Family and Children's Medicaid MA-3420 RE-ENROLLMENT
VI. RECEIPT OF CORRECT MAF/MPW MAIL-IN FORMs
A. After receipt of the Re-enrollment Form
1. Mail the recipient the DMA-5046, Medical Transportation Assistance-Notice of Rights, once the re-enrollment form is received. For re-enrollments conducted in the office, complete the DMA-5046 during the interview.
a. Document the date and whether the DMA-5046 was sent or given to the recipient.
b. Review the DMA- 5046, if returned. If the recipient indicates he wishes to request assistance with transportation, assist by following procedures in MA-3550, Medicaid Transportation. File the DMA-5046 in the record.
c. Do not mail a DMA-5046 to MIC/NCHC recipients at re-enrollment.
REVISED 07/01/11 – CHANGE NO. 12-11
2. If the DMA-5063 or DMA-5063R is returned and the caretaker responds “yes” to both questions in one of the boxes for questions 1 -5 on page 4, the child has special health care needs. Enter the appropriate code in EIS.
a. If the DMA-5063 or DMA-5063R is returned and both questions in one of the boxes for questions 1 – 5 on page 4 are checked “yes” and there is no name listed, call the client to get the name of the child. If you are unable to reach the client by phone, mail the DMA-5063 or DMA-5063R to him asking him to write the name of the child and to return the form as soon as possible.
b. Do not attempt to contact the client if only one question is answered “yes” on questions 1 – 5 on page 4 and the other is blank or if the parent did not sign the DMA-5063 or DMA-5063R.
B. Compare The Form to The Last Form in Record
Review the DMA-5063 or the DMA-5063R and compare information on the form to the last re-enrollment or application to determine if there are any changes that may need follow-up.
C. Request for Coverage For a Caretaker or an Additional Child
If the re-enrollment forms, DMA-5063 or DMA-5063R, request coverage for a caretaker or a child not currently receiving Medicaid, treat as an application.
1. Enter an unsigned DSS-8124 to register an application.
2. The date of application is the date the DMA-5063 or DMA-5063R is received in the agency and is complete. Always date stamp the date the application or other information necessary for processing the application is received in the agency. If an application is received for a case that is pending county reassignment, follow instructions in MA-3340, County Residence, to complete the re-enrollment. Process the application after the re-enrollment is complete.
3. Application processing requirements found in MA-3200, Initial Contact, and MA- 3217, Evaulate Coutny/ DSS Performance, apply to the application. This includes an evaluation in all Medicaid aid program/categories, including MPW or MAABD.
4. If the information included on the application indicates that the individual(s) should apply for Aged, Blind and Disabled Medicaid program:
a. Within one workday of receipt of the application, send the DMA-5063 or DMA-5063R, Health Check/NC Health Choice for Children Application, to the appropriate Medicaid unit within the agency.
b. Document on the log that the application was sent to another unit.
REVISED 07/01/11 – CHANGE NO. 12-11
c. The date of the Aged, Blind and Disabled Medicaid application is the date that the complete DMA-5063 or DMA-5063 was received in the agency.
d. Do not require the individual to sign another application.
e. Use the DMA-5063, DMA-5063R, or DMA-5000 to process the application for the adult or child or both in the most appropriate Medicaid category.
5. Enter the application on the DMA-5066, Log for NC Health Choice/Medicaid Mail-In Applications as specified in MA-3207, Receiving Mail-In Applications.