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Page 8 – State Medicaid Director

MSP Application

Upon receiving an MSP application in the form of the LIS data transmission from SSA, the State must act upon it in the same manner, and in accordance with the same deadlines, as if the data were an application submitted directly by the applicant to the State.

According to 42 CFR 435.913, a finding of eligibility or ineligibility must be made for each application, unless the individual withdraws the application or is deceased; therefore, all data transmitted as an application for MSP (on the MSP application file) will need to be adjudicated. Below are some examples:

Additional Information is Needed: If the State does not have adequate information from the MSP application file to make an eligibility decision for MSP, the State is responsible for contacting the applicant to give the applicant an opportunity to provide further information. This includes sending a pending notice when requesting the information, and an approval or denial notice when the decision is made.

LIS Application Denied by SSA: If the MSP application file indicates that SSA denied the application for any reason, the data is still considered an application for MSP and the State is responsible for adjudicating the application. This includes LIS denials for individuals who are: Over the income standard; over the resource limit; failure to cooperate with SSA; and beneficiaries who do not have Medicare Part A or Part B.

Self-Attestation: If the MSP application file indicates that the applicant provided self- attestation that he or she is over the resource limit for LIS, the information is still considered an application for MSP and the State is responsible for adjudicating the application.

While States are not required to use the MSP model application, a State must still consider the model application as initiating the MSP process, and afford an individual wishing to do so the opportunity to apply for Medicaid on the State form without delay (42 CFR 435.906). If a State receives an MSP model application in any language, the State must either accept and process the application or have a procedure to ensure that individuals who present the model form are given a prompt and meaningful opportunity to complete the State MSP form and to provide supplemental information as needed.

Verification of Information

SSA verifies income data for purposes of making an LIS determination by reviewing the application and information from a variety of sources. When determining resource eligibility for LIS, SSA estimates the value of liquid resources using an extrapolation process based on the Internal Revenue Service income matches.

States are not required to separately verify income and resources that are reported by SSA on the MSP application file. However, States need to remember that SSA only reports LIS-specific items, not all income and resources that may be used to determine MSP eligibility. For example, SSA will not count the value of life insurance policies when determining LIS eligibility. Unless a State has an approved State plan provision excluding the applicable income or resources under the authority of section 1902(r)(2) of the Act, these items would be considered when determining MSP eligibility and would be subject to requirements for State verification.