OBSOLETE POLICY CHIP MANUAL |
Special Notice: Effective March 18, 2020 until the end of the Health Emergency due to COVID-19, refer to the Q&As in this manual for special instructions about:
· Applications received from testing sites for the COVID-19 uninsured testing.
· Applications submitted by an Authorized Representative with the form 114COVID.
Application Requirement
Individuals must complete and sign an application to apply for CHIP. The application must be received by a DWS office, outreach office or the Federally Facilitated Marketplace (FFM). After signing an initial application, a client does not always have to submit a signed application for the eligibility agency to consider a new application date.
The following sections define what an application is, how the agency determines the application date, and the eligibility determination process. (See Section 102 for client responsibilities.)
The Federally Facilitated Marketplace will only accept the Federal Single Streamlined application, online or on a paper application.
The Medicaid agency will accept applications in the following ways:
Paper Application for Medical Assistance
All paper applications must have an original signature.
The agency will accept a signed paper application sent by FAX as an original signature.
If the agency receives an unsigned paper application, the agency will send a signature page to the applicant to sign and return.
Online Applications for Medical Assistance
Applicants may apply online.
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 or handwritten signatures transmitted via any other electronic transmission must be accepted.
Federally Facilitated Marketplace (FFM) Account Transfers
Applicants have the option to apply for medical assistance through the state Medicaid and CHIP agency or through the single streamlined application through the FFM.
For individuals assessed eligible for Medicaid/CHIP by the FFM, their account will be transferred to the state Medicaid/CHIP agency for a final determination. This may include an initial application, a FFM review or a change report through the FFM. (See section 220-9 to determine what actions to take to coordinate with FFM plans.)
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.
The client or worker must write on the review form what assistance the client wants to apply for.
The client or worker can write a new household member’s name on the review form and state the client wants to apply for medical assistance for that person.
The review form with the request for assistance must be submitted to DWS.
Telephone Applications
Applicants may ask to apply by telephone.
If an application is completed over the phone, the eligibility worker will mail a copy of the completed application to the applicant to review.
The applicant must sign and return the signature page within the application-processing period.
Clients must complete TPL information.
Verbal Request to Add Medical Assistance 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. 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.
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.
The Following Situations are Considered New Applications, but do not Require an Application Form
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.
When medical assistance ends because the client did not return requested verification for a change report, the date the client 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.
If medical assistance ends for failure to complete the review, a client 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 client 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.
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 client must complete and sign a new application form.
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 701-1) If the applicant does not return the signature page within the application-processing time, the agency will deny the application.
If the client 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.
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.