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


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101.04.02 Applying Without Delay (Rev. 10/01/13)

An application must be taken immediately for any person who expresses a desire to apply. A clearly ineligible person may file an application that must be accepted and then denied.


The person must be allowed to complete the application while in the office. An application is considered complete when it has enough information to determine eligibility.


  • The date the signed application is received must be documented.

  • For paper applications, the application date is the date it is received and must be documented on the first page of the application

  • All paper applications must be added to MEDS in pending status within three (3) working days of its receipt.

  • A face-to-face interview is not required; however, if an application filed online, in person or by mail is not complete, the Medicaid eligibility worker must contact the applicant within five (5) working days from the date of the request to obtain the required information. The eligibility worker can require a telephone or personal interview in order to obtain the information necessary to complete the eligibility determination. However, if the contact is by mail, the eligibility worker must retain the original application and mail a copy to the applicant requesting the missing information. The applicant cannot be required to complete another application form.

  • If an applicant calls DHHS to request an application, the effective date of the application is the date on which the signed and dated application is received, NOT the date of the phone call.

  • For applications completed by telephone, the date of application is the date the telephonic signature is captured.

  • An unsigned application should never be discarded. If an unsigned application is received, it should be returned to the applicant with an explanation that it must be signed. No further action is required since an application is not valid until signed.

  • The date a faxed application is received by the agency is considered the date of application.

  • The date an online application is electronically signed and submitted to the agency is considered the date of application.

  • Regardless of when the application is entered into the MEDS computer system, the date of application is the date the signed application was received, whether complete or incomplete.

  • If an applicant needs to return any other information needed to make a decision, a written list must be sent to the applicant.

    • The written list must give the applicant a deadline to return the information.

    • For applications submitted through the Healthy Connections Citizen Portal or the Health Information Marketplace, the applicant may receive a list of unverified information, such as identity or income. This is provided on a PDF copy of the application generated by ACCESS. The eligibility worker will utilize current verification policies to verify this and any other financial and non-financial information needed to determine eligibility.

    • The DHHS Form 1233 ME, Medicaid Eligibility Checklist, should be used to request additional information for applications to be complete.

    • The request must be mailed or given to the applicant by the end of the business day following the day the completed application is received.

Table of Contents

101.04.03 Processing Applications (Rev. 10/01/13)

Applications are generally accepted and processed by Local Eligibility Processing (LEP), the Division of Central Eligibility Processing (DCEP), or the Central Institutional Unit (CIU) at the State Department of Health and Human Services (DHHS).




  • The Division of Central Eligibility Processing (DCEP) processes applications for the TEFRA, and Breast and Cervical Cancer (BCCP) programs. Applications received by LEP or CIU staff should be forwarded to DCEP at the following address within five business days. The application must not be held for the return of additional information.

SC Department of Health and Human Services

Division of Central Eligibility Processing

1801 Main Street J-2

Post Office Box 100101

Columbia, South Carolina 29202-3101

Fax # (803) 255-8223


  • The MSP/QI unit in the Division of Central Eligibility Processing (CEP) processes all applications for the Qualifying Individuals (QI) program. All QI applications received in the county office must be forwarded within five business days to the Division of Central Eligibility Processing for processing. The application must not be held for the return of additional information. The eligibility workers should NOT pend these applications in MEDS. Applications will be processed by MSP/QI staff in CEP. Applications should be sent to the following address:


Regular Mail:

Division of Central Eligibility Processing

MSP/QI Unit

Post Office Box 100101

Columbia, South Carolina 29202-3101
Courier Mail:

Division of Central Eligibility Processing

MSP/QI Unit

1801 Main Street J-2

Columbia, South Carolina 29202-3101


  • The Local Eligibility Processing (LEP) processes all other FI (MAGI) and SSI (Non-MAGI) related programs except Nursing Home (Income Trust) and Working Disabled. Refer to MPPM 101.04.04 for instructions concerning applications of DHHS employees and immediate family members.

  • If a person is temporarily absent from the DHHS regions that includes their county of residence, the DHHS office where the individual is physically located should take scan the application into OnBase, pend the application in MEDS, and forward it to the individual's region of residence for processing within five (5) business days. The application must not be held for the return of additional information.


