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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 M0130.400 14

E. Notification for Retroactive Entitlement Only There are instances when an applicant is not eligible for ongoing eligibility but is eligible for retroactive benefits or a change in the applicant's situation during the application process results in the applicant being eligible for only a limited period of time. Only one notice is sent to the applicant covering both actions. Statements of the exact dates of eligibility, the date of ineligibility, and the reason(s) for ineligibility must be included on this notice.

M0130.400 Applications Denied Under Special Circumstances

A. General Principle When an application is withdrawn or the applicant cannot be located, the application is denied. The reason for the denial must be recorded in the case record, and a notice must be sent to the applicant's last known address. B. Withdrawal An applicant may withdraw his application at any time. The request can be verbal or written. An applicant may voluntarily withdraw only his application for retroactive coverage by signing a statement or by a verbal statement specifically indicating the wish to withdraw the retroactive coverage part of the application. A written withdrawal request must be placed in the case record. A verbal request for withdrawal can be accepted only from the applicant or case head, or the authorized representative. A verbal request must be documented in the case record with the date and time the withdrawal request was received, the name of the person who made the withdrawal request, and the name and title of the agency staff person who took the call. When the applicant withdraws an application, the eligibility worker must send a notice of action on MA to the applicant. C. Inability to Locate If mail is returned, the worker must follow the returned mail policy in M0130.500. The agency must attempt to contact the applicant by at least two methods in addition to sending a letter to the last known address informing the applicant of the agency's attempt to locate them and asking that they contact the office. For applicants who are documented as homeless and do not provide a mailing address, maintain all correspondence at the local agency. If the applicant does not respond or contact the agency within 45 days of the date of application, deny the application. D. Duplicate Applications The worker will review a duplicate application to verify there are no changes in circumstances, request(s) for coverage, or other actions that need to be acted on. Applications received requesting MA for individuals who already have an application recorded (i.e. pending) or who are currently active and receiving coverage will be denied due to duplication of request. Document current coverage on the notice. For duplicate applications submitted by individuals currently enrolled in coverage, the denial notice must include the member’s coverage status, as appropriate: • the application has been approved for a new level or type of coverage; or

• the application has been denied for new services, but the member remains enrolled in their current level or type of coverage; or

• the requested coverage was denied and the member’s existing coverage is being terminated. Do NOT deny an application for “overlapping coverage” without adding an explanation to the Notice of Action on Medicaid.