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support and maintenance that may be identified by the agency, in writing, in accordance with § 40-00-2.5 of this Title. Good cause exceptions are considered when requested in writing. B. State Agency responsibilities include: 1. Assistance -- Applicants who are incapacitated or are otherwise unable to fulfill these responsibilities on their own or with the assistance of an authorized representative may request additional assistance from an LTSS eligibility specialist. The EOHHS reserves the discretion to authorize such assistance the Secretary or his or her designee deems appropriate. 2. Voluntary Withdrawal – An applicant may request that an application for Medicaid benefits be withdrawn at any time either through their secure on- line account or by submitting the request in writing via the U.S. Mail or fax to the EOHHS or DHS agency representative. The Medicaid agency sends a notice to the applicant verifying the time and date of the voluntary withdrawal and indicating that the applicant may re-apply at any time. 3. Privacy of Application Information – Application information must only be used to determine eligibility and the types of benefits a person is qualified to receive. Accordingly, the EOHHS, the agencies under its umbrella, and all other entities serving as its agents in the Medicaid eligibility process maintain the privacy and confidentiality of all application information and in the manner required by applicable federal and State laws and regulations. 4. Application Timeliness -An applicant may appeal and request a hearing on the basis of the timeliness if the State fails to provide notification of outstanding documentation and make a determination of eligibility on an application within the ninety (90) day review period. 5. State Payments - In accordance with R.I. Gen. Laws § 40-8-6.1, an LTSS provider may request State-only payment for LTSS if a determination of eligibility on a completed application, as defined herein, has been pending for more than ninety (90) days without action taken by the State. 4.11 Renewal of Medicaid LTSS Eligibility A. LTSS Medicaid financial and general eligibility must be re-evaluated at least once a year. This annual review is now referred to as a renewal. Federal regulations [42 C.F.R. 435.916(b)] require these annual reviews to consider only those eligibility factors that are subject to change and, to the full extent feasible, utilize electronic data sources for verification purposes. Accordingly, LTSS Medicaid renewals require beneficiaries to review information from the IES on key general and financial eligibility factors that has been updated by internal and external data sources, and report any inaccuracies or changes. The requirements for