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.
Terms Used In Idaho Code 31-3503E
- Applicant: means any person who is requesting financial assistance under this chapter. See Idaho Code 31-3502
- Application: means the combined application for state and county medical assistance pursuant to sections 31-3504 and 31-3503E, Idaho Code. See Idaho Code 31-3502
- Board: means the board of the catastrophic health care cost program, as established in section 31-3517, Idaho Code. See Idaho Code 31-3502
- Clerk: means the clerk of the respective counties or his or her designee. See Idaho Code 31-3502
- Department: means the department of health and welfare. See Idaho Code 31-3502
- Hospital: means a facility licensed and regulated pursuant to sections 39-1301 through 39-1314, Idaho Code, or an out-of-state hospital providing necessary medical services for residents of Idaho, wherein a reciprocal agreement exists, in accordance with section 31-3503B, Idaho Code, excluding state institutions. See Idaho Code 31-3502
- Medicaid eligibility review: means the process used by the department to determine whether a person meets the criteria for medicaid coverage. See Idaho Code 31-3502
- Medically indigent: means any person who is in need of necessary medical services and who, if an adult, together with his or her spouse, or whose parents or guardian if a minor or dependent, does not have income and other resources available to him from whatever source sufficient to pay for necessary medical services. See Idaho Code 31-3502
- Obligated person: means the person or persons who are legally responsible for an applicant including, but not limited to, parents of minors or dependents. See Idaho Code 31-3502
- person: includes a corporation as well as a natural person;
Idaho Code 73-114
Resources: means all property, for which an applicant and/or an obligated person may be eligible or in which he or she may have an interest, whether tangible or intangible, real or personal, liquid or nonliquid, or pending, including, but not limited to, all forms of public assistance, crime victims compensation, worker’s compensation, veterans benefits, medicaid, medicare, supplemental security income (SSI), third party insurance, other insurance or apply for section 1011 of the medicare modernization act of 2003, if applicable, and any other property from any source. See Idaho Code 31-3502 State: when applied to the different parts of the United States, includes the District of Columbia and the territories; and the words "United States" may include the District of Columbia and territories. See Idaho Code 73-114
(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.