16 Del. Admin. Code § 20000-20103
In accordance with section 1413(b)(1)(A) of the Affordable Care Act, the agency must accept an application from the applicant, an adult who is in the applicant's household, as defined in 42 CFR § 435.603(f), or family, as defined in section 36B(d)(1) of the United States Code (U.S.C.), an authorized representative, or if the applicant is a minor or incapacitated, someone acting responsibly for the applicant, and any documentation required to establish eligibility -
The Application, Affidavit of Citizenship and Responsibility Statement must be signed by the individual or a representative of their choice. For individuals who are minors or incapacitated a signature is required by someone acting responsibly on the applicant's behalf. The date of application is the date the application is received by LTC Medicaid Office.
42 CFR 435.906; 42 CFR 435.907(a) and Social Security Act 1943(b)
The Federal regulation at 42 CFR 435.911 requires that Medicaid determine eligibility within 90 days for applicants who apply for Medicaid on the basis of disability. This time standard covers the period from the date of application to the date Medicaid mails notice of its decision to the applicant.
The DSS Medicaid worker must explain this 90-day time standard to the applicant or representative. It must be emphasized to the applicant or their representative, that all documentation needed for the worker to determine Medicaid eligibility must be received by the date indicated on the "We Need" letter (Form 415) or the application will be denied. In cases where verification is incomplete, the worker will give the applicant 15 days to return the information on the initial "We Need" letter (Form 415). The date by which all documentation must be received must be clearly noted on this form.
The Medicaid worker will automatically give all applicants an extension of 15 days, if needed, using a second "We Need" letter (Form 415) to note the required documentation and the deadline date. At the request of the applicant, a second extension of 15 days may be granted using a third Form 415. With supervisory approval, a further extension may be granted in cases with unusual circumstances. Unusual circumstances include, but are not limited to, awaiting placement in a Medicaid nursing facility bed or difficulty obtaining an out-of-state deed. Medicaid is held to the 90 day timeliness standard except in unusual circumstances. If the information is not received by the given deadline date, the application will be denied.
It is the applicant or representative's responsibility to obtain the documentation needed to determine the applicant's eligibility for Medicaid. The applicant should provide the required documentation by the deadline date. The applicant will be given an extension of 15 days via a second Form 415. An additional 15 day extension will be granted upon the applicant/representative's verbal or written request. A further extension is not granted except in cases of unusual circumstances.
16 Del. Admin. Code § 20000-20103
22 DE Reg. 66( 7/1/2018) (Final)