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


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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

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