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Exit Survey
 
 
State
 
 
 
If additional documentation is required, please describe.
   
 
 
 
If no additional documentation is required, are there any additional action needed to complete the MSP app?
   
 
 
 
IS the applicant notified of the need to provide additional information/documentation to complete the MSP application?
 
Yes
 
No
 
Other
 
 
 
 
If so, please describe the notice process.
   
 
 
 
If an application is sent with the letter, is a pre-filled application form sent? 
 
Yes
 
No
 
Other
 
 
 
 
If the applicant must submit additional information, how do they submit it to the state Medicaid agency? ex. online, mail, by phone, etc.
   
 
 
 
Is there a time limit in which an applicant must provide additional information?
   
 
 
 
Does your state Medicaid ageny share the LIS leads data with your agency?
   
 
 
 
Does your state Medicaid agency track whether applicants respond to the LIS leads data? Does the new application data of into a single "case file"?