101.04.08 WHERE TO FILE THE APPLICATION

Applications should be filed with or directed to the regional office that serves the applicant’s county of residence. However, applications for individuals living in another RO’s service area must be accepted by any regional office. The regional office must review each application upon receipt and confirm the accuracy of the address if there is a question about the responsible office. The following guidelines should be followed based on the appropriate situation: Application Filed with Correct RO Date stamp the form if received as a hard copy. Register the application within 48 hours (certain applications are auto registered, such as Account Transfers from the FFM or LIS applications from SSA). Also, scan and upload the application, and any other documents provided, to the appropriate folders in MEDS under case documents. If ABD application received in-person for coverage groups requiring telephonic interview, conduct interview if possible If interview cannot take place, or if application received by mail or electronically, schedule required telephonic interview in writing within 10 calendar days of receipt of application. MAGI applicants applying in person must be offered assistance, if requested. Application Filed with Incorrect RO Accept the application and date stamp; Register the application with the appropriate county and RO within 48 hours of receipt. Also, scan and upload the application and any other documents provided to the appropriate folders in MEDS under case documents. Applications that are auto registered (CWP/FFM/LIS) in the wrong RO should be transferred within 48 hours of receipt. All applications that are not transferred within 7 days or applications for which a 307 has If ABD application received in-person for coverage groups requiring telephonic interview, conduct interview, if possible; offer assistance to MAGI applicants, if requested. Inform the applicant of the RO that will handle the case. already been issued should not be transferred until after the case is completed. Combination ABD/MAGI Households Combination ABD/MAGI households are defined as cases in which there is both an ABD applicant or recipient living in the same household as MAGI applicants or recipients. ABD and MAGI individuals living in the same household are treated as one case in the system and one record is created, with the person designated as the head of household as the primary case head. The regional office that serves the household’s county of residence is the office responsible for the ABD/MAGI members, regardless of where the application is filed or whether the ABD and MAGI applications are filed at the same time or separately. If an ABD applicant/recipient is institutionalized which causes other ABD/MAGI applicants or recipients to live apart from the institutionalized individual but the household remains bound by relationship (marriage, parent/child), two separate cases are set up in the system; one for the at-home household members and one for the institutionalized member. One case record is established with the person who is the head of household of the ABD institutionalized case as the primary case head. The regional office that serves the county where the nursing facility is located is responsible for both ABD and MAGI cases Applications Filed with the Federally Facilitated Marketplace (FFM) Applications for MAGI-related Medicaid or CHIP may also be filed on-line with the Federally Facilitated Marketplace or FFM. The FFM is also referred to as the health insurance exchange. An FFM operates in states that choose not to build their own state-operated exchange. The FFM for MS determines eligibility for enrollment in qualified health plans and insurance affordability programs and assists in determining eligibility for Medicaid and CHIP by verifying certain application information through a Data Services Hub. If an individual or family appears to be eligible for Medicaid or CHIP based on Hub verified data, the FFM transfers the electronic account, referred to as an Account Transfer, to MS for completion of the application. • An individual who applies for Medicaid coverage in MS through the FFM has their electronic application information transferred to DOM via a process referred to as an Account Transfer (AT). • AT’s received from the FFM are evaluated for MAGI-related coverage initially but if any household member indicates on the AT that a disability exists or if the individual is aged, that household member is evaluated for ABD coverage. • The “insurance affordability program” referenced above is a term that includes Medicaid, CHIP and coverage in a qualified health plan through the FFM that provides advance payments of a premium tax credit or cost-sharing reductions to qualified individuals. • MAGI-related denials that do not indicate possible ABD eligibility are automatically referred to the FFM for an evaluation of coverage in other insurance affordability programs. Non-Medicare ABD denials are also referred to the FFM for an evaluation of coverage. NOTE: Referrals to the FFM are made upon denial provided the application is not denied for administrative reasons, such as, failure to comply with application requirements, voluntary withdrawal or any other denial due to failure to complete the application process.