31-3503E. MEDICAID ELIGIBILITY DETERMINATION. The department shall:
(1) Require the hospital to undertake an initial review of a patient upon stabilization to determine whether the patient may be medically indigent. If the hospital’s initial review determines that the patient may be medically indigent, require that the hospital transmit a completed combined application for state and county medical assistance and a written request for medicaid eligibility determination to the department any time within thirty-one (31) days of the date of admission.
(2) Undertake a determination of possible medicaid eligibility upon receipt from the hospital of the completed combined application for state and county medical assistance and written request for medicaid eligibility determination. The department will use the medicaid eligibility guidelines in place as of the date of submission of the completed combined application for state and county medical assistance, apply categorical and financial eligibility requirements and use all sources available to the department to obtain verification in making the determination.
(3) In order to ascertain medicaid eligibility, require the patient or the obligated person to cooperate with the department according to its rules in investigating, providing documentation, submitting to an interview and notifying the department of the receipt of resources after the initial review form has been submitted to the department.
(4) Promptly notify the patient of medicaid eligibility.
(5) Act on the completed combined application for state and county medical assistance as an application for medicaid. An application for medicaid shall not be an application for financial assistance pursuant to section 31-3504, Idaho Code. Except as provided in this section, an application for financial assistance shall not be an application for medicaid.
(6) Utilize the verification and cooperation requirement in department rule to complete the eligibility determination.
(7) Notify the patient or the obligated person, the hospital or the clerk of a denial and the reason therefor. If, based on its medicaid eligibility review, the department determines that the patient is not eligible for medicaid, transmit a copy of the completed combined application for state and county medical assistance to the clerk. Denial of medicaid eligibility is not a determination of medical indigence.
(8) Make income and resource information obtained from the medicaid eligibility determination process available to the county to assist in determination of medical indigency at the time the department notifies the county of the final medicaid eligibility determination.
The completed combined application for state and county medical assistance shall be deemed consent for providers, the hospital, the department, respective counties and the board to exchange information pertaining to the applicant’s health and finances for the purposes of determining medicaid eligibility or medical indigency.
History:
[31-3503E, added 2009, ch. 177, sec. 7, p. 565; am. 2010, ch. 273, sec. 6, p. 696; am. 2011, ch. 291, sec. 7, p. 800.]