101.04.03 SUBMITTING AN APPLICATION AND APPLICATION FILE DATE

An application for Medicaid may be filed in any of the following described submission methods. The application file date is the date a valid application form is received by the agency: • In person in any regional office, official out-stationed location or other location outside the regional office where eligibility staff are on official duty, such as a nursing home, hospital or other public facility. The filing date is the date received by the office or other location. • By mail in any regional office - o Applications received by mail which arrive after the end of the month but were postmarked by the last day of the month will be considered to have been received by the regional office on the last day of the month in which they are postmarked. • By fax in any regional office. The filing date is the date received by the agency (central or regional office, whichever office first receives the application). An original signature is not required, • By on-line submission of the application to DOM. The filing date is the date received by the agency (central or regional office). An electronic signature is accepted for applications filed on-line with the agency. • By on-line submission of the application through Common Web Portal. The filing date is the date received by the agency (central or regional office). An electronic signature is accepted for applications filed on-line with the Common Web Portal. • By on-line submission of the application to the Federally Facilitated Marketplace (FFM), which is then transferred to DOM. The filing date is the date the application is received by the FFM. An electronic signature is accepted for applications filed on-line through the FFM. • By telephone via a telephonically recorded application process. By telephone via a telephonically recorded application process. The date of filing is the date the telephonic signature is recorded, which should be the date of the telephone interview. Telephone applications are conducted by Medicaid office staff completing the appropriate paper application based on applicant statements that are recorded, including the telephonic signature. A request for a telephonic application received by central office or regional office staff must be coordinated for the interview to be recorded. Upon request, office staff will schedule the telephone interview with the applicant. ABD telephone applications may be accepted by a regional office when circumstances prevent the applicant from applying or being interviewed in any other manner. The date of the telephone interview is the date of filing. The telephonic signature must be recorded. Once a signed and dated application has been received by the agency, it must not be altered by adding, changing or deleting any information. During an interview, an applicant may make changes to the information on an application. If the interview is in-person, the applicant must initial the changes. If the change to information on the application is reported in any other manner, it must be documented in the case record and/or in the case narrative, but not on the application form.