PM 17-04-02.

If the pending application included Food Stamps, progress the application to FS Only. If FS were approved with a one or 2-month approval period, restore the FS application; see WAG 17-01-03-d.

AIS Denials

  1. (EW) When the decision is made to deny an application, process the denial in Option 5 of (AIS) as follows:
    • Item 33 -Enter the TAR that describes the reason for the denial. See:
    • Item 39 -The system centrally generates Form 360C if Item 39 is blank or coded 00. The TAR entered in Item 33 identifies the message that prints on Form 360C. The Form 360C is dated and mailed no later than 2 workdays following the date the action is transmitted. A daily list, IM Change Notices Issued Centrally, Intake Notices Issued Centrally, is sent to the FCRC to verify the information on the denial notice.

      Enter code 80 or 92 in Item 39, as needed, if the FCRC issues Form 458SP, Form Revised text458LTC, Form 458 and/or Form 458M for the Medical, QMB Only, SLIB Only, or QI-1 Only denial. The TAR entered in Item 33 identifies the message entered on the notice. 

  2. (EW) If required, get supervisory approval on the Eligibility Summary/Disposition page of Form 2378C.
  3. (System) Produces Form 552 showing the denial action.

IPACS Denials

    • (EW) Complete the following Items on Form 552 if an application is denied through IPACS:

Item 2 -Enter the 6-digit date (month, day, and year) of denial. The date of denial is the month, day, and year the applicant was determined ineligible.

Item 3 -Enter TA 05.

Items 5, and 8-10 - Complete.

Item 33 -Enter the TAR that describes the reason for the denial. See:

Item 39 -Enter the Client Notice Code that fits the case situation. For Medical, QMB Only, SLIB Only, or QI-1 Only denials, enter code 80 or code 92, as required, in Item 39. Complete and send Form 458SP, Form Revised text458LTC, Form 458 and/or Form 458M.

  • REMARKS -If temporary medical was approved and is active at the time the Medical application is denied, enter that case number in REMARKS (see WAG 17-03-03). The temporary medical case is not centrally canceled unless the temporary medical case number is entered in this Item.

Notices for Community Regular and Spenddown (AABD, FamilyCare Assist, All Kids)

(FCRC) Send applicant the original Notice of Decision on Application for Medical Assistance - MANG Non Spenddown (Form 458), when:

  • a Community Regular application or a Community Spenddown application is denied through AIS, and the central notice is suppressed because the worker has reason to manually send the notice of decision; or
  • a Community Regular application or a Community Spenddown application is denied through IPACS.

NOTE: Send a copy of the Form 458 to the hospital, long term care facility, or DHS facility, if the application was made on Form 2378H.

Send Form 360L to interested parties such as vendors, authorized representatives, and agencies, etc. (see WAG 17-01-04-c).

Notices for Long Term Care Applications (AABD)

(FCRC) Send applicant the original Revised textNotice of Decision on Application for Medical Assistance - MANG Nursing Home/Supportive Living Facility (Form Revised text458LTC) when:

  • a Long Term Care application is denied through IPACS; or
  • a Long Term Care application is denied through AIS and the Form 360C is suppressed because the worker has reason to send the manual Form 360.

NOTE: Send Form 360L to the hospital, long term care facility, or DHS facility if the application was made on Form 2378H (see WAG 17-01-04-c ).

If applicant requests, send a copy of the Form Revised text458LTC to any interested parties the applicant identifies.