Revision 07-1; Effective January 1, 2007

 

1. Reasons for Opening Aged, Blind, or Disabled MAO Cases

The code selected should represent the occurrence, during the six months preceding the date of approval for assistance, which had the greatest effect in producing the need for assistance.

When two or more reasons apply in a case, use the code for the reason primarily responsible for the need for assistance. If a reduction in income or resources and an increase in need are of equal importance, the code reflecting the reduction in income or resources should be used. If the increase in need is considerably greater than the reduction in income, the increased need becomes the primary reason.

Computer-printed reasons to the applicant will be initiated by use of the appropriate opening code. The statements that are to be computer-printed to the applicant are listed after each opening code for informational purposes.

The appropriate opening code should be taken from the following list and entered on the Form H1000-A.

 

Reasons Relating to Material Change in Income or Resources During Six Months Preceding Approval for Assistance

A change in income or resources should be regarded as material only if the amount of the reduction or loss of income is substantial in relation to the need for assistance. A loss of income that is based on need, such as assistance from a public or private agency, is not regarded as a material change in income. (Cases transferred from another assistance program will be coded 047.)

 

Earnings Lost or Reduced

Code 028 (TP03, 14) — Use this code if the applicant lost employment or had a reduction in earnings during the six months preceding application.

Computer-printed reason to applicant:

"Your earnings are less due to loss of or decrease in employment."

 

Support From Other Person

Code 038 (TP03, 14) — Use this code if the needs of the applicant have been met wholly or in part through contributions from a person and such contributions have been discontinued or reduced during the six months preceding application.

Computer-printed reason to applicant:

"Income available to you from another person is less."

 

Other Income

Code 041 (TP03, 14) — Use this code if the applicant suffered a loss of or reduction in income during the six months preceding application from some source other than those specified in Codes 028 or 038. Examples of such income are RSDI; an allowance, pension, or other payment connected with military service; unemployment benefits; workmen's compensation; and rental income. Do not include the loss of any income that was based on need.

Computer-printed reason to applicant:

"Income available to you is less."

 

Assets Depleted or Reduced

Code 044 (TP03, 14) — Use this code if the assets of the applicant have been depleted or reduced during the six months preceding application to an amount permitted under Department policy.

Computer-printed reason to applicant:

"Your financial resources have been reduced."

 

No Material Change in Income or Resources During Six Months Preceding Approval for Assistance

If the need for assistance is caused primarily by some change other than a loss of or reduction in income or assets of the applicant, use one of codes 045 through 055.

Such a change may result, for example, if the allowance for a standard budget item is raised; if an eligibility requirement such as residence is liberalized; or if an applicant's needs increased without a material change in income or assets.

 

Increased Medical Needs

Code 045 (TP 03, 14) — Use this code if the requirements of the applicant increased during the six months preceding application as a result of need for medical care without a corresponding increase in income or resources. The term medical care is used in the generic sense, that is, it embraces all items usually considered medical or remedial care, including care in a nursing facility.

Computer-printed reason to applicant:

"You have increased medical expense."

"Sins cuentas médicas han aumentado."

 

Miscellaneous

Code 047 (TP 03, 14) – Program Transfer — Use this code if the recipient receiving assistance is being transferred from a non-DHS assistance program to a DHS assistance program.

Computer-printed reason to applicant:

"You have changed from one type of assistance program to another."

"Su caso ha sido traspasado de inn programa de asistencia a otro."

 

Codes 048-052 (TP 03, 14) – Attained Technical Eligibility — If the applicant has been living below Department standards and the only change during the last six months is that the applicant has now fulfilled some technical eligibility requirement, enter the appropriate code for the particular requirement from the following codes (048-052). Do not use these codes if the applicant was eligible during the six months period but postponed applying. In such circumstances, code 053 should be used.

 

Code 048 — Age

Computer-printed reason to applicant:

"You now meet the age requirement."

"Ahora usted cumple con el requisito de edad."

 

Code 049 — Residence

Computer-printed reason to applicant:

"You now meet residence requirement."

"Ahora usted cumple con el requisito de residencia."

 

Code 050 — Citizenship or Legal Entry

Computer-printed reason to applicant:

"You now meet the citizenship requirement."

"Ahora usted cumple con el requisito de ciudadanía."

