Official Course Description: MCCCD Approval: 06/26/01
HSA118 20014-20082	LEC	3 Credit(s)	3 Period(s)
Medical Assistance Determination
Overview of Federal and State policies and procedures for determining medical eligibility. Includes medical assistance eligibility determination, application procedures, non- financial and financial eligibility factors, emergency services for ineligible aliens, duration of coverage, and decision notices and changes. Prerequisites: None.

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MCCCD Official Course Competencies:
HSA118   20014-20082	Medical Assistance Determination

1.	Describe general policies for determining medical assistance eligibility. (I)
2.	Describe types and treatment of medical assistance applications. (I, II)
3.	Explain the verification process. (II)
4.	Identify financial eligibility criteria. (III)
5.	Calculate financial eligibility with respect to disregards. (III)
6.	Identify emergency services for ineligible aliens. (IV)
7.	Explain the criteria for the duration of medical assistance coverage. (V)
8.	Determine appropriate decision notices for case completion. (VI)
9.	Determine eligibility for medical assistance applicants. (I - VI)
10.	Explain applicant's change reporting requirements. (VII)

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MCCCD Official Course Outline:
HSA118   20014-20082	Medical Assistance Determination

I. Medical Assistance Eligibility Determination A. Policy Overview 1. Manual Format 2. Desk Aids 3. Senate Bill 1151/House Bill 2007 4. Medical Assistance Categories 5. Definitions B. Systems Overview 1. Data Security 2. Handbook and Equipment 3. Mandatory Systems 4. Problem Resolution 5. Documents/Forms II. Application Procedures A. Policy Segment B. Types of Medical Assistance Applications 1. State 2. County C. Treatment of State Applications 1. Where to Apply 2. Effective Date of Application D. Treatment of County Applications 1. Where to Apply 2. Effective Date of Application E. Processing Deadlines F. Institutionalized applicants G. Withdrawal H. Receipt and Action of Second Application I. Filing Units 1. Relationships 2. Household Composition J. Client Interview Process 1. Scheduling 2. Stages of the Interview 3. Missed Appointments 4. Home Visits 5. Reviews K. Verification and Documentation 1. The Three-Step Process 2. Verification Factors 3. Questionable Information 4. Cooperation Agreement 5. Refusal To Cooperate 6. Failure to Provide Requested information L. Referral for Potential Benefits 1. Types of Benefits 2. Verification of Other Benefits 3. Exceptions to Referral Process M. Third Party Liability N. Time Limits O. Case Audits P. Reopening Cases III. Financial Eligibility Factors A. Income 1. Available 2. Earned 3. Unearned 4. Contract 5. Verification 6. Earned Income Disregards 7. Prospective Budgeting Overview 8 Lump Sum Income 9. Deeming income B. Resources 1. Aid to Families with Dependent Children (AFDC) Tables 2. Ribicoff Children C. Budgeting 1. Prospective Budgeting 2. Payment Standard 3. Disregards D. Sibling Exclusion Rules E. Disregards IV. Emergency Services for Ineligible Aliens A. Conditional Resident Aliens B. Immigration and Reform Control Act (IRCA) Aliens C. Undocumented Aliens D. Emergency Episodes E. Eligibility Periods V. Duration of Medical Assistance Coverage A. Prior Quarter Months B. Criteria 1. Persons Affected 2. Budgeting 3. Verification VI. Decision Notices A. Approval B. Denial C. Closure D. Change of Medical Assistance Category E. Emergency Episode VII. Changes A. Reporting Requirements B. Methods of Reporting Changes C. Adding/Removing Households Members D. Removing Household Members from households with Pregnant Women E. Loss of Contact F. Change of Residence G. Change in Resources H. Change in Income I. Change in Expenses J. Post-Partum Coverage K. Newborn Eligibility L. Time Frames

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