Amy’s recertification was denied because she failed to provide verification of her self employment income after pending.
How long does she have to ask for a re-open?
90 days
Note: during COVID-do not term after pending. Add COVID extension.
What are the critical ages in Medicaid?
6
19
21
Jill is receiving FPP but re-applies and is reporting that she is pregnant.
What is the correct action?
- Deny the application for ‘already receiving’
2. Complete an ex-parte recertification to determine if Jill is eligible for a Medicaid Program that covers pregnancy
DHB 5097s have a ______ calendar timeframe at application and changes.
12
DHB 5097s have a ______ calendar timeframe at recertification
30
When would you complete a spin off to Adult Medicaid?
When an individual is:
- age 65+
- blind
- disabled
When would you complete a spin off to RMA?
When an individual is a protected alien, within their first 8 months from their DOE and only eligible for FPP.
What does ‘ex-parte’ mean?
To complete an evaluation with information already in the agency and with electronic sources.
To only reach out to the individual if eligibility cannot be determined based off of the information already in the agency.
When can you deny an application for failure to provide (FTP)?
- On day 45
- For FFM apps, cannot deny until it has been pending for 45 days per the O&M report.
- 2 pends must have been sent
- The 2 pends must be sent a least 13 days apart
- The 2nd pend must be expired
- All records, onbase, submitted docs etc must be checked prior to denial
- Must override notice and send manually (through Planet press)
-
Anna was pended on 7/17.
When can the 2nd pend be sent?
7/30 at the earliest