 

Code 051 — Blindness or Disability

Computer-printed reason to applicant:

Blind – "You now meet the agency's definition of economic blindness."

Ciego – "Ahora esta agencia considera que la condición de usted es ceguedad económica."

Disabled – "You now meet the agency's definition of disability."

Incapacitado – "Ahora esta agencia le considera a usted incapacitado(a)."

 

Code 052 — Other Technical Eligibility Requirement

Computer-printed reason to applicant:

"You now meet eligibility requirements."

"Ahora cumple usted con los requisitos de elegibilidad."

 

Code 053 (TP 03, 14) – Needy and Eligible — Use this code if the applicant has been needy and eligible over an extended period of time (more than six months prior to application) but postponed applying and during this period lived at a level below the Department standards.

Computer-printed reason to applicant:

"You meet all eligibility requirements."

"Usted cumple con todos los requisitos de elegibilidad."

 

Code 055 (TP 03, 14, 18, 19, 22, 23, 24, 51) – Denied in Error — Use this code if a case is reopened after having been closed by mistake, either as a result of an erroneous report of death or an erroneous denial, including a denial made on presumptive ineligibility. Reassign the previous case number. Make the medical effective date as the date after the denial.

Use this code to open MQMB and QMB coverage in order to prevent a gap in QMB coverage. Code 055 will allow QMB eligibility to begin prior to the application file date.

Computer-printed reason to applicant:

"Your case was closed by mistake."

"Su caso fue cerrado por error."

 

2. Reasons for Denial of Aged, Blind, and Disabled MAO Applications and Cases

Reasons for denying applications or closing cases are classified into four major groups: (1) death of applicant or recipient; (2) ineligible with respect to need; (3) ineligible with respect to requirements other than need; and (4) miscellaneous reasons.

Select the code reflecting the primary reason for denial. If a reason producing ineligibility with respect to need and reason producing ineligibility with respect to some requirement other than need occur at the same time, use the code for need. If several events occur simultaneously, none of which, alone, would produce ineligibility with respect to need, but collectively they do make the recipient ineligible, use the code for the reason having the greatest effect.

Although the applicant or recipient will receive a card explaining action taken on his/her case, the worker should make an adequate interpretation of the decision to the applicant or recipient.

Computer-printed reasons to the applicant or recipient will be initiated by use of the appropriate closing code and the computer will automatically print out the appropriate reason to the recipient corresponding to the code used.

The statements that are to be computer-printed to the applicant or recipient are listed after each closing code. The Spanish translations are to assist workers in completing FL-4 (MAO) and Form h1801. The Spanish translation will not be included on the Form H1029 mailed by the State Office.

The appropriate denial code should be taken from the following list and entered on the Forms H1000-A/B. These codes may be used on both Forms H1000-A and H1000-B with any type program unless otherwise specified.

 

Death

Code 059 – Death — Use this code if an application is denied because of death of applicant, or active case is closed because of death or the recipient.

Do not use this code for deceased applications that are simultaneously opened and closed.

Computer-printed reason to applicant or recipient:

No reason necessary — no notice will be sent to applicant or recipient.

 

Ineligible with Respect to Need: Material Change in Income or Resources During Last Six Months

A change in income or resources should be regarded as material only if the additional income is substantial in relation to the need for assistance. A material change in income or resources may result from the conversion of nonliquid assets into cash or other non-income producing assets into income producing assets, as well as from earnings or other direct income. A material change in income or resources does not necessarily mean a change with respect to cash income. For example, a recipient who has been keeping house may go to live with another person who provides food, clothing, and shelter.

 

Earnings

Code 060 – Earnings of Applicant or Recipient — Use this code if an application is denied because of applicant's earnings from employment, or active case is denied because of a material change in income as a result of recipient's employment or increased earnings. The change in earnings must have occurred during the preceding six months. Earnings may be from self-employment, seasonal employment, increased employment, or higher wages.

Computer-printed reason to applicant or recipient:

"Your employment earnings meet needs that can be recognized by this agency."

"Su salario es suficiente para cubrir las necesidades que esta agencia puede reconocer."

 

Code 061 – Earnings of Spouse — Use this code if an applicant is denied because of earnings of his or her spouse, or active case is denied because of a material change in income as a result of employment or increased earnings of spouse. The change in earnings must have occurred during the preceding six months. Earnings may be from self-employment, seasonal employment, increased employment, or higher wages.

