403.11 Case Processing

(Rev. 10/01/23)

The Standard of Promptness is 45 days; however, if a disability case needs to be determined, 90 days may be allowed.

Procedures Regarding Application Process: Application Form For SSI-eligible applicants, the DHHS Form 1728 ME , SSI Recipient Request for Optional State Supplementation, is primarily used. However, the DHHS Form 3400 Healthy Connections Application AND DHHS Form 3400-A , Additional Information for Select Medicaid Programs, OR the DHHS Form 3401 , Application for Nursing Home, Residential or In-Home Care may be used. For Non-SSI eligible applicants, the DHHS Form 3401, Healthy Connections Application for Institutional/Waiver/OSS, is primarily used. However, the DHHS Form 3400 Healthy Connections Application, used in conjunction with Additional Information for Select Medicaid Programs, DHHS Form 3400A, is also acceptable For Medicaid eligible individuals under a different category, a new application is not required, but the worker must evaluate the case to determine if the individual meets the eligibility criteria for OSS. Intake – Applications may be submitted online, by mail, by telephone via the call center, or in person taken at the following locations: County Eligibility Office where the applicant resides County Eligibility Office where CRCF is located Processing Responsibilities for the County Eligibility Office Scan applications received by LEP staff into OnBase. (Refer to the Document Type Guide.pdf for specific instructions) Gather all required documents available for processing at initial contact and scan the documents into OnBase as appropriate. Forward any questions regarding an OSS application or OSS beneficiary to OSS Provider Eligibility at OSSProElig@scdhhs.gov OSS Specialty Unit Eligibility Worker Responsibilities When the application is not taken in person, ensure Primary Individual/Authorized Representative is advised of the following: – Eligibility Requirements – Standard of Promptness – Rights and Responsibilities, to include: Fair Hearing and Process of Appeal Civil Rights Requirement to Give Complete/Accurate Information Requirement to Report Changes Within 10 Days Requirement to Repay Benefits Received Ineligibly – Verification and Documentation Requirements – Computer Matches – Coverage Information and Retroactive Benefits Disseminate all appropriate pamphlets and handbooks. Set up Case Record and pend case in Cúram-CGIS Verify and/or document all eligibility criteria. Analyze verifications and apply appropriate policy. Calculate countable income and resources: If ineligible, deny and determine if eligible in another category. If eligible, request slot. When slot is approved and applicant enters a facility, complete DHHS Form CRCF-01. Enter information in Cúram-CGIS to authorize benefits. Using the DHHS Form 3229-A , Notice of Approval/Denial for Medical Assistance/ Optional Supplementation, inform the applicant of the amount of income that can be kept each month for personal needs.