Eligibility Online Manual

M408A Creating Narratives

Purpose: This section will assist in completing narratives for Medicaid case files.

Current Policy Effective Date: July 1, 2006

Date Last Reviewed: May 23, 2007

Previous Policy:


1. Narratives Must Be Factual

Narratives must record actual events and facts. They must not contain speculation or emotional reactions.

2. Narratives Must Be Complete and Concise

3. Narratives Must Be Clear

Narratives do not need to be in complete sentences. Standard abbreviations and clear punctuation must be used.

4. Narratives Must Be Accurate

Narratives must list events as they occurred, in chronological order.

5. Narratives Must Be Recorded Promptly

Narratives must be recorded as soon as possible, not reconstructed at a later time or date.

6. Narratives Must Be Legible

Narratives must be able to be read by others and written with a word processing program whenever possible.

7. Narratives Must Answer Questions Not on Applications

Narratives must be written to answer any questions that are not clear on the application, including, but not limited to:

    • When did the applicant come in or call?

    • Why did the applicant contact you?

    • Who is contacting you?

    • What program(s) is the applicant applying for or what change was reported?

    • Where does the applicant work?

    • How long will employment last?

Discrepancies between information in the case file/application and information being provided by the individual must be recorded.

8. Narratives Must Demonstrate How Eligibility Determined

Narratives must clearly show how the eligibility decision was made, including:

    • How the best estimate was determined.

      • Start and stop date of work.

      • How often client receives pay, listing actual pay dates.

      • Hourly wage and number of hours worked per week.

      • Bonuses, overtime schedule, commissions, tips, shift differential, etc.

    • Why income was counted or excluded.

    • Excel spreadsheet, if used.

    • Income calculations, when Excel spreadsheet not used.

    • How the vehicle value was determined.

    • Why resources were used and how values were determined.

    • Who was included in the benefits and why others were excluded.

      • Record if Medicaid was offered to family members and if they refused.

9. Narratives Must Include Certain Information

Narratives must include the following information:

    • Third party involvement (such as a representative), including names, dates, and phone numbers.

    • Supportive statements for eligibility decisions, including denials and closures.

    • Whether someone attended with the individual, such as a family member, friend, or an interpreter.

    • Document that client was informed of rights and responsibilities.

10. Narratives Must Be Entered When Contact Made with Clients

Narratives are necessary for each instance contact is made with clients or action is taken on a case.

11. Case Files Must Note if Clients Pose Danger to Workers

Workers must be aware and make others in the office aware if clients are potentially dangerous. Follow current office protocol in these cases.

12. Narratives Must Be Initialed or Signed


Defining Requirement: 42 CFR 435.913

Clarifying Information:

1. A Case Narrative Is Defined as:

  • A State record and may be reviewed by other Benefit Specialists, supervisors, managers, consultants, quality control investigators or other state employees.

  • A record that may be used as evidence in court or for an administrative hearing.

  • A record of pertinent, historical facts and must be clear, concise, and accurate.

  • Documentation of the eligibility determination.

Worker Responsibilities: