Provider Notice issued 12/12/14

​Required Use of Application for Benefits Eligibility (ABE) for LTC Providers

This Notice informs LTC providers that effective November 1, 2014 all LTC providers submitting applications for residents who are applying for Medicaid eligibility are required to use the on-line application system, ABE. However, the Department of Human Services (DHS) will accept paper applications received until seven days after this notice. Thereafter, LTC providers submitting applications must use ABE.

Completion of form HFS 3654 is a requirement of eligibility for long term care benefits. LTC facilities are encouraged to assist the person applying for Medicaid assistance by ensuring that form HFS 3654 is completed and submitted with the application. Failure to submit this form with the application, or with the requested verifications, may cause a delay in the processing of the application. Upload the completed form when submitting an ABE application. Form HFS 3654 Additional Financial Information for Long Term Care Applicants (pdf) has been improved and revised. A link to the form has been provided and the new version is available for immediate use.

The Department periodically completes form revisions due to changes in statute, rulemaking or policy. Providers should frequently check the HFS/DHS websites to ensure that they are using the most current version of the form.

Resources to assist providers using ABE are available on the Healthcare and Family Services Web site. An August 27, 2014 presentation titled, “Completing an ABE Application for LTC Facilities (pdf)” provides step-by-step guidance in using ABE. A September 24, 2014 video presentation, one of six ABE seminars that were given throughout the state, was recorded and posted on the HFS Web site.

Questions regarding this Notice may be directed to the Bureau of Long Term Care at 217-782-0545.

James M. Parker, Acting Administrator
Division of Medical Programs