Computer-printed reason to applicant or recipient:

"Employment earnings of your husband or wife meet needs that can be recognized by this agency."

"El salario de su esposo o esposa es suficiente para cubrir las necesidades que esta agencia puede reconocer."

 

Support From Other Person

Code 066 — Use this code if an application is denied because of support from another person, or active case is denied because of the receipt of or increase in support from another person. The change must have occurred during the preceding six months.

Computer-printed reason to applicant or recipient:

"Income available to you from another person meets needs that can he recognized by this agency."

"El dinero que recibe de otra persona es suficiente para cubrir las necesidades que esta agencia puede reconocer."

 

Benefits – Pensions

Code 067 – RSDI — Use this code for applicants or recipients denied if the material change in income resulted, or will result from the receipt of or increase in benefits under the Federal RSDI program during the preceding six months.

Computer-printed reason to applicant or recipient:

"Income available to you from Social Security Benefit meets needs that can be recognized by this agency."

"La entrada que tiene a su disposición de los Beneficios del Seguro Social es suficiente para cubrir las necesidades que esta agencia puede reconocer."

 

Code 068 – Other Federal — Use this code if an application is denied because of receipt of a Federal benefit or pension other than RSDI, or active case is denied because of receipt of or increase in a Federal benefit or pension other than RSDI, during the preceding six months. Examples of such income include Veterans' Administration, Federal Civil Service Retirement, or SSI.

Computer-printed reason to applicant or recipient:

"Income available to you from other Federal benefit or pension meets needs that can be recognized by this agency."

"La entrada que tiene a su disposición de otros beneficios o pensiones federales es suficiente para cubrir las necesidades que esta agencia puede reconocer."

 

Code 069 – State or Local — Use this code if an application is denied because of receipt of a benefit or pension administered by a state or local government, or active case is denied because of receipt of or increase in a benefit or pension administered by a state or local government during the preceding six months. Examples include workmen's compensation benefits, State employees', teachers' or policemen's retirement.

Computer-printed reason to applicant or recipient:

"Income available to you from state or local benefit or pension meets needs that can be recognized by this agency."

"La entrada que tiene a su disposición de beneficios o pensiones locales o del estado es suficiente para cubrir las necesidades que esta agencia puede reconocer."

 

Code 070 – Non-Governmental — Use this code if an application is denied because of receipt of a non-governmental pension or benefit, or active case is denied because of receipt of or increase in a non-governmental benefit or pension during the preceding six months. Examples are pensions from United Auto Workers Union and other pensions financed by private industry.

Computer-printed reason to applicant or recipient:

"Income available to you from pension or benefit meets needs that can be recognized by this agency."

"La entrada que tiene a su disposiciòn de beneficios o pensiones es suficiente para cubrir las necesidades que esta agencia puede reconocer."

 

Code 071 – Other Income — Use this code if an application is denied because of receipt of, or active case is denied because of receipt of or increase in income during the preceding six months other than that covered by codes 060-070. Examples are income from investments or real property.

Computer-printed reason to applicant or recipient:

"Income available to you meets needs that can be recognized by this agency."

"La entrada que tiene a su disposición es suficiente para cubrir las necesidades que esta agencia puede reconocer."

 

Excess Assets

Code 072 — Use this code if an application is denied because of excess resources, or active case is denied because of receipt of or increase in resources during the preceding six months. Examples are cash, savings bonds, inheritance of money or property, and increase in income from investments or real property.

Computer-printed reason to applicant or recipient:

"Resources available to you from other property meets needs that can be recognized by this agency."

"Los recursos de otra propiedad que tiene a su disposición son suficientes para las necesidades que esta agencia puede reconocer."

 

Ineligible with Respect to Need: No Material Change in Income or Resources During Last Six Months

Decreased Medical Needs

 

Code 073 — Use this code if an applicant or recipient is ineligible because the need for medical or remedial care (available under the department's program) decreased during the preceding six months.

Computer-printed reason to applicant or recipient:

"Your need for medical care expenses that can be recognized by this agency is less."

"Se ha reducido la necesidad que esta agencia puede reconocer de gastos médicos."

 

Ineligible With Respect to Requirement(s) Other Than Need

If two or more reasons apply, code the one occurring first. If the occurrences were simultaneous, code the reason appearing first on the list.

