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

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101.01 Introduction (Eff. 10/01/05)

This chapter provides guidelines for processing eligibility determinations for all Medicaid coverage groups.

101.02 Definitions (Eff. 10/01/05)

101.02.01 Applicant (Eff. 10/01/05)

An individual whose signed application for Medicaid has been received by the Department of Health and Human Services.

101.02.02 Authorized Representative/Responsible Party (Rev. 10/01/13)

An individual who is acting for the applicant/beneficiary with his knowledge and consent and who has knowledge of his circumstances.

If an application is made for a person without his knowledge and consent, the Medicaid office must advise the person making the request that the agency can take no action until the knowledge and consent of the applicant/beneficiary or his authorized representative party is obtained.
The Authorized Representative/Responsible Party should be informed of their responsibilities for the Medicaid determination and appeals process. The DHHS Form 1282 ME, Authorization for Release of Information and Appointment of Authorized Representative for Medicaid Applications Reviews and Appeals, DHHS Form 3400 Appendix C, Healthy Connections Application for Medicaid and/or Affordable Health Coverage, or the SCDHHS HIP-02, Authorization to Disclose Health Information, must be given to the Authorized Representative/Responsible Party.

Examples of an Authorized Representative/Responsible Party:

  • Relative

  • Friend

  • Attorney

  • Employee of an agency or facility which holds custody Medical Facility

  • Third Party Medical Service Organization

  • Third Party Private Eligibility Service Organization

Legal representatives (attorneys) acting as the Authorized Representative for the applicant/beneficiary through the application and appeals process must:

  • Use DHHS Form 934-A, Appointment of Applicant’s Legal Representative for Medicaid application and appeals process. (A DHHS Form 1282 ME, DHHS Form 3400 Appendix C, or SCDHHS HIP-02 will not be necessary.)

  • Designate an individual appointee to sign the form and communicate with the agency. (Note: The Company’s name does not qualify as the signature.)

  • Obtain the signature of the applicant to allow for the release of protected health information under HIPAA regulations.

  • If an attorney is providing legal representation for an applicant in a legal proceeding, the DHHS 934-A is not required.

101.02.03 Reserved for Future Use (Eff. 09/01/12)

101.02.04 Beneficiary (Eff. 10/01/05)

An applicant approved for and receiving Medicaid benefits.

101.02.05 Incapacitated Individual (Eff. 10/01/05)

An individual unable to act on his own behalf due to a physical or mental condition.

101.02.06 Incompetent Individual (Eff. 10/01/05)

An individual adjudged to be mentally incompetent by a probate court.

101.02.07 Individual with Limited English Proficiency (LEP) (Eff. 10/01/05)

An individual whose primary language is not English and who is not competent enough to communicate in any language other than his native language.

101.02.08 Sensory Impaired Individual (Eff. 10/01/05)

An individual who has a partial, profound, or complete loss of hearing or sight.

101.03 Application Form (Eff. 10/01/13)

All applications for Medicaid must be filed on a State Department of Health and Human Services approved application form, be legible, and should be completed on;ine in ink or by typing when possible. A signed and dated application provides a legal document that:

  • Clearly signifies intent to apply;

  • Puts the applicant on notice that he/she is liable for the truthfulness of the information on the application;

  • May be introduced as evidence in court;

  • Provides sufficient information to begin an accurate determination of eligibility; and

  • Provides notice to the applicant of his rights and responsibilities.

Note: Refer to MPPM 101.04.02 regarding unsigned applications. An electronic signature is valid for applications submitted through an approved on-line source, such as the Healthy Connections Citizen Portal or The Benefit Bank. A telephonic signature is valid if submitted through an approved source.
A completed application form must be on file for every applicant/beneficiary. Once a properly signed and dated application has been submitted, the Medicaid Eligibility Worker must not alter the application by adding, changing, or deleting any information. During an interview, an applicant can make changes to the information on an application. The change must be initialed by the applicant on any submitted paper application. Changes reported to the eligibility worker by any other means must be documented in the MEDS Notes screen.
The DHHS Form 3400, Healthy Connections Application for Medicaid and/or Affordable Health Coverage, is the application used to apply for Medicaid coverage. For some specialty programs an addendum may be needed to collect additional information. A person applying only for Nursing Home, Waiver Services, or Optional State Supplementation can use the DHHS Form 3401, Healthy Connections Application for Institutional/Waiver/OSS, instead of the DHHS Form 3400. Any valid Medicaid application that is turned in must be accepted. Any additional information that is not contained on the submitted application required to process the application for a particular category must be requested from the applicant, but the applicant cannot be required to complete an additional application. A new application is not required for a current Medicaid beneficiary seeking assistance under another category. The eligibility worker must evaluate the application on file, and request any additional information needed to determine if the beneficiary meets the eligibility criteria for the new category.


  • Supplemental Security Income (SSI) recipients - Applications maintained by the Social Security Administration

  • SSI recipients entering a nursing facility or the Home and Community-Based Services waiver program who will continue to qualify for SSI

  • Title IV-E Foster Care beneficiaries

  • Title IV-E Adoption Assistance beneficiaries

Table of Contents

Treatment of Special Situations

  • SSI recipients who enter a facility and have their SSI benefits terminated will be required to file a Medicaid application.

  • Dual eligibles (recipients of both RSDI and SSI benefits) who enter a facility permanently (more than 90 days) and whose RSDI benefit is greater than $50 will usually have their SSI benefits terminated. Therefore, a Medicaid application will be required.

  • Dual eligibles entering a facility temporarily (less than 90 days) usually continue to qualify for SSI. Therefore, they will not be required to complete a Medicaid application.

  • Minor child no longer under the care and control of his parents, legal guardian, or caretaker relative who would normally file for benefits on his behalf, may file his own application.

  • Department of Social Services (DSS) workers may apply for children in the custody of DSS.

  • Pregnant minors may file their own applications.

  • An authorized representative/responsible party may file an application on behalf of an adult unable to file on his own behalf.

  • If an applicant/beneficiary signs a paper application with an “X,” two witnesses must also sign it.

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