EE6
Timely Determinations
CMS-required outcome
Individuals who apply for Medicaid based on disability receive an eligibility determination within 90 days and all other applicants receive an eligibility determination within 45 days.
Default metrics
- Percentage of determinations (individuals) whose eligibility is based on non-MAGI methodologies which took less than or equal to 90 days (use Performance Indicator Data #12 'Processing Time for Determinations' submitted to CMS)
- Percentage of determinations (individuals) whose eligibility is based on MAGI methodologies which took less than or equal to 45 days (use Performance Indicator Data #12 'Processing Time for Determinations' submitted to CMS)
- Percentage of determinations (individuals) whose eligibility is based on MAGI methodologies which took less than or equal to 45 days (use Performance Indicator Data #12 'Processing Time for Determinations' submitted to CMS)
- Number of undetermined MAGI related applications (individuals) that are greater than 45 days from when they were received.
- Number of undetermined non-MAGI related applications (individuals) that are greater than 90 days from when they were received.
Regulatory sources
- For states, District of Columbia, Northern Mariana Islands, and American Samoa:
- - 42 CFR 435.911-912(range cite; opens 435.911)
- For Guam, Puerto Rico, and the Virgin Islands:
- - 42 CFR 436.901