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Third Party Liability 4.4.4

Each applicant who is legally able must assign to the Department rights to third party resources, unless s/he has good cause for not cooperating. A third party resource is a person, entitlement, or program that is liable for payment of all or a part of an individual’s medical expenses. In most instances, the third party is an insurance company.

An applicant must surrender to the District Government any reimbursements or other payments received from an insurance company, court settlement, or other source for health care or medical services that were covered, and paid for, by the District’s Medicaid or medical assistance programs. See Part V, Chapter 3: Program Requirements and Sanctions, Third Party Requirements, for additional information.

PROCESSING APPLICATIONS 4.5

Applications for the Alliance program may be submitted by mail, facsimile, or in person at any IMA service center. Applicants should use the Combined Application that is used to apply for multiple programs. Applicants may also submit their applications to an out-stationed IMA employee working in a community setting. Every applicant has the right to file an application on the same day that s/he contacts IMA. An application is considered to be filed when the signed and dated application form is received by the IMA representative.

Except as otherwise stated below, applications for the Alliance program are processed in accordance with policies established for AR Medicaid in Part III: Chapter 1, Application Processing: Filing an Application.

Who May File the Application 4.5.1

Any individual or either spouse of a married couple may file the application for Alliance benefits. The applicant may designate an authorized representative to act on his/her behalf. See Part III: Chapter 1, Application Processing: Filing an Application, for additional information on designating an authorized representative. An applicant has the right to refuse to name an authorized representative.

Application Review 4.5.2

Effective September 27, 2011, a face-to-face interview with the applicant is required to complete applications for Alliance benefits. During the face-to-face interview, the SSR shall:

 inform the applicant of his/her rights and responsibilities;  explain the program and related services;  outline the conditions of eligibility and indicate what verification and information are necessary to determine eligibility;  notify the applicant that information s/he provides will be matched by computer with information from other local, state and federal agencies; and  explore and resolve any unclear or incomplete information.

Request for Waiver of Face-to-Face Interview 4.5.2a

Applicants may request a waiver of the face-to-face interview requirement on the basis of being unavailable during the application period due to hospitalization, disability, or being aged 65 or older. Applicants (or their authorized representatives) must submit the following supporting documentation to be considered for a waiver: