117 APPLICATION PROCESSING TIME FRAMES SR 98-29, 06/98 (FAM-A)

Mail a Notice of Decision to the individual as soon as an eligibility has been determined, but no later than 45 calendar days from the application date.

Exception: Mail the Notice of Decision to the individual as soon as possible when the decision cannot be reached due to a failure or delay on the part of the applicant or any other unusual circumstances beyond the control of the Division of Family Assistance. Document the reason for the delay in the case file.

Give priority processing to all KidsCare PLUS and poverty level pregnant woman applications.

• KidsCare PLUS and poverty level pregnant woman applications must be processed no later than the day following the date all verification is provided.

Agencies authorized to use Form 800P, Application for Medical Assistance for Low Income Pregnant Women and Children, may make presumptive eligibility determinations. Presumptive eligibility is a process in which a provider makes a preliminary eligibility decision based on an interview with the applicant and documentation available at the interview.

• The agency worker has 5 working days to provide a notice of determination to the individual and the District Office via Form 800PE, Notice of Presumptive Eligibility Decision.

• Individuals found presumptively eligible must be opened for benefits within 5 days of receipt of Form 800PE by the District Office.