MS 1372 (1)

[All individuals have the right to make an application and receive a decision on their eligibility for Medicaid (MA). Individuals may apply in-person, via telephone, via the Self-Service Portal (SSP), or by a home visit, if requested. Individuals are never refused the right to apply even if it appears that they do not meet technical or financial eligibility requirements.Applications and/or recertifications with an Authorized Representative (AR) may be completed with the appropriate documentation, refer to MS 1371.

Individuals making an application on the SSP are not required to complete an interview. If verification is required, a Request for Information (RFI) will be issued. If no verification isneeded, eligibility will be determined without worker intervention.

NOTE:Workers are still required to complete a thorough interview with individuals applying in person or by phone.

Individuals may also apply for the Medicare Savings Program (MSP) usingthe mail-in application, form MAP-205, Application for Medicare Savings Programs,without completing an interview. For additional information on the mail-in process, refer to MS 4500.]

Use the following procedures when conducting an interview.

A. If the individual is physically or mentally disabled, elderly, or has another special need, provide reasonable accommodations to any special needs the individual may have no matter where the interview is conducted. Accommodation to special needs may include but is not limited to:

1. Interpreter services for hearing impaired individuals. For more information on interpreter services for the hearing impaired, refer to Volume I, MS 0220;

2. Additional space for the interview to accommodate an individual in a wheelchair;

3. Scheduling appointments when special transportation services are available;

4. If the individual does not speak English, obtain interpreter services. For more information on interpreter services, refer to Volume I, MS 0230; or

5. Making a home visit.

B.Inquire KAMES and Worker Portal to determine if an individual has previously received MA. If so, review the case(s) thoroughly.

C. Run system checks as appropriate, i.e. BENDEX, SDX, external agency searches, Eligibility Advisor (EA), etc. to review for potential income and resources.

D. Explain retroactive MA coverage and ask if the individual has unpaid medical expenses in any of the prior three months. For information regarding retroactive MA, refer toMS 1450.

E. Explain the requirement to cooperate with Third Party Liability (TPL). Enter all health insurance information on Worker Portal. For information regarding TPL, refer to MS 1660. Note: Medicare Part D is not considered TPL, as Medicaid does not provide prescription coverage for Medicare recipients. Do not enter Medicare Part D information on Worker Portal.

F. Ask all the questions on Worker Portal as the interview progresses.

G.[Enter case notes on Worker Portal while the applicant/recipient is still present or on the phone.]

H. Inform individuals of their rights and responsibilities:

1. Advise the individual that all changesmust be reported within 10 days of the date of the change;

2.Explainform MA-2, Medicaid Penalty Warning. Form MA-2must be signed by the applicant to verify they understand the potential consequences for committing fraud. The form may be signed electronically or hardcopy atface-to-face interviews. For phone interviews, form MA-2 may be signed with voice signature. Otherwise, Worker Portal will mail form MA-2 to the individual for signature and the case will pend for its return;

3.Advise the individual of their right to request a hearing to appeal any adverse decision;

4.If the applicant is age 18, or will be 18 before the next election, explain the voter registration process and complete the voter registration question on Worker Portal. Refer to Volume I, MS 0640 and MS 0650 for procedures regarding voter registration; and

5.Provide all mandatory informational forms and/or pamphletsrequired at application/recertification. Thoroughly explain all forms.

a. For face-to-face interviews, forms requiring signature may be signed electronically or hardcopy;

b. For phone interviews:

i.Inform the applicant of all forms they can expect to receive;

ii. Explain the information contained in the forms; and

iii. [For any forms not signed by voice signature, explain that theymustbe signed and returned.]

I.Inform the individual of Medicaid processes:

1.Explain the Managed Care program if any individuals in the household are required to enroll with a Managed Care Organization (MCO). For informationon Managed Care, refer to MS 1340.

2.Explain the KYHealth card if any individuals in the household are exempt from managed care enrollment. For information on the KYHealth card, refer to MS 1240.

3.Advise the applicant/recipient to contact their MCO or Medicaid Member Services with any questions regarding coverage or billing.The appropriate phone number is listed on the MCO card or the back of the KYHealth card.

J.Explain to the applicant/recipient what is required to process the casetimely and that Medicaid will be denied or discontinued if mandatory verificationis not returned within allotted timeframes.

Note: Individuals have 30 days to return requested information before the application denies, unless additional time is requested.

K.Explain the difference between mandatory and optional verification.

L.The applicant/recipient must sign the application. If the interview is face-to-face, electronic or hardcopy signature is acceptable. If the interview is by phone, the application summary may be signed by voice signature. Otherwise, Worker Portal will mail the application summary to the individual for signature and the case will pend for its return.

Note: The application may be signed by the applicant, the applicant’s statutory benefit or Supplemental Security Income (SSI) payee, legal guardian, power of attorney (POA), or AR. If the application summary is signed by a mark,such as an X, another person must sign the application as a witness. The witness may be related or unrelated to the applicant.

M.If additional verification is required, run eligibility to generate an RFI.

N.Any verification provided at the interview must be scanned to the Electronic Case File (ECF) at that time.

O.If all verification is provided at the time of the interview, dispose the application/recertification.

P.Ensure that all of the applicant/recipient’s questions are answered.

Q. After the Interview:

  1. Individuals may provide verification by mail or faxto the Centralized Mail Center, by uploading documentation to the SSP, or by returning to any DCBS office.
  1. Scan all verificationreturned to the DCBS office into ECF upon receipt. All documents pertaining to eligibility for the current certification period must be scanned into ECF.

3.If additional information is required from the Medical Support and Benefits Branch (MSBB), send the request tothe regional Program Specialist immediately to prevent delays in processing the case.