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Manual Title Chapter Page Revision Date Virginia Medical Assistance Eligibility M01 October 2024 Subchapter Subject Page ending with Page M0130 APPLICATION PROCESSING M0130.300 13

a. Approvals

As applicable, the notice must state that: • the application has been approved, including the effective date(s) of coverage and the date of the next annual renewal; • retroactive Medicaid coverage was approved, including the effective dates. • For approvals of limited coverage, the notice or a separate system- generated notice must state that the application has been referred to the VIM for determination of eligibility for the APTC. b. Denials

As applicable, the notice must state that: • the application has been denied, including the specific reason for denial cited from policy; • retroactive Medicaid coverage was denied, including the specific reason for denial cited from policy. • When the applicant (other than a Medicare beneficiary or deceased individual) is ineligible for MA for any reason other than the inability to determine eligibility, either the notice or a separate system-generated notice must state that the application has been referred to the VIM for determination of eligibility for the APTC. c. Delays The notice must state that there is a delay in processing the application, including the reason. d. Other Actions Other actions for which a notice must be sent include when a request for re- evaluation of an application in spenddown status has been completed.

e. Advance Health Care Directive An Advance Health Care Directive insert is required to be included with an initial notice of eligibility. The insert (available at https://fusion.dss.virginia.gov/bp/BP-Home/Medical-Assistance/Forms, must be included with the initial approval or denial Notice of Action. This insert is not required when adding a person to an existing case, at redetermination, when a change is reported or when coverage is cancelled.