 

Refusal To

Code 076 – Furnish Information — Use this code if an application or active case is denied because of refusal to comply with department policy or to furnish information necessary to determine eligibility. This code does not apply to applicants or recipients who fail to return their client-completed form. Code 091, Failure To Furnish Information, should be used in this circumstance.

Computer-printed reason to applicant or recipient:

"You did not wish to furnish enough information for this agency to establish eligibility for assistance."

"Usted no quiso darnos suficiente información para que esta agencia pudiera establecer su calificación para asistencia."

 

Code 077 (Form H1000-B Only) – Follow Agreed Plan — Use this code for those situations in which a recipient was granted assistance with the understanding that he would take certain steps to utilize resources that were not actually available at time of application but could be made available through recipient's efforts.

Computer-printed reason to applicant or recipient:

"You did not wish to follow agreed plan so that eligibility for assistance could be continued."

"Usted no quiso cumplir con el plan convenido para continuar su calificación para asistencia."

 

Other Requirements

Code 080 – Blind (Not Blind) Disabled (Not Disabled) — Use this code if a blind applicant does not meet the definition of economic blindness or a blind recipient is denied because his vision has been restored. Also, enter if a disabled applicant does not meet the definition of total and permanent disability or a disabled recipient is no longer totally disabled. If recovery from the incapacity is accompanied by employment or increased earnings, use codes 060 or 061.

Computer-printed reason to applicant or recipient:

Blind – "You do not meet the agency's definition of economic blindness."

Disabled – "You do not meet the agency's definition of total and permanent disability."

Blind – "Usted no cumple con la definición de ceguedad económica de la agencia."

Disabled – "Usted no cumple con la definición de incapacidad total y permanente de la agencia."

 

Code 081 – Not Enrolled in Medicare Part A — Use this code if the applicant is not enrolled for Medicare Part A benefits and therefore cannot qualify for Qualified Medicare Beneficiary (QMB) or the Qualified Disabled Working Individuals (QDWI) programs. Use the code to deny a QMB or QDWI case if the client becomes unenrolled in Medicare Part A.

Computer-printed reason to applicant or recipient:

"You do not have Medicare Part A benefits."

"Usted no tiene los beneficios de la Parte A de Medicare."

 

Code 083 (Form H1000-A Only) – 30 Consecutive Days Requirement — Use this code if an applicant has been denied because he does not meet the 30 consecutive day requirement.

Computer-printed reason to applicant:

"You have not lived in a Medicaid-certified long-term care facility for 30 consecutive days."

"Usted no tiene 30 días consecutivos de vivir en un establecimiento certificado por Medicaid para proveer atención de largo plazo."

 

Code 086 – Admitted to Institution — Use this code if an applicant or recipient has been denied because he is an inmate of or has been admitted to an institution.

Computer-printed reason to applicant or recipient:

"You have been admitted to an institution."

"Usted fue admitido en una institución."

 

Code 087 – Age — Use this code if an application or active case is denied because evidence proves ineligibility on the basis of age. This code does not apply to disabled recipients transferred to aged assistance on becoming 65 years old. In these cases use code 122, Category Change.

Computer-printed reason to applicant or recipient:
"You do not meet the age requirement."
"Usted no cumple con el requisito de edad."

 

Code 088 – Residence — Use this code if evidence proves applicant is ineligible on the basis of residence, or if a recipient is known to have moved out of the state or remained out of the state longer than the minimum time allowed. If a recipient has moved out of the state to obtain employment, support from relatives, or for other known reason, use the code for that reason, rather than code 088. If an applicant or recipient cannot be located, use code 095.

Computer-printed reason to applicant or recipient:

"You do not meet residence requirements for assistance."

"Usted no cumple con los requisitos de residencia para asistencia."

 

Code 089 – Citizenship or Legal Entry — Use this code if an applicant or recipient is ineligible because he is not a citizen nor a noncitizen lawfully admitted for permanent residence in the United States nor residing in the United States under color of law.

Computer-printed reason to applicant or recipient:

"You do not meet legal United States entry or citizenship requirement for assistance."

"Usted no cumple con el requisito para asistencia de entrada legal en los E.U., ni de naturalización."

