Medicaid

What Your Client Needs to Apply

Your client may need, at a minimum, to provide the following information to apply to Medicaid:

• Social Security number
• Proof of disability from a qualified physician
• Information about income and assets (anything that can be used to buy food)

Application Process
Renewal Process
Appeals Process

Application Process
Once your client applies for Medicaid benefits, his/her application should be processed within 45 days from the date the application was submitted if he/she has provided all the necessary information. If your client has a disability, the application process can take up to 90 days.

If your client applies for Medicaid through a joint program application (i.e., Medicaid, Food Stamps or TANF application), your state must still determine Medicaid eligibility within the Medicaid time standard (45 days and 90 days if your client has a disability).

If the application process is delayed due to a non-Medicaid related requirement, the Medicaid portion of the application must still be processed in order for a determination to be made in a timely manner consistent with Medicaid rules.

For more information on Medicaid in your state, visit www.cms.hhs.gov/medicaid/statemap.asp.

Renewal Process
Once your client is determined eligible for Medicaid, the state must review his/her eligibility at least once a year or when there is a change in his/her circumstances, such as an increase or decrease in any cash assistance he/she might be receiving. Determinations of blindness and disability are not subject to annual redetermination.

During the renewal process, the state is required to conduct an ex parte review. This means that states are required to rely on information that is available to state Medicaid agencies, without contacting the client, in order to determine if the client remains eligible.

Your client should not be required to provide information that:

• Is not relevant to his/her ongoing eligibility
• Has already been provided or relates to an eligibility factor that is not subject to change, such as date of birth or U.S. citizenship

Appeals Process
If your client is denied enrollment into Medicaid, he/she will receive a notice from the state informing him/her of the denial, reason(s) for it and the appeals process. If your client wishes to file an appeal, it should be done as soon as possible to avoid Medicaid benefits being cut off.