113 APPLICATION PROCESSING TIME FRAMES SR 13-06, 10/13 (MAM-A)

Generate a Notice of Decision (NOD) to the individual as soon as eligibility has been determined, but no later than:

• 30 calendar days from the application date for Children’s Medicaid (CM);

• 45 calendar days from the application date for Old Age Assistance (OAA), Aid to the Needy Blind (ANB), Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB) and SLMB135, Qualified Disabled and Working Individuals (QDWI), or medical assistance for families with children; 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, and Medicaid for Employed Adults with Disabilities (MEAD).

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 Medicaid Assistance and the individual’s information is being shared electronically with the Affordable Insurance Exchanges/Marketplace for eligibility determination for one of the other ACA related health coverage options.