumptive coverage only ;

• provides notice of the results of the final Medicaid eligibility determination simultaneously to the applicant and the QE including the CIN for billing purposes;

• documents in the case record delays in the receipt of completed applications from the QE that result in untimely determinations of eligibility;