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


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101.04.04 Processing Applications of DHHS Employees And Family Members (Rev. 10/01/13)

DHHS employees cannot process their own Medicaid application, re-determination, re-budget, or change. They cannot make changes to information in MEDS; nor directly add, remove, replace, or edit documents or verification in the case record.




  • DHHS employees must not process or maintain case(s) that include a member of their household or immediate family. They cannot make changes to information in MEDS; nor directly add, remove, replace, or edit documents or verification in the case record of an immediate family member.

  • DHHS employees must not review, research or change information on MEDS related to a member of their household or immediate family.

  • The case of an immediate family member cannot be processed or maintained in the county or location of the DHHS employee. The case must be forwarded to the appropriate location as indicated in the procedures below

  • Immediate family includes the employee’s spouse, children, and the following relations to the employee or the spouse of the employee: mother, father, brother, sister, grandparent, legal guardian, and grandchildren.

  • For all other relatives of the employee or their household, if an employee becomes aware of a family member or relative applying for or receiving Medicaid benefits, the situation must be discussed with the immediate supervisor. The supervisor will determine the proper course of action for the handling of the case. Depending on the specific circumstances, the supervisor may determine that:




    • No special treatment of the case is required;

    • The case must be processed and maintained by another employee;

    • The case must be processed by the supervisor; or

    • The case must be processed according to the procedures in place for immediate family members.

The supervisor must document in the case record the decision and the reasoning for the specific course of action recommended. If the supervisor determines that the case needs to be processed according to the procedures for an immediate family member, the supervisor should contact the supervisor of the location before sending the record to explain why the case is being sent.





Procedures for Processing Applications of DHHS Employees, Members of their Household or Immediate Family Members:
Any application or active case in any local eligibility office must be processed using the following procedures. When the application is made in person, a supervisor or his designee must provide intake. The application must be pended in MEDS by the supervisor as a courtesy application. The application along with all submitted documentation must be forwarded within five business days to the appropriate location, as determined below, for processing. The application must not be held for the return of additional information. The location taking the courtesy application should not make a request for any additional information, but provide the appropriate address and instruct the applicant/authorized representative to send information to that location. The receiving location is responsible for generating a DHHS 1233 ME to request any additional information that is still outstanding. If an applicant/authorized representative brings documents or other verification, forward to the location processing the application by the end of the next business day.
MEDS Procedure: In the “Applicant County” field on HMS04, the eligibility worker must enter the actual county where the applicant is residing.


  • Applications for FI and SSI related categories for employees located at the local eligibility office or the DHHS downtown Columbia office must be forwarded within five business days to Local Eligibility Processing, Attn: Region IV Administrator for assignment. The Administrator will assign the case to a supervisor, who will make the decision as to who will handle the case record. The address is:


Mailing Address: SC Department of Health and Human Services

Region IV Medicaid Office

Post Office Box 128

Columbia, SC 29147-0183


Courier Address: SCDHHS Region IV Medicaid Office

7499 Parklane Road, Suite 176 and Suite 180

Columbia, SC 29223

Attn: Regional Administrator




  • Applications for FI and SSI-related categories for Region IV employees, members of their household, and/or immediate family must be forwarded within five business days to Local Eligibility Processing, Attn: Region VII Administrator for assignment. The Administrator will assign the case to a supervisor, who will make the decision as to who will handle the case record. The address is:

SCDHHS Region VII Medicaid Office

First Federal Bank Building – 2nd Floor

1601 11th Ave

Conway, SC 29526

Attn: Regional Administrator




  • The Division of Central Eligibility Processing (DCEP) processes all applications for QI, TEFRA, and BCCP, including employees, members of their household, and/or immediate family. The application along with documentation submitted with the application must be forwarded within five business days to the Division of Central Eligibility Processing, Attn: Division Director. The Director will assign the case to a supervisor, who will make the decision as to who will handle the case record. The address is:

SCDHHS


Division of Central Eligibility Processing

1801 Main Street, J-220

Columbia, SC 29202

Attn: Division Director




  • The Central Institutional Unit (CIU) processes all applications for Income Trust and Working Disabled, including employees, members of their household, and/or immediate family. The application along with documentation submitted with the application must be forwarded within five business days to Eligibility, Enrollment and Member Services, Central Institutional Unit, Attn: Division Director. The Director will assign the case to a supervisor, who will make the decision as to who will handle the case record. The address is:

SCDHHS


Eligibility, Enrollment and Member Services

Central Institutional Unit

1801 Main Street, J-3

Columbia, SC 29202

Attn: Division Director




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