Department of Human Services: Chapter 2: Sections 2.1 thru 2.3

ALL

It is IMA's goal that eligibility determinations should be made within ten days from the date that all information necessary to determine eligibility has been submitted. IMA is not legally obligated to meet this timeframe, though it is generally expected that SSRs do so.

AR: If an applicant fails to provide the necessary verification by the tenth day following the application filing date, ACEDS generates a Ten-Day Notice, Form 804, (Application Reminder) on the tenth day or the next available work day. The Ten-Day Notice lists all of the information outstanding on the checklist which was issued at the time the application was filed.

If the applicant fails to provide the necessary verification before the 30th day, then an ACEDS-generated 30-Day Notice Application Follow-Up is sent to the applicant on the 30th day following the application filing date or the next available workday).

The applicant has 15 days from the date the 30-Day Notice was sent to provide the information necessary to establish eligibility. If the necessary information is not provided by the 15th day after the 30-Day Notice was sent, a denial notice is sent on the 15th day following the date the 30-Day Notice was sent. If, however, verification is received from the applicant within the last five days of the 15-day period after the 30-Day Notice was sent, but eligibility cannot be determined by the 15th day after the 30-Day Notice was sent, then the SSR has an additional day for each day within the last five days that verification was not received to determine eligibility.

Example

Ms. Scott was unable to return information verifying her status to receive MA until the 13th day after the 30-Day Notice was sent. Since the verification information was received within the 15-day period, the application should not be denied for failure to provide needed information. However, the SSR might not be able to determine eligibility within the 45-day timeframe because the information was not provided until the 13th day following the date the 30-Day Notice was sent. The SSR has three additional days to determine eligibility and still be considered to have met the timeliness standard; in other words, the SSR has 18 days after the 30-Day Notice was sent in order to determine eligibility.

An eligibility determination notice must be mailed no later than 45 days from the date of application or 15 days after the 30-Day Notice (Form 803) was sent, if that is later than 45 days from the application date.

AX: See AR.

SR: See AR. In addition, for disability-related MA cases, the timeframe for application disposition is different than for other MA cases. The Department has 90 days to make a final eligibility determination in disability-related cases. Within 45 days, however, the Department must assess the individual's eligibility for MA for all non-financial and financial criteria except disability.

If the individual would be eligible for MA even if the MRT does not determine the individual disabled because, for example, the individual is a parent or caretaker of minor children, the individual's Medicaid application must be approved within 45 days under the appropriate program type (AR or AX). (In this circumstance, the individual should be encouraged to complete the medical evaluation form because a disability finding will affect whether the individual is placed in a managed care organization.) Additionally, to the extent that the customer is eligible for a special Demonstration program such as the 1115 (50-64) program, s/he should be processed under that program type (please see Part III, Chapter 6: Medicaid Demonstration and Waiver Programs).

Within 90 days, the full MA eligibility determination, including the disability determination, must be made. If found eligible for disability-related MA, eligibility is retroactive to date of application.

QM: See AR.

TANF

See AR

IMA must determine eligibility and provide the applicant an opportunity to participate (i.e. provide an EBT card and have issuance facilities open and available for the household to obtain benefits) within 30 calendar days following the date the application was filed.

For households applying prior to their release from an institution, the 30 day timeliness standard begins on the date of their release.

For households applying at an SSA office, the timeliness standard begins on the date the application is filed with SSA (see Section 1.7.1: Applying for Food Stamp Benefits through the SSA in Part III).

For households entitled to expedited service, the timeliness standard requires that households have the opportunity to receive their EBT cards within seven calendar days from the date the application is filed (see Section 4.5: Time Standards in this Part). For individuals who apply at SSA, this timeliness standard begins on the date the application was received at an IMA service center.

If the SSR cannot make an eligibility determination within 30 days from the date of filing, the cause of the delay must be determined. Delays are either household caused or Department caused (see Section 2.3.1: Household-Caused Delays in Benefits Processing and Section 2.3.2: Department-Caused Delays in Benefit Processing in this Chapter).