For applications received from DHEC, the following procedures apply:
DHEC must enter the date of receipt in the top right corner of the DHHS Form 3400, which includes a provision for Family Planning. The date of receipt is the date the Applicant completed and signed the application form at DHEC. The DHEC date of receipt is considered the date of application.
When Family Planning applications sent by DHEC staff are accompanied by the DHEC 1591, Family Planning Applications MAILED to DHHS, use the following procedure:
On the DHEC 1591, place a check beside the name of each application received.
Sign and return the DHEC 1591 to the originator acknowledging receipt of the applications.
DHEC must make every effort to ensure that each application is signed, all questions are answered, and the applications are completed legibly.
Copies are accepted. DHEC may also use the VCME web tool to verify citizenship, and a stamped copy of the verification may be sent with the application.
The Family Planning eligibility requirements include non-financial and financial requirements.
Identity MPPM 102.02
State Residency MPPM 102.03
Citizenship/Alienage MPPM 102.04
Enumeration/SSN MPPM 102.05
Assignment of Rights to Medical Support MPPM 102.07
Applying for and Accepting other Benefits MPPM 102.08
If the Applicant/beneficiary does not meet citizenship/alienage requirements, eligibility for Family Planning services cannot be approved.
Family income cannot exceed 194% of the FPL MPPM 103.01
204.05.04 Family Planning Eligibility Decisions
Procedure for Determining Family Planning Eligibility
If Applicant is eligible for full benefits under MAGI rules, the worker will:
Virtually print the MAGI workbook into the case record in OnBase
From the HMS49 screen, press the PF3 key to access the HMS07 screen
Select the members that you want to include in the budget group. Press the F16 key to access to HMS59 screen.
On the HMS59 screen, enter the PCAT, the members that are applying and non-applying. Enter “ADD” in the action field
Enter $0.00 on the Countable Income filed on the ELD01 screen.
On the MEDS NOTES screen, enter the actual countable income and FPL from the MAGI workbook.
Complete Make Decision on ELD01.
Make sure the begin date for all members is correct on ELD02.
Complete Act on Decision.
Virtually print the MAGI workbook into the case record on OnBase.
If Applicant is ineligible for full benefits under MAGI rules, the worker will:
Annotate the MEDS NOTES screen to indicate that the application was reviewed for eligibility.
Applications processed in MEDS for individuals who do not have Medicare and who are either denied for full benefits or approved for Family Planning (PCAT 55) must be referred to the FFM. An email must be sent to FFMTransfer@spmail.scdhhs.gov.
204.05.05 Family Planning Special Case Considerations
Since Family Planning is not an emergency service, emergency services are not covered for an individual in the Family Planning payment category. (Refer to MPPM 102.04.11.)
Individuals under age 19 who apply for Family Planning are considered a household of one. In determining eligibility for this group, the state considers only the income of the applicant.
204.05.06 Family Planning Verification and Budgeting
The Eligibility Worker must accept the Applicant/beneficiary’s declaratory statement regarding income. The Eligibility Worker must complete systems checks (IEVS, SDX, Wage Match, and BENDEX). If the Medicaid Eligibility Worker discovers a discrepancy, the Applicant/beneficiary must be contacted for an explanation. For more information regarding identity verification, refer to MPPM 201.
The net monthly income is measured against 194% of the FPL. If income is at or below 194% of the FPL, the Applicant is income eligible. (Refer to MPPM 103.01.) For more information regarding household composition, refer to MPPM 202.
204.05.07 Family Planning Retroactive Coverage
For FP, if retroactive benefits are requested, a separate determination must be made for each month using the reported income for each month. Retroactive benefits may be considered for up to three calendar months before the month of application. (Refer to MPPM 101.05).