Eligibility Online Manual

M1005B E01 DETERMINING ELIGIBILITY WITH E01 PAYMENT STATUS

Purpose: This section will assist in determining whether an individual is eligible for Medicaid benefits when the SDX indicates a payment status of E01.


Current Policy Effective Date: September 1, 2010

Date Last Reviewed: March 31, 2010

Previous Policy: January 1, 2007

POL M1005B: DETERMINING ELIGIBILITY WITH E01 PAYMENT STATUS

1. Clients May Have Payment Status Code of “E01”

The SDX shows eligibility with a payment status code of “E01.”

2. Clients Residing in Licensed Medical Institution

The client is SSI eligible, but does not receive a payment because he or she is residing in a licensed medical institution.

3. Clients Potentially Eligible Under Another Medicaid Coverage Group

The client must complete an DHCF-300 Disability Application to determine if eligible under another Medicaid coverage group.

Reference:

Defining Requirement: Social Security Act § 19

Clarifying Information:

1. E01 is defined as individuals who are SSI eligible but do not receive payments because they are in a licensed medical institution.

2. SSA does not determine Medicaid eligibility for an individual in E01 status on the SDX.

Worker Responsibilities:

Determining Eligibility Under Another Medicaid Coverage Group

1. Require a DHCF-300 Disability Application.

2. Determine eligibility under another Medicaid coverage group.