The purpose of this policy directive is to provide guidelines to assist workers with the Medicaid application process. It has come to our attention, through clients contacting Customer Assistance and the Governor's Office, that some persons do not understand their Medicaid coverage. Therefore, we want to be sure that our clients are receiving adequate explanations regarding their rights, responsibilities, and benefits.

When the Medical Services Policy Manual is revised, it will include instructions on what information and explanations should be provided during the interview. Until the revision is complete, workers should refer to this directive as needed to insure that all necessary information is given to the client during the interview.

A new case summary form is being developed for Medicaid only to be used in Family and Medically Needy categories since the DCO-96 no longer meets the needs for Medicaid. On the new form, a checklist including these guidelines will be included.

During the interview the worker should do the following:

1. Explain the time limits for processing applications, i.e., 45 days unless MRT decision is needed, then 90 days.

2. Give the applicant a copy of PUB-040 (last revision 7/97), "Your Guide to Medicaid Services in Arkansas", and briefly discuss covered services.

3. Explain the Primary Care Physician (PCP) Program. If not exempt, review the DCO-2613 with the applicant and give him/her a copy. Complete the DCO-2609.

4. Explain benefits available under the Child Health Services Program and provide the applicant with a copy of DCO-2650, "Notice of Availability of Child Health Services for Medicaid Eligible Children Under Age 21" and/or PUB-028, "Child Health Services (EPSDT)".

5. Explain change reporting requirements and give the applicant a copy of PUB-182, "Medicaid Reporting Responsibilities". Be sure to include worker's name and telephone number on PUB-182.

6. Explain the applicant's responsibility to assign any rights to medical support and third party liability payments to the Arkansas Medicaid Program. Explain that any third party insurance is required to pay first and that Medicaid is always the payor of last resort.

7. Inform the applicant of the verification required to determine eligibility and why the information is needed.

8. Explain procedures for obtaining a Medicaid Photo Identification Card.

9. Explain how to use the Medicaid ID card, e.g., show card to provider every time medical treatment is sought; inform previous providers of approval and Medicaid number so they can receive payment for services provided prior to approval.

10. Explain when coverage may begin. Inquire about any medical bills in the retro months and explain possible coverage of those months.

11. Explain the spenddown process when applicable. Explain that spenddowns are for a fixed period of time not to exceed three months. Explain, if known, that based on the application and information provided, the applicant may be eligible for certain months. Inform the client that if the spenddown application is approved, the Agency will mail a notice that will state the spenddown (eligibility) period. Stress the importance of carefully reading any notice sent by the Agency. Explain that, if they continue to have medical bills when the period ends, they should reapply.

12. Explain to all applicants that if approved they will get a notice telling them when coverage begins. It is important to pay careful attention to the dates of Medicaid coverage, especially any possible retro months.

1. Explain other services available, including Food Stamp Benefits, Family Planning, Children's Medical Services, TEA, and ARKids First.

2. Explain the applicant's right to appeal any adverse action taken by the Agency, including denial of benefits, case closure, or untimely processing of application.

3. Explain the applicant's responsibility to cooperate with the Office of Child Support Enforcement (if applicable) in establishing paternity and obtaining medical support, the right to claim good cause for not cooperating, and the consequences of failure to cooperate.

4. Explain the applicant's responsibility to cooperate with Quality Assurance.

6. Explain how the Social Security Number is used, e.g., in computer matching with SSA and ESD.

7. Explain estate recovery (Long Term Care and Home and Community Based Waiver only).

8. Encourage the applicant to contact the worker anytime there are questions concerning Medicaid eligibility or services.

Inquiries to: Jack Tiner, 682-8259

Teri Wright, 682-8258

Ann Dawson, 682-8254

Boyce Lovett, 682-1562