This is the second step in the application process. A referral is passed to the LTC financial eligibility unit within two days of being referred to the Medicaid PAS unit.

An application for Medicaid is made only when an interview is held with the applicant or his family member who is applying on the applicant’s behalf. Should anyone hold Power of Attorney or Guardianship over the applicant, he also must attend the interview along with the applicant/family member, unless his attendance is waived by the supervisor. In addition, the application form must be signed listing those individuals for whom Medicaid coverage is being sought. The applicant or his representative must sign the Application, Affidavit of Citizenship, and Responsibility Statement. The application date is considered to be the date of the interview unless the interview requirement is waived. The interview can only be waived if the applicant is medically unable to come in for the interview and there is no family member, POA agent or Guardian medically able to come in for the interview or other good cause exists. The unit Supervisor must approve the waiving of the interview requirement.

For cases in which the interview is waived, the application must be date stamped when it is received in the Division of Medicaid and Medical Assistance office. The stamped date sets the base for the timeliness of determination.

9 DE Reg. 997 (12/01/05)

The Federal regulation at 42 CFR 435.911 requires that Medicaid determine eligibility within 90 days for applicants who apply for Medicaid on the basis of disability. This time standard covers the period from the date of application to the date Medicaid mails notice of its decision to the applicant.

The DSS Medicaid worker must explain this 90-day time standard to the applicant or representative during the initial interview. It must be emphasized during the interview that all documentation needed for the worker to determine Medicaid eligibility must be received by the date indicated on the "We Need" letter (Form 415) or the application will be denied. In cases where verification is incomplete, the worker will give the applicant 15 days to return the information on the initial "We Need" letter (Form 415). The date by which all documentation must be received must be clearly noted on this form.

The Medicaid worker will automatically give all applicants an extension of 15 days, if needed, using a second "We Need" letter (Form 415) to note the required documentation and the deadline date. At the request of the applicant, a second extension of 15 days may be granted using a third Form 415. With supervisory approval, a further extension may be granted in cases with unusual circumstances. Unusual circumstances include, but are not limited to, awaiting placement in a Medicaid nursing facility bed or difficulty obtaining an out-of-state deed. Medicaid is held to the 90 day timeliness standard except in unusual circumstances. If the information is not received by the given deadline date, the application will be denied.

It is the applicant or representative's responsibility to obtain the documentation needed to determine the applicant’s eligibility for Medicaid. The applicant should provide the required documentation by the deadline date. The applicant will be given an extension of 15 days via a second Form 415. An additional 15 day extension will be granted upon the applicant/representative’s verbal or written request. A further extension is not granted except in cases of unusual circumstances.