113 APPLICATION PROCESSING TIME FRAMES (MAM)

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An application must be acted upon promptly and without undue delay. For the MAGI categories, non-MAGI categories where no medical determination is needed to determine eligibility, and non-MAGI re-applications that require a disability determination but a previous approval has a future review date or no review date, and the assistance group does not report having a trust or annuity, eligibility is determined using a simplified process that does not required an interactive interview. For all categories of medical assistance, generate a Notice of Decision (NOD) to the individual as soon as eligibility has been determined, but no later than:

• 45 calendar days from the application date for all MAGI-related medical assistance groups and for Old Age Assistance (OAA), Aid to the Needy Blind (ANB), Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB) and SLMB135, and Qualified Disabled Working Individuals (QDWI); and

• 90 calendar days from the application date for Aid to the Permanently and Totally Disabled (APTD), Nursing Facility (NF) services, all Home and Community-Based Care (HCBC) services, including Choices for Independence (CFI) services, Medicaid for Employed Adults with Disabilities (MEAD), and Medicaid for Employed Older Adults with Disabilities (MOAD).

Exceptions:

• Generate the NOD 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 DHHS. Document the reason for the delay in the case file.

• Generate the NOD to the individual as soon as possible when the individual is not eligible for medical assistance and the individual's information is being shared electronically with the Federally Facilitated Marketplace (FFM) for eligibility determination for one of the other Affordable Care Act (ACA)-related health coverage options.

References: 42 CFR 435.911, 42 CFR 435.912, 42 CFR 435.1200(e)