1. (System) Issues and sends Form 360C when an application is approved or denied for regular Medical via AIS, and code 00 is posted for Item 39 of Form 552.
  2. (FCRC) When there is no SNAP request, enter code 80 in Item 39 of Form 552 when approving or denying a regular Medical application via IPACS.
  3. (FCRC) Complete and mail Notice of Decision on Application for Medical Assistance - Regular MANG (Form 458), when a decision is made to:
    • approve or deny an initial application as regular Medical via IPACS; or
    • approve or deny in AIS and a central notice is not desired.
    1. Enter the following statement on Form 458 when a Medical application is denied because the applicant was found "not disabled" (for AABD) by the Client Assessment Unit (CAU):

      You do not meet the Department's definition of disabled. If you wish to get more information about the reason for this decision, contact your local DHS office. 

  4. (FCRC) Complete and mail a Notice of Decision on Application for Medical Assistance - MANG Long Term Care (HFS 458LTC), when a decision is made to:
    • authorize a Revised textnursing home (NH) or supportive living facility (SLF) Medical case with or without a spenddown, or
    • deny the application and a central notice is not wanted.
    1. Enter code 80 in Item 39. Send a Revised textNursing Home/Supportive Living Facility Resource Calculation (HFS 2500) with the notice.

      NOTE: For a community case at application, or for backdated months that are before the case became Revised textNH or SLF, use HFS 458LTC to notify the client of the application decision and the change in case status. Send HFS 2500 with the notice.

  5. (FCRC) Complete and mail a Notice of Limited Approval of Medical Assistance Application (Form 458D), when:
    • a All Kids Assist/Moms and Babies case is not eligible for the month of decision or any backdated month, and
    • spenddown exists for each month eligibility exists.
  6. (FCRC) Complete and mail a Notice of Decision on Applications for Payment of Medicare Premiums, Deductibles and Coinsurance (Form 458M), to inform AABD Medical applicants of:
    • eligibility/ineligibility for Medicare cost-sharing benefits as a QMB, or
    • payment of Medicare Part B SMIB premiums as an SLIB.
  7. (FCRC) Complete and mail a Notice of Decision on Application (MANG) for a MediPlan Card (Form 458SP), with Form 458SPA/SPB attached, if needed, to inform an applicant they are eligible for spenddown enrollment.