Note: An initial budget based on the applicant's allegation of income, pregnancy, citizenship, and family circumstances must be completed on the day an application is received to determine eligibility for OCWI (Pregnant Women). If the eligibility worker cannot process the application the date received, a decision must be made by the end of the next business day, and the reason the application could not be processed must be documented in the case record. It is important that the pregnant woman has coverage to access prenatal care as quickly as possible. Refer to MPPM 203.02.02 for specific instructions on processing OCWI (Pregnant Women) applications.


  • All applications involving Income Trusts and the Working Disabled are processed and maintained by the Eligibility, Enrollment and Member Services, Central Institutional Unit (CIU). However, local eligibility staff remains responsible for Intake duties. When an Income Trust or a Working Disabled application is received, the following steps should be taken:




    • Scan the application in OnBase and re-index to the Institution Queue,

    • Pend the application in MEDS,

    • If OnBase is not available, fax the application and the DHHS Form 1233-ME to CIU. The fax number is 803-255-8350.

    • The application and any verification obtained at intake should be scanned into OnBase or forwarded within five (5) business days via Courier mail to the following address. The application must not be held for the return of additional information.

Eligibility, Enrollment and Member Services

Central Institutional Unit

1801 Main St–J-3

Columbia, SC 29202


    • The applicant or authorized representative should be instructed to send any requested verifications or information to the following address:

Eligibility, Enrollment and Member Services

Central Institutional Unit

P O Box 8206



Columbia, SC 29202


  • Department of Disabilities and Special Needs (DDSN) sponsored eligibility workers are located in the DDSN regional offices. These eligibility workers are responsible for processing Medicaid applications for the following groups:




    • Institutionalized individuals who must meet the Intermediate Care Facility/Intellectual Disabilities (ICF/ID) level of care to qualify for Medicaid coverage of the cost of care in the facility;

    • Individuals applying for waivered services under the Intellectual Disabilities and Related Disabilities (ID/RD) Waiver; and

    • Persons applying for waivered services under the Head and Spinal Cord Injury (HASCI) Waiver.

    • An application taken by the county or Local Eligibility Processing office for services through the ID/RD waiver should be forwarded with available verifications to the DDSN sponsored eligibility worker for processing. The application must not be held for the return of additional information. Additionally, the application should be faxed to the ID/RD Coordinator at (803) 898-9660.

    • An application taken by the county or Local Eligibility Processing office for services through the HASCI waiver should be forwarded with available verifications to the DDSN sponsored eligibility worker for processing. The application must not be held for the return of additional information. Additionally the application should be faxed to the HASCI Coordinator at (803) 935-5269.

Table of Contents

Application Processing/Case Maintenance

Situation

County Responsibility

Child in DSS Custody

Region holding custody processes application and maintains case, even if child moves.

Adult in DSS Custody

Region holding custody processes application. Transfers case if beneficiary moves.

Nursing Facility (including swing beds)

Applicant SSI-eligible

Region with active SSI case determines eligibility and transfers completed case if beneficiary is in another region.

Applicant Medicaid eligible

Region with active Medicaid case determines eligibility and transfers completed case if beneficiary is in another region.

Applicant not SSI-eligible – application filed prior to entering facility

Region of residence processes application and transfers completed case if beneficiary enters facility in another region.

Applicant not SSI-eligible – application filed after entering facility

Region where facility is located processes application and maintains case.

Residential Care Facility

Applicant SSI-eligible

Region with active SSI case determines eligibility and transfers completed case if beneficiary is in another region.

Applicant Medicaid eligible

Region with active Medicaid case determines eligibility and transfers completed case if beneficiary is in another region.

Applicant not SSI-eligible – application filed prior to entering facility

Region of residence processes application and transfers completed case if beneficiary enters facility in another region.

Applicant not SSI-eligible – application filed after entering facility

Region where facility is located processes application and maintains case.

Hospital

Region of residence processes application and maintains case.

Institution for Mental Disease (IMD)

Region where applicant resided before entering IMD processes application and maintains case.

To determine processing responsibilities for mail-in applications, refer to MPPM 101.04.01.



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