Haw. Code R. § 17-1711.1-32 - Determination of eligibility for Medicaid

(a) The department shall determine eligibility according to federal and State regulations and policies. The decision regarding eligibility or ineligibility shall be supported by facts in the applicant's record. Each application shall be determined as eligible or ineligible unless the application is withdrawn or discontinued under section 17-1711.1-22.

(b) Timely dispositions of eligibility or ineligibility shall be made within:

(1) Ninety days from the date of application for an applicant applying for medical assistance on the basis of disability including applications for long-term care; or

(2) Forty-five days from the date of application for all other applicants.

(c) A determination of eligibility or ineligibility shall be completed within the applicable time standards except in unusual circumstances such as:

(1) A delay or failure of an applicant or appropriate required agency to take required action; or

(2) An administrative or other type of emergency beyond the department's control.

(d) The department shall not use the time standards specified in paragraph (b) of this section as a waiting period before determining eligibility or for a denial due to failure of the department to determine eligibility timely.

(e) A delay beyond the applicable time standard under paragraph (b) of this section attributed to the department shall not result in the withholding of medical assistance from the applicant. A presumption of eligibility for medical assistance shall be made:

(1) Effective the ninety-first day for an applicant applying on the basis of disability including for long-term care, or on the forty-sixth day for any other applicant until a determination of eligibility is completed; and

(2) The reason for the delay shall be documented in the applicant's record.

(f) For an applicant subject to MAGI methodology who meets the financial requirements for eligibility and for whom the department is providing a reasonable opportunity to provide documentation of citizenship or immigration status, the department, consistent with the applicable timeliness standard, shall furnish medical assistance.

(g) For an applicant who is applying for a MAGI-excepted group and for whom additional information is required to determine eligibility, eligibility shall be determined under a MAGI group until the determination of eligibility on any other basis is completed.

(h) For an individual determined ineligible for Medicaid, the department shall transfer the individual's application information for other insurance affordability programs as appropriate pursuant to 42 C.F.R. §435.1200(e).

Notes

Haw. Code R. § 17-1711.1-32

[Eff 09/30/13] (Auth: HRS §§ 346-14, 346-29; 42 C.F.R. §§435.907, 435.911, 435.912, 435.914, 435.945, 435.1200) (Imp: HRS § 346-29; 42 C.F.R. §§435.907, 435.911, 435.912, 435.914, 435.945, 435.1200)