South carolina department of health and human services medicaid policy and procedures manual

101.09.07 Continuous Eligibility for Children Under Age 19 (Rev. 07/01/10)

If a child under age 19 is approved for full range of Medicaid benefits, eligibility continues for 12 months regardless of changes in family income or other circumstances. This policy should be applied when determining or re-determining eligibility for a child under age 19, regardless of the category. This continuous coverage may also be referred to as a protected period. When approving a Budget Group (BG) with a child under 19, enter the Next Review Date (NRD) on ELD01 as one year from the current date .The Protected Period End Date (PPED) will be set to one year from the decision date.

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  If a child dies, his eligibility should be terminated.
  
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  If a child moves out of state, his eligibility should be terminated.
  
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  If a child attains the maximum age for the category, an exparte determination must be completed.
  
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  If a child becomes an inmate of a public institution, the eligibility worker must indicate an “I” on the ELD02 screen in MEDS. (Refer to MPPM 102.09.01)
  
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  If a person under age 19 is eligible under the OCWI (Pregnant Women) category, and her baby is born or pregnancy otherwise terminates before she attains the age of 19, her eligibility in OCWI should continue for one year from the decision date or until her 19^th birthday, whichever comes first.
  
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  If the beneficiary is approved for retroactive coverage but not approved for the application month.
  
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  If a child is approved for coverage and has been given up to 90 days as a reasonable opportunity to supply verification of Citizenship and/or Identity and verification is not returned, his eligibility can be terminated.
  

101.09.08 SSI Recipients in E01 Payment Status (Eff. 10/01/05)

Some SSI recipients are eligible for SSI, but do not receive a payment. These recipients are identified on SDX with payment status code E01: Eligible for Federal and/or State benefits based on eligibility computation, but no payment is due based on the payment computation. The SDX subsystem establishes Medicaid as payment category 32 (ABD) with a review date six months from the date the payment status code was received and processed. The case is automatically assigned to the default eligibility worker for the county. The eligibility worker receives alert 350: BUDGET GROUP HAS BEEN ASSIGNED TO YOU. These cases must not be transferred to the Division of Central Eligibility Processing.

101.09.09 Case Record Retention Schedule (Eff. 10/01/05)

Case Records are to be retained in the active file until denial of the request for, or termination of participation in the Medicaid Program. Once assistance is denied or terminated, transfer the case record to the inactive file. The record is retained in the inactive file within the agency for a minimum of four years. After this period, the case record can be destroyed.

101.10 Written Notification (Eff. 10/01/05)

An applicant/beneficiary must be given written notification of any positive or negative action taken on his case. This requirement applies to applications and active cases.

101.10.01 Applications (Eff. 10/01/05)

The agency/MEDS must send each applicant a written notice of the decision on his application. If eligibility is denied, the notice must include the reason for the action, the specific regulation supporting the action, and an explanation of the right to request a hearing. Applicants requesting retroactive coverage must receive a written notice of eligibility in the retroactive period. The DHHS Form 3229-A, Notice of Approval\Denial for Medical Assistance/Optional Supplementation, is used to notify applicants when retroactive coverage is added to MEDS using the DHHS Form 3238, MEDS Correction Request.

101.10.02 Active Cases (Rev. 04/01/11)

When an action is taken on an active case due to a change in circumstances, the beneficiary must be notified in writing. MEDS will send an appropriate notice to the beneficiary. A beneficiary must be given advance notice about any adverse action, for example termination or reduction of benefits. The notice must include the reason for the action, the specific regulation supporting the action, and an explanation of the right to request a hearing.