E. The requirement to send out two requests for information with 10 calendar days between requests changed to sending out two requests for information with 12 calendar days between requests. (The 10-10 rule became the 12-12 rule.)
B. Except for self-employment income, the applicant’s statement can no longer be accepted as verification of income. Third party verification is now required for earned and unearned income in all aid/program categories. Income deductions such as childcare and operational expenses must also be verified.
DATE: AUGUST 12, 2002
Manual: Family and Children’s Medicaid MA-3210
Change No: 07-03
To: County Directors of Social Services
Effective: October 1, 2002
On February 5, 2002, Judge Graham C. Mullen, Chief Judge, U.S. District Court for the Western District of North Carolina, dismissed the Alexander Consent Order. The February 1992 version of the Consent Order required payment of penalties or remedial fines if the counties did not process applications according to federal regulations and State rules.
Judge Mullen approved a “Plan to Assure Timely and Quality Services to Applicants for Medicaid, otherwise known as the Exit Plan”. The Centers for Medicare and Medicaid Services and Legal Services had approved this Exit Plan. The State had worked with a group of county representatives in developing this plan.
The persons from the following counties who worked on this plan were:
Brenda Davis of Catawba County
Millie Brown and Elva Quinn of Duplin County
Dave Bradshaw and Dale Moorefield of Forsyth County
Betty Barnes of Johnston County
Jean Biggs and Vicki Lewis of Martin County
Sarah Bradshaw and Alvinia Parker of Sampson County
Although the Exit Plan does not change all that the counties wanted, it did result in the dismissal of the Consent Order. The Exit Plan reflects the commitment of both the State and the counties to continue to provide accurate benefits to our citizens in a timely manner. Each county in the State deserves recognition for its efforts. It is critical that counties continue to provide accurate benefits in a timely manner.
Work First (WF) applications are not under the Exit Plan. However, a Work First application is considered an application for Medicaid. If a person comes to the agency to ask for financial assistance, he must be given the opportunity to apply for Medicaid that same day. This applies even if the county requires the person to go to the Employment Security Commission or to the Child Support Enforcement office before taking a WF application.
Due to changes needed in the Eligibility Information System, all aspects of the Exit Plan could not be implemented until EIS was ready. In DMA Administrative Letter No. 19-02, some policy changes were made without EIS support. These included:
As a result of enhancement to EIS, all of the aspects of the Exit Plan can now be implemented.
MA-3210, Application Processing, Verification Requirements, has been rewritten and renamed MA-3210, Verification Requirements For Applications.
As with applications pending solely for medical bills to meet a deductible, the days an application pends solely for one of the reasons listed above are excluded from application processing times. The exclusion of time begins the day after the DMA-5098/DMA-5098S, Your Application For Medicaid Is Pending, is mailed and ends on the day the information is received or the case is disposed of, whichever occurs first.
This policy change is effective October 1, 2002.
Apply these changes to any applications taken on or after October 1, 2002. For applications dated prior to October 1, 2002, follow the policies and procedures in effect prior to October 1, 2002.
Remove: MA-3210, Application Processing, Verification Requirements
Insert: MA-3210, Verification Requirements For Applications and Figures 1A, 1B, 2A, and 2B.
Online Manual: Entire Section Revised with hyperlinks to forms.
Remove: MA-5000, Figure and Instructions for the following form:
DMA-5025, Notice Of Binding Decision For Medicaid Deductible
Insert: Nothing to insert
Online Manual: This form has been added to the policy section.
If you have any questions regarding this material, please contact your Medicaid Program Representative.
(This policy was researched and written by Vanessa Broadhurst, Policy Consultant, Medicaid Eligibility Unit.)
MA-3210, Fig. 1A, DMA-5099
MA-3210, Fig. 1B, DMA-5099S
MA-3210, Fig. 2A, DMA-5098
MA-3210, Fig. 2B, DMA-5098S
For questions or clarification on any of the policy contained in these manuals, please contact your local county office.