Optional State Supplementation (OSS) - No SSI 85 Local eligibility worker DHHS Form 3401 OR DHHS Form 3400 AND DHHS Form 3400-B Optional State Supplementation (OSS) for SSI recipient 86 Local eligibility worker SSI Recipient Request for OSS (Pickle) 16 eligibility worker DHHS Form 3400 and DHHS Form 3400-A Pass-Along Children (PAC) 20 State Office completes ex parte determination when child reaches age 18. to category to which child is being “ex parted.”) Qualified Disabled Working Individuals (QDWI) 50 CIU DHHS Form 3400 and DHHS Form 3400-A Qualified Medicare Beneficiaries (QMB) 90 Local eligibility worker DHHS Form 3400 and DHHS Form 3400-A Qualifying Individuals (QI) 48 DCEP (Eligibility is determined during the limited enrollment period) DHHS Form 3400 and DHHS Form 3400-A OR QI Application Refugee Assistance 70 Local eligibility worker DHHS Form 3400 Ribicoff 91 eligibility worker DHHS Form 3400 Specified Low Income Medicare Beneficiaries (SLMB) 52 Local eligibility worker DHHS Form 3400 and DHHS Form 3400-A Supplemental Security Income (SSI) 80 N/A N/A TEFRA/Katie Beckett 57 DCEP DHHS Form 3400 and DHHS Form 3400-A Waiver Services (WS) SSI 15 Local eligibility worker DHHS Form 3401 OR DHHS Form 3400 AND DHHS Form 3400-B Home and Community Based Services for SSI recipient (SSI-WS) 80 N/A N/A Working Disabled (WD) 40 CIU DHHS Form 3400 and DHHS Form 3400-A Former Foster Care (FFC) 61 Local eligibility worker DHHS Form 3400
101.12 Rights of Applicants/Beneficiaries (Eff. 01/01/14) Any individual applying for and/or receiving assistance has certain rights and responsibilities relating to receipt of Medicaid benefits. This section describes the rights and responsibilities of applicants/beneficiaries. 101.12.01 Opportunity to Apply (Eff. 01/01/14) Any individual who requests Medicaid assistance, including those who are clearly ineligible, must be allowed to apply immediately. Eligibility Workers must make a reasonable effort to assist the applicant in establishing eligibility. 101.12.02 Civil Rights and Non-Discrimination (Eff. 01/01/14) Persons applying for, or receiving benefits or services any program administered by or through the SC DHHS, shall not be discriminated against in any manner. The following non-discrimination laws apply to Medicaid: Title VI of the Civil Rights Act of 1964 prohibits discrimination based on race, color, or national origin. V, Section 504 of the Rehabilitation Act of 1973, as amended, prohibits discrimination based on handicap. Title II, Section 202 of the Americans with Disabilities Act of 1990, guarantees equal opportunity for qualified individuals with disabilities in employment, public accommodations, transportation, public service, state and local government services and communications. This Act requires that interpreters be available for applicants/beneficiaries, if needed. The Age Discrimination Act of 1975 prohibits discrimination on age. Any individual who feels that he/she has been subjected to such discrimination may file a signed, written complaint within 180 calendar days of the alleged discriminatory act, by mailing the complaint to: South Carolina Department of Health and Human Services Attn: Civil Rights Division Post Office Box 8206 Columbia, South Carolina 29202-8206 All complaints will be investigated in accordance with and federal laws and regulations. 101.12.03 Confidentiality of Information (Rev. 10/01/13)