 

Code 090 (Form H1000-A Only) – Prior Eligibility (Used for Simultaneous Open and Close Only) — Use this code if an applicant is either deceased or currently ineligible for assistance but was eligible for Medicaid coverage during a prior period.

Computer-printed reason to applicant:

"Medical assistance was granted during a prior period, but you are not eligible now for medical or financial assistance."

"Consiguió asistencia médica durante un periodo anterior, pero ahora no califica para asistencia médica ni financiera."

 

Code 091 – Failure to Furnish Information — Use this code only when an applicant or recipient fails to execute and return the completed eligibility form.

Computer-printed reason to applicant or recipient:

"You failed to complete and return the necessary eligibility form."

"No devolvió usted debidamente completada la forma necesaria para calificar."

 

Code 092 – Other Eligibility Requirement — Use this code if an application or active case is denied because applicant or recipient does not meet an eligibility requirement other than need not covered by codes 076-089.

Computer-printed reason to applicant or recipient:

"You do not meet eligibility requirements for assistance."

"Usted no cumple con los requisitos para calificar para asistencia."

 

Code 136 – Failure to Provide Proof of U.S. Citizenship — Use this code if an application or active case is denied because applicant or recipient is a U.S citizen or national and fails to provide proof of U.S. citizenship.

Computer-printed reason to applicant or recipient:

“(Last, First) is not eligible for Medicaid because proof of U.S. citizenship was not provided. As soon as this information is provided, this person may be eligible for Medicaid.”

“(Last name, first name) no llena los requisitos de Medicaid porque no presentó prueba de ciudadanía estadounidense. Una vez que esta persona presente la información, es posible que llene los requisitos de Medicaid.”

 

Miscellaneous Reasons

Code 094 – Appointment Not Kept — Use this code when an applicant or recipient is denied because: (1) he/she has failed to keep an appointment, and (2) he/she has made no response within 10 days to a follow-up inquiry.

Computer-printed reason to applicant or recipient:

"You failed to keep your appointment."

"Usted no vino a la cita qine tenía."

 

Code 095 – Unable to Locate — Use this code if an applicant or recipient is denied because he/she cannot be located.

Computer-printed reason to applicant or recipient:

"You cannot be located."

"No lo podemos localizar a usted."

 

Code 096 (Form H1000-A Only) – Application Filed in Error — Use this code if an application is to be denied because of being filed or pending in error or to deny a duplicate application, that is, more than one application filed for an individual in the same category.

Computer-printed reason to applicant:

No reason necessary - no notice will be sent to applicant.

 

Code 097 – Transfer of Property — Use this code if an application or active case is denied because of transfer of property, either real or personal, for purpose of qualifying for or increasing the need for assistance.

Computer-printed reason to applicant or recipient:

"You transferred property that has an effect on your eligibility for assistance."

"Usted transfirió propiedad que afecta su calificació; para asistencia."

 

Code 098 – Voluntary Withdrawal — Use this code only if an applicant does not wish to pursue his/her application further, or if a recipient requests that his/her grant be discontinued and the underlying cause for the withdrawal request cannot be determined. If a specific reason for the withdrawal can be determined, always use the applicable code. Do not use for applicant/recipients who have moved out-of-state. Code 088 will be used for this reason.

Computer-printed reason to applicant or recipient:

"You have requested that your application for or your grant of assistance be withdrawn."

"Usted ha pedido que su aplicación para, o su concesión de asistencia sea retirada."

 

Code 099 – Other Miscellaneous — Use this code only if an application or active case is denied for a reason which cannot be related in some respect to one of the preceding codes. Include under this code cases closed because the applicant or recipient is incarcerated, or was originally ineligible.

Computer-printed reason to applicant or recipient:

"You do not presently meet eligibility requirements."

"Al presente usted no cumple con los requisitos para calificar."

 

3. Reasons for Sustaining Aged, Blind, and Disabled MAO Cases

Notices to recipients for all redeterminations are computer-printed on special forms. These notices are "triggered" by the action code entered on the Form H1000-B. Since the reason is general, an adequate interpretation should be made to the recipient for any action taken to sustain the case.

 

Code

110 – "You remain eligible for medical coverage."

121 – Type Program Transfer — "You have been transferred to another type of medical assistance."

122Category Change — "You continue to be eligible for medical assistance."

(Note: Use Code 122 if both type program and category change.)