Denying an Application (Ongoing or PQ)

An application may only be quick denied for any of the following reasons:

  • Age 65 (All applicants requesting coverage are age 65 or over and no eligible children in the home)
  • Receipt of SSI (All applicants are receiving SSI and no eligible children in the home, unless the woman is under age 56 and eligible for UWHS or is applying for MPW)
  • Receives/Entitled to Medicare (All applicants are receiving or entitled to Medicare and no eligible children in the home unless the participant is applying for MPW)
  • Duplicate Applications (Only to be used when multiple applications have been received for the same household requesting coverage for the same time period)
  • Participant’s self-attested income is over the threshold for all participants

 

NOTE: MEDES automatically denies FFM Applications where all adult applicants are age 65 or older and there are no children or pregnancies listed on the application. An Application Case (AC) is created and has a status of ‘Denied’ with a reason of ‘AGE OUT 65’. An IM-33R-FFM is sent.

 

NOTE: Authorize the Application Case for zero benefits if applicants do not share at least one denial reason, and are not eligible for any benefit. A Product Delivery Case is created with zero benefits. See the Authorize an Application Case guide.

 

An IM33R notice is automatically generated and sent to the applicant upon denial of Ongoing Health Benefits. An IM-33RPQ is automatically generated and sent to the applicant upon denial of Prior Quarter (PQ) benefits.

 

Denying an Application Case (AC) is used when all of the applicants are ineligible based on the same eligibility-factor. The only exception is outlined in the MEDES Update Document.

 

TO DENY AN APPLICATION CASE

1. From the Application Case > Eligibility Checks sub-tab
2. Select the Check Eligibility hyperlink

NOTE: All household members must have a DCN assigned before running eligibility check

3. Select Yes in the Check Eligibility popup box
4. Select Programs sub-tab

NOTE: Ongoing Health Benefit Applications and PQ Applications will be listed separately. Denial is determined individually for either or both based on the reasons listed above

5. Select Deny
6. Select the dropdown menu in the Denial Reason field from the popup box
7. Select the appropriate reason for the denial

NOTE: You do not need to make a note in the Deny Program popup box

8. Select Save. The status of the program changes from Pending to Denied

NOTE: If the program status does not change, press F5 key to refresh

9. Add a note on the Head of Household’s Person Page > Client Contact sub-tab > Notes folder describing the action taken. See MEDES Notes & Comments for more information on notes