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

101.08.02 SSI-Related Applications (Non-MAGI Eligibility Groups) (Rev. 10/01/13)

Federal rules require that applications be approved or denied, and the applicant notified within 45 days from the date the application was filed. The timeframe is 90 days where disability must be determined before the eligibility determination can be completed. The date of application is counted as the first day of the 45-day count.

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  If verification is needed from the applicant, the Medicaid eligibility worker is required to complete the DHHS Form 1233 ME, Medicaid Eligibility Checklist, requesting the needed information and should allow at least 21 days for the applicant to submit the information to allow the application to be processed within 45 days.
  
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  For disability cases, the blindness/disability determination process outlined in MPPM 102.06.02A must be initiated within five (5) working days from the date of application.
  
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  For SSI-related applications, income and resources must be verified using SSI verification standards.
  
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  For persons residing in an institution or receiving home and community-based services, additional verifications must be obtained. For example, the Medicaid eligibility worker must verify: (1) a sanctionable transfer did not occur, (2) the level of care determination, and (3) all trusts were evaluated by the Eligibility, Enrollment and Member Services at the Department of Health and Human Services.
  

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  If an application is denied solely for failure to provide information, and the applicant provides all needed verifications within 30 days from the date on the denial notice, the date of the previous application must be used to determine the effective date.
  

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  If an ongoing case is closed solely for failure to provide information, and a completed signed review form with all required verifications is received within 30 days from the date of the closure notice, the case should be treated as a review and continued eligibility for the beneficiary should be determined using the information provided. Refer to MPPM Section 102.04.03
  

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  Eligibility should be determined as if the verification was received with the first request. The case record should be documented with the date the information was received. If retroactive eligibility is requested, it should be based on the date of the previous application.
  
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  Refer to MPPM Chapter 304, Nursing Home - Waivered Services - General Hospital, for additional policy regarding persons residing in institutions or receiving home and community-based services.
  
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    For individuals who have been determined to meet all eligibility requirements except the requirement to be institutionalized or receive home and community based services for 30 consecutive days, the standard of promptness may be extended. On the 45^th day following the application date, the Medicaid eligibility worker should request an Extension of Promptness following MEDS procedures. (Refer to MPPM 101.08.03). The application should remain in pending status while the applicant is waiting to enter a facility or the waiver.
    
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    When an applicant enters the nursing facility or waiver, the applicant/ authorized representative must be contacted to obtain the applicant’s current income or resources, and the case record must be updated with any information that has changed.
    

101.08.03 Extension of Promptness MEDS Procedure (Rev. 07/01/09)

If an application has not been approved within the 45 or 90-day standard of promptness and there is a valid reason, the corresponding Extension of Promptness code must be entered into MEDS. A code should only be entered into MEDS once the application is over the standard of promptness. The only exception is for an applicant who is awaiting the 30 consecutive day requirement for institutional care. The valid reason code may be entered into MEDS once the applicant starts the 30-day wait if approval would take place after the standard of promptness.