CHIP Policy

1701-1 What is an Application?

Effective Date: January 1, 2024

No Previous Policy

 

The Medicaid agency will accept applications in the following ways:

 

1. Paper Application for Medical Assistance  

1. All paper applications must have an original signature. The agency will consider the following as an original signature:
   1. Signed paper application received by mail or in person at a DWS employment center.
   2. A signed paper application sent by FAX.
   3. A telephonic signature
2. If the agency receives an unsigned paper application, the agency will send a signature page to the applicant to sign and return.   

2. Online Applications for Medical Assistance

1. Applicants may apply online.  
2. The online application process includes an online signature that meets state law as a legal signature.  The applicant must complete the online signature for the application to be valid. Electronic, handwritten or telephonic signatures transmitted via any other electronic transmission must be accepted.

3. Non-Medical Review Forms as Applications

Households with an open non-medical assistance case may use the review form as an application for medical programs. The review form must be signed.  

1. The individual or worker must write on the review form what assistance the individual wants to apply for.
2. The individual or worker can write a new household member’s name on the review form and state the individual wants to apply for medical assistance for that person.
3. The review form with the request for assistance must be submitted to DWS.

4. Telephone Applications  

1. Applicants may ask to apply by telephone.   
2. Individuals must complete all eligibility sections, including the TPL information of an application.
3. The applicant must sign within the application processing period. The applicant may sign by
   1. Telephonic signature

1. Documented and stored by the agency.
2. A confirmation receipt will be sent to the applicant via the communication method they have selected.
   2. Mailed application returned no later than the last day of the application processing period received

·       In person

·       By mail or

·       Fax 

5. Verbal Request to Add Medical Assistance to a Pending Application

1. An applicant who has a pending application for other types of assistance may make a verbal request to add CHIP to the application.
2. The applicant must make the verbal request while the application for other assistance is still pending, and within 30 days of the application date.  If the 30th day is a non-business day, the applicant has until the first business day following the 30th day to make the verbal request.  The date the applicant makes the verbal request to add CHIP is the date of application for medical assistance.  
3. If the agency has approved or denied the application for other assistance, or if it is more than 30 days after the application date, the applicant cannot make a verbal request to add CHIP.  The applicant must submit a new application to request medical assistance.

6. The Following Situations are Considered New Applications, but do not Require an Application Form  

1. A household with an open medical case can add a new household member by contacting the eligibility agency.   Request information about the new household member as needed to determine eligibility. A signature is not required. TPL information for the new household member must be requested and the voter registration option must be offered to a new adult household member.  
2. When medical assistance ends because the individual did not return requested verification for a change report, the date the individual provides all of the requested verification is a new application date if it is submitted by the last day of the month immediately following closure. A signature is not required. TPL, voter registration and rights and responsibilities information can be waived.  
3. If medical assistance ends for failure to complete the review, an individual can re-apply by responding to the review request within 3 months following the review closure. No signature is required.  

·       The response may be a phone call, submission of the review papers or verification documents.  

·       If the individual provided updated TPL information during the failed review period, do not request it again to complete the review.  

·       TPL, voter registration and rights and responsibilities information can be waived if the worker completed these in the review period.   

4. When an application is denied because the applicant fails to provide all requested verification, the applicant may provide all of the requested verification within 30 days of the denial notice date. The date the verification is received is a new application date.  No signature is required. TPL, voter registration and rights and responsibilities information can be waived. If a medical assistance case is closed for more than one calendar month, the individual must complete and sign a new application form.   

7. Unsigned Applications

If the agency receives an unsigned application for medical assistance, require the applicant to complete the signature page. If the applicant completes and returns the signature page within the application-processing time, retain the date of application. (See Section 1701-2) If the applicant does not return the signature page within the application-processing time, the agency will deny the application.

• If the individual returns the completed signature page within the 30 days following the date the denial notice was mailed, consider the date of receipt a new application date with a new retroactive period.  

8. Incomplete Applications

When the application is not complete enough for the agency to determine eligibility, the agency will contact the applicant and offer ways for the applicant to complete the form. The applicant must complete the form by the end of the application-processing period or the agency will deny the application.