OBSOLETE POLICY CHIP MANUAL |
Effective: October 1, 2012
To enroll in CHIP an individual must apply by completing an application form. (See Section 701-1 for more information about effective dates.) The applicant has several choices of how to complete and file an application. In some situations, a signed application is not required including children losing Medicaid or UPP coverage. (See Sections 602, 701, 804-3 and 220-8 for more information about CHIP enrollment for children who lose Medicaid or UPP eligibility.)
Paper application - Applicants may pick up a paper application at an eligibility agency office, print one from the website or ask that one be mailed to them. A paper application must be completed, signed and dated and then submitted to the eligibility agency office in person, by mail, or by fax.
Telephone applications - Applicants may ask to apply by telephone. The agency has the discretion to decide when to complete applications over the phone. When applying by phone, the agency will send a copy of the application form to the applicant. The applicant must sign and return the signature page to the appropriate office no later than the last day of the application processing period.
Online Applications - Applicants may complete an on-line application and submit it via the Internet. When applying online, applicants submit an online signature. The online signature is accepted as a legal signature. The applicant can print a copy of the application and other important information provided for their own records.
Review Form - If an individual or household is currently open for CHIP, a review form may be used as an application for another type of assistance, or for a new household member. The individual must indicate on the form what type of assistance is being requested, who the household wants to cover, and the date. The review form with the request must be delivered to a local office.
The review form may also be used as an application when it is received the month immediately following the review month. (See 701-3)
Verbal Request to Add CHIP to a Pending Application - An applicant who has a pending application for other types of assistance may make a verbal request to add CHIP to the application.
The applicant must make the verbal request while the application for other assistance is still pending, and within 30 days of the application date of the pending application. 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 a medical program, including CHIP, is the date of application for medical assistance.
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 must submit a new application.
Incomplete Applications - When the application is not complete enough to determine eligibility, the agency will contact the applicant and offer ways for them to complete the form. The form must be complete by the end of the application processing period to retain the application date. If the applicant does not complete the application, the agency will deny the application.
An unsigned application is not complete and the department cannot determine eligibility until it receives the signature. The applicant must return the signed signature page no later than the last day of the application processing period, or the agency will deny the application. (See #4 below)
Application Date:
The eligibility worker must establish the date of application to determine when CHIP coverage can begin. (See Section 602 for effective dates of enrollment and Section 602-1 about the 4 day grace period.)
The application date will be established as follows:
Paper Applications:
The date of application is the date the eligibility agency receives a completed, signed paper application by the close of business on a business day.
Except for the situation described in C., the date of application is the next business day when a paper application is received after business hours at an agency office, other than an outreach office.
When a paper application is received at a local office (other than an outreach office) after the close of business on the last business day that the agency’s offices are open in the week and before the offices open on the first business day of the next week, the application date is the previous Friday unless Friday is a state holiday. If Friday is a state holiday, the date of application is the next business day.
Applications sent via Fax:
When the eligibility agency receives an application sent by FAX on a business day by the close of business, the date of application is that day.
When the eligibility agency receives an application sent by FAX after the close of business on one business day, on a state holiday, on a Saturday or Sunday and by the close of business on the next business day, the date of application is that next business day.
Applications received online through the "mycase" system
The application date for an application received online through the "mycase" system is the date the application is filed online.
Applications received at Outreach Locations:
When an application is received at an outreach office location at a time the outreach office is staffed, the application date is the date the application is received by the outreach worker.
When an application is received at an outreach office location at a time the outreach office is closed, the application date will be the last business day that a DWS staff person was available at the outreach office to accept or collect applications.
Unsigned or Incomplete Applications
If the application has not been signed when the local office or outreach office receives it, the applicant must provide a signed signature page within the application processing time to retain the original application date.
An applicant who files an application online must complete the online signature. If they fail to complete the online signature, the agency will send a signature page to the applicant. The applicant must sign and return the signature page within the application processing period to retain the date of the online application.
If the signature page is received within 30 days after the application has been denied for lack of a signature, the date the signature page is received will be the new application date. If the signature page is received more than 30 days after the application has been denied, the applicant will have to reapply.
If an application is incomplete, the agency will contact the applicant and offer ways for them to complete it. The application must be completed by the end of the application processing period, or it will be denied. If the application is completed in the 30 days after a denial, the new application date is the date the application is completed.
When a worker completes an application over the phone with an applicant, the date of application is the date the application is taken over the phone by the worker. The applicant must return a signed signature page within the application processing time to retain the original application date. Signed signature pages received after the application has been denied will be treated in accordance with the provisions of 4C.
When a household with an open CHIP case asks for CHIP for an additional person, the application date is the date the household requests CHIP by the close of business on a business day. If the request is mailed to the office, the date of application is the date the agency receives the written request. To determine the date of application when a CHIP enrollee asks to change from CHIP to Medicaid, PCN or the UPP program, follow the policy in the Medicaid manual, section 703-2 #6.
When a household member makes a verbal request to add CHIP to an application pending for other types of assistance within 30 days of the pending application date, the date the applicant makes the verbal request is the date of application.
If an applicant is ineligible in the application month, the agency may use the same application form to determine eligibility for the following month. In this case, the new application date is the first day of such following month.
Applications received when an application is already pending:
If a new application is received while an application is already pending, the application date does not change.
The agency reviews the second (or third, etc.) application for any new information.
If new information is discovered or needs to be addressed, it becomes a part of the existing application process.
Application received after CHIP benefits are issued.
Review new application for changes and new information.
If new information is discovered, consider the new application to be a change report and take appropriate action. (See Section 804 for CHIP changes.)