Verification Not Provided
Deny (MA-LTC applicant) or close (MA-LTC enrollee) eligibility for payment of LTC services if the person does not provide verification required to determine MA-LTC eligibility by the end of the processing period. Do not deny or close eligibility for basic MA if the verification is not required to determine MA eligibility.
Send the Medical Assistance Payment of Long-term Care Services DHS-4915 notice if you are closing or denying LTC services and the MAXIS notice is not created.
When denying or closing MA-LTC eligibility for failure to provide verification you must notify the waiver case manager or LTCF. Send one of the forms listed below to notify the appropriate person/facility of the denial or closure:
- Lead Agency Case Manager/Worker Communication Form (DHS-5181) (PDF).
- LTC/County Communication Form (DHS-3050) (PDF).
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Reporting and Verification