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UPDATED: FEBRUARY 2005
488
OTHER ELIGIBILITY REQUIREMENTS DECISION AND NOTIFICATION
ACCEPTANCE
Description: When an application for Medicaid is accepted, Medicaid is authorized for a stated person(s) for a specific period of time. The applicant is notified as to who was accepted or denied and the effective date of authorization. Policy: When an application is accepted and Medicaid is authorized, notification in writing shall be sent to the applicant.
References: SSL Sect.
366 366-a
Dept. Reg.
358-3.3 358-4.1 360-2.4 360-2.5
ADMs
04 OMM/ADM-6
97 OMM/ADM-2 96 ADM-15 89 ADM-21 87 ADM-41
Interpretation: Written notification to the applicant includes a copy of the applicant's budget and an explanation of what care or services are authorized. If limitations are placed upon care or services, the limitations are explained in the letter. A copy of the notice is also sent to the medical provider (e.g., nursing home or hospital), as appropriate.
When only certain members of the applying household (group applying) are accepted for coverage, the coverage is explained in the notice to the applicant. The notice also advises the applicant of his/her responsibility to inform the district of any changes in his/her financial situation and/or any other changes affecting eligibility.
In addition to the standardized notice, an A/R with excess income (See INCOME EXCESS) is given a copy of the "Explanation of Excess Income Program" letter. When appropriate, a copy of the “Provider/Recipient Letter” and the Optional Pay-In Program for Individuals with Excess Income” (See 96 ADM-15) is sent to A/Rs with excess income. The “Provider/Recipient Letter” lists incurred medical expenses for which the A/R is responsible or partially responsible. A copy of the “Provider/Recipient Letter” is (MRG)