101.04 Application Process (Eff. 10/01/13)
The following sections detail procedures for the application process. Applications may be submitted on-line, in person, or by mail. If these application methods cannot meet the applicant’s needs, a telephone application can be conducted through contact with The Benefit Bank of South Carolina. As part of the telephone application process, the person assisting the applicant must read the applicant the Rights and Responsibilities associated with the application and the applicant must acknowledge that they understand and accept these Rights and Responsibilities. A recording will capture the acknowledgement of the Rights and Responsibilities, as well as permission to submit the application.
Locations for local eligibility offices may be found at County Offices Contact Info. The Healthy Connections Member Service Center will receive calls from citizens who may be seeking assistance to complete the DHHS Form 3400, Healthy Connections Application for Medicaid and/or Affordable Health Coverage.
101.04.01 Choice of Category (Eff. 10/01/12)
Persons are allowed to make an application for the Medicaid program of their choice. Applicants who insist on applying for Medicaid under a specific category of assistance must be given the opportunity to have eligibility determined using the criteria for that category. If the applicant would likely be eligible under another coverage group, the Medicaid eligibility worker should explain the advantages of applying under the more appropriate coverage group. If an applicant meets the eligibility criteria of more than one coverage group, he/she generally has the option to choose the group under which eligibility is established. The eligibility worker should advise the applicant which category of assistance may be the best choice based on a review of the family's circumstances.
an application
OR REQUEST
for . . .
|
payment category
|
should be
received and
processed
by . . .
|
recommended
application
form
|
Adoption Assistance (Title IV-E)
|
51
|
Local eligibility worker
|
No application form necessary
|
Adoption Assistance (Special Needs/-Subsidized)
|
13
|
Local eligibility worker
|
DHHS Form 3400, Healthy Connections Application
|
Aged, Blind, and Disabled (ABD)
|
32
|
Local eligibility worker
|
DHHS Form 3400 and DHHS Form 3400-A, Healthy Connections Addendum for Specialty Programs
|
ABD-Nursing Home (ABD-NH)
|
33
|
Local eligibility worker
|
DHHS Form 3401, Healthy Connections Application for Institutional/Waiver/OSS
OR
DHHS Form 3400 AND
DHHS Form 3400-B Institutional Addendum
|
Breast and Cervical Cancer Program (BCCP)
|
71
|
Received by BestChance Network (BCN), Local Eligibility Worker or Division of Central Eligibility Processing (DCEP)
Processed by (DCEP)
|
DHHS Form 3400 and DHHS Form 3400-A
|
Disabled Adult Children (DAC)
|
19
|
Local eligibility worker
|
DHHS Form 3400 and DHHS Form 3400-A
|
Disabled Widows/-Widowers (DWW)
|
18
|
Local eligibility worker
|
DHHS Form 3400 and DHHS Form 3400-A
|
Elderly Widows/-Widowers (EWW)
|
17
|
Local eligibility worker
|
DHHS Form 3400 and DHHS Form 3400-A
|
Essential Spouse (ES)
|
81
|
Local eligibility worker
|
DHHS Form 3400 and DHHS Form 3400-A
|
Family Planning (FP)
|
55
|
Local eligibility worker
|
DHHS Form 3400
|
Foster Care (Title IV-E)
|
31
|
Local eligibility worker
|
No application form necessary
|
Foster Care - Regular (RFC)
|
60
|
Local eligibility worker
|
DHHS Form 3400
|
General Hospital (GH)
|
14
|
Local eligibility worker
|
DHHS Form 3400 AND DHHS Form 3400-A
|
PHC
|
88
|
Local eligibility worker
|
DHHS Form 3400
|
Low Income Families (LIF)
|
59
|
Local eligibility worker
|
DHHS Form 3400
|
Nursing Home – No SSI
|
10
|
Local eligibility worker
|
DHHS Form 3401
OR
DHHS Form 3400 AND DHHS Form 3400-B
|
Nursing Home for SSI Recipient (SSI-NH)
|
54
|
Local eligibility worker
|
No application form necessary
|
Income Trust –
Nursing Home & HCBS
|
10, 15
|
Central Institutional Unit (CIU)
|
DHHS Form 3401
OR
DHHS Form 3400 AND DHHS Form 3400-B
|
Optional Coverage for Women and Infants (OCWI)
|
12, 87
|
Local eligibility worker
|
DHHS Form 3400
|
Optional State Supplementation (OSS) - No SSI
|
85
|
Local eligibility worker
|
DHHS Form 3401
OR
DHHS Form 3400 AND DHHS Form 3400-B
|
Optional State Supplementation (OSS) for SSI recipient
|
86
|
Local eligibility worker
|
DHHS Form 1728 ME
SSI Recipient Request for OSS
|
Pass-Along (Pickle)
|
16
|
Local eligibility worker
|
DHHS Form 3400 and DHHS Form 3400-A
|
Pass-Along Children (PAC)
|
20
|
State Office completes exparte determination when child reaches age 18.
|
(Refer to category to which child is being “exparted.”)
|
Qualified Disabled Working Individuals (QDWI)
|
50
|
CIU
|
DHHS Form 3400 and DHHS Form 3400-A
|
Qualified Medicare Beneficiaries (QMB)
|
90
|
Local eligibility worker
|
DHHS Form 3400 and DHHS Form 3400-A
|
Qualifying Individuals (QI)
|
48
|
DCEP
(Eligibility is determined during the limited enrollment period)
|
DHHS Form 3400 and DHHS Form 3400-A
OR
DHHS Form 914 QI Application
|
Refugee Assistance
|
70
|
Local eligibility worker
|
DHHS Form 3400
|
Ribicoff
|
91
|
Local eligibility worker
|
DHHS Form 3400
|
Specified Low Income Medicare Beneficiaries (SLMB)
|
52
|
Local eligibility worker
|
DHHS Form 3400 and DHHS Form 3400-A
|
Supplemental Security Income (SSI)
|
80
|
N/A
|
N/A
|
TEFRA/Katie Beckett
|
57
|
DCEP
|
DHHS Form 3400 and DHHS Form 3400-A
|
Waiver Services (WS) -No SSI
|
15
|
Local eligibility worker
|
DHHS Form 3401
OR
DHHS Form 3400 AND DHHS Form 3400-B
|
Home and Community Based Services for SSI recipient (SSI-WS)
|
80
|
N/A
|
N/A
|
Working Disabled (WD)
|
40
|
CIU
|
DHHS Form 3400 and DHHS Form 3400-A
|
Qualifying Categories for Medicaid
Qualifying Category (QCAT) is the categorical eligibility criteria under which the applicant/beneficiary is applying for or receiving assistance. This field is completed on ELD00 in MEDS.
Q-CAT
|
Allowable Payment Category
|
Beneficiaries
|
10
|
10, 14, 15, 16, 32, 33, 54, 80, 85, 86, 90
|
Aged (Over age 65)
|
20
|
10, 14, 15, 16, 19, 32, 33, 40, 54, 57, 80, 81, 85, 86, 90
|
Blind
|
30
|
11, 12, 30, 55, 59, 87, 88, 91
|
FI-Related Groups
|
31
|
31, 51
|
IV-E Foster Care
|
50
|
10, 14, 15, 16, 17, 18, 19, 20, 32, 33, 40, 50, 54, 56, 57, 71, 80, 81, 85, 86, 90
|
Disabled (Under age 65)
|
60
|
13, 60
|
Regular Foster Care
|
70
|
70
|
Refugee/Entrant
|
Applicants assessed for Medicaid eligibility are assessed utilizing either MAGI or Non-MAGI methodology, depending on the Payment Category for which they are applying.
Medicaid Categories
MAGI
|
PCAT
|
Category
|
11
|
Transitional Medicaid
|
12
|
Optional Coverage for Women and Infants (Infants to Age 1)
|
13
|
Special Needs/Subsidized Adoption
|
55
|
Family Planning
|
59
|
Low Income Families
|
60
|
Regular Foster Care
|
87
|
Optional Coverage for Women and Infants – Pregnant Women
|
88
|
Optional Coverage for Women and Infants – Partners for Healthy Children
|
91
|
Ribicoff Children
|
Non-MAGI
|
PCAT
|
Category
|
16
|
1977 Pass Along
|
17
|
Early Widows/Widowers
|
18
|
Disabled Widows/Widowers
|
19
|
Disabled Adult Children
|
20
|
Pass Along Children
|
31
|
Title IV-E Foster Care
|
32
|
ABD
|
40
|
Working Disabled
|
48
|
Qualifying Individual
|
50
|
Qualified Disabled and Working Individual
|
51
|
Title IV-E Adoption
|
52
|
SLMB
|
80
|
SSI
|
81
|
SSI with Essential Spouse
|
90
|
Qualified Medicare Beneficiaries
|
INSTITUTIONAL
|
PCAT
|
Category
|
10
|
MAO – Nursing Home
|
14
|
MAO – General Hospital
|
15
|
MAO – Other
|
33
|
ABD - Nursing Home
|
54
|
SSI Nursing Home Beneficiaries
|
85
|
OSS Only
|
86
|
OSS with SSI
|
SPECIALTY
|
PCAT
|
Category
|
57
|
TEFRA
|
70
|
Refugee Assistance
|
71
|
Breast and Cervical Cancer
|
Table of Contents
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