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The application is considered to be an application for medical coverage. Evaluate eligibility for full Medicaid benefits and if ineligible, consider coverage under NC Health Choice.
REISSUED 04/01/14 – CHANGE NO. 02-14
(III.)
An application has been created to use as a joint application for Medicaid/NC Health Choice. Supplements are provided to evaluate for MAF eligibility. This application and supplements replace the previous Family and Children's Medicaid Application and consist of the following:
REISSUED 04/01/14 – CHANGE NO. 02-14
(III.D.1.)
Follow procedures in MA-3200, Initial Contact, to log requests for assistance.
Complete the DMA-5095 (DMA-5095S), Medicaid/Work First Notice of Inquiry only if no application is taken for any program.
Explain services available to the applicant. Advise the applicant that, if approved for NC Health Choice, DMA will provide information about covered services and how to obtain them.
All applications are processed as Medicaid until income verification establishes ineligibility for Medicaid, and eligibility or ineligibility for NC Health Choice.
REISSUED 04/01/14 – CHANGE NO. 02-14
(III.F.)
NOTE: NC Health Choice is excluded from monitoring and the report card. However, applications in which individuals are approved for Medicaid remain subject to monitoring and the report card requirements. Refer to MA-3217, Evaluating County/DDS Performance.
Mail In DSS Health Dept. DATE RECEIVED / / |
The application contains a source field (see example above) for specifying whether an application was completed by the county dss, provided by or assisted by the health department or was a mail-in application. State law requires that source of application be tracked. This information must be entered in the "How App Received" field on the 8124 screen prior to disposition of the application.
A "mail-in" is any application (other than one obtained from the health department) which is mailed or brought to the dss by the applicant without being interviewed by an IMC. Enter code "M" in EIS.
A dss application is any application in which a face to face interview is conducted in any location by an IMC. The DSS should supply the DMA-5063 (DMA-5063, Spanish), Medicaid/NC Health Choice Application, to its staff at any outstation locations where interviews are conducted. Enter code "D" in EIS.
A health department application is an application which is distributed and stamped by the health department, and is mailed or brought in to the dss without a face to face interview being conducted by an IMC. Enter code "H" in EIS.
REISSUED 04/01/14 – CHANGE NO. 02-14
(III.)
Evaluate for MAF when the applicant requests coverage for an individual who does not meet MIC/NC Health Choice eligibility requirements.
Evaluate for retroactive Medicaid when the applicant indicates there are medical expenses in any of the three months prior to application. Enter a separate application in EIS for the retroactive period. This application is subject to monitoring and the report card.
For questions or clarification on any of the policy contained in these manuals, please contact your local county office